Medical records review is an important process in personal injury litigation, which helps determine the extent and seriousness of the injury sustained and the medical services provided. Many factors come into play in deciding the outcome of an auto injury case, and state laws are an important consideration in this regard. For example, if you live in a no-fault state (a state that follows no-fault laws), statutes limit your potential sources for recovery of damages. In addition, your ability to bring a lawsuit may also be restricted.
In a no-fault insurance system, when a person is involved in an accident, his/her auto insurance provider automatically pays for certain damages regardless of fault, up to a particular limit. No-fault insurance is different from tort insurance in which at-fault drivers in a crash are responsible for paying the other driver’s medical expenses, and must also pay for additional damages such as pain and suffering, and lost wages. In the tort system, someone must be found to be at fault for causing the accident.
The following U.S states have no-fault insurance laws.
- District of Colombia
- Florida
- Hawaii
- Kansas
- Kentucky
- Massachusetts
- Michigan
- Minnesota
- New Jersey
- New York
- North Dakota
- Pennsylvania
- Utah
Personal injury litigation being among the most common civil litigation seen in state courts each year, no-fault states find it difficult to deal with this problem. Though most personal injury cases may settle before they proceed to trial, they remain on the court’s calendar adding to the court caseload. To handle this challenge, all no-fault states have introduced a “threshold” for personal injury recovery. For instance, in Florida your injuries must meet certain qualifications if you wish to sue the owner/driver of a motor vehicle that injured you in a car accident. If your injury is not determined to be a “serious impairment,” your case will be dismissed.
Under Florida’s personal injury liability law, you are not liable for another person’s injuries even if you caused the car accident unless those injuries meet a certain medical threshold. In cases where the injuries do not meet this threshold, the injured person may not recover for the injuries themselves, or the pain, mental anguish, suffering and inconvenience experienced as a result of those injuries. In Florida, drivers are required to carry $10,000 in personal injury coverage to pay for medical expenses arising out of car accidents. The no-fault insurer will cover all your medical expenses and reimburse you for lost wages, travel expenses, and other out-of-pocket expenses. No-fault insurance will act in place of medical insurance (if you don’t have one) after a car accident.
As mentioned at the beginning, in a no-fault state, your recovery options for injuries is often limited because these states assume that much of your compensation will be covered by your no-fault insurance. States such as Florida and New York with larger populations witness huge number of personal injury claims from car accidents. To reduce litigation, these states have introduced the no-fault law wherein you are guaranteed some form of compensation irrespective of who is at fault for the accident. To recover damages other than economic damages, i.e. damages for your pain and suffering, your injury has to be serious enough.
Injuries sustained that meet the threshold standard and allow you to seek compensation more than what is paid out by your no-fault insurer are categorized into four.
- Significant and permanent loss of a major bodily function
- Significant and permanent scarring or disfigurement
- Permanent injury within a reasonable degree of medical probability
- Death
It is important to remember that the same injury may affect different people in quite different ways. Age, physical condition, and medical condition may have an impact on the seriousness of the injury.
In a no-fault state your first and legally ideal source of recovery is your own insurance company. An injured person can file a suit against another party only if statutorily specified conditions such as the above discussed are met. Though no-fault laws may limit the recovery options, they have the advantage that you are covered by your own insurance even if you sustain minor injuries or “total” your vehicle with no injury whatsoever. Your claim is paid much faster than it would be with the court system involved.
Personal injury attorneys may file litigation even if it is not clear whether an injured person meets the threshold. Both the plaintiff and defendant will have to present evidence that shows whether the injuries meet the threshold. For this, plaintiff attorneys hire expert medical witnesses who perform a medical records review to obtain information regarding the nature of injury, its extent and how it has impacted the injured person’s life and then testify in court. The judge and jury rely on such evidence in case the seriousness of the injury is questioned by the opposite party. Serious injuries such as coma, broken bones, paralysis and so on clearly meet the threshold. In other cases, the evidence presented by the attorney regarding how the injury personally impacted the injured person’s life and function becomes the most important factor to help decide whether the injury meets the threshold.
