Medical records review is a crucial step during the investigation stage of a personal injury case. The results of the case are built on the basis of the investigation aspect, which makes proper investigation and preparation very important to ensure a positive outcome. The plaintiff on his/her part must be extremely attentive in thoroughly documenting the incident and collecting relevant evidence. Personal injury attorneys utilize medical review services to ensure that they have all the medical details required to develop the case. Attorneys usually begin the investigation immediately after accepting a case because as time passes it may be difficult to obtain favourable information for the client. For instance, eyewitness information is more accurate immediately after an event. Moreover, immediate and comprehensive preparation of a case maximizes its value.
An early and thorough investigation will yield factual information that is vital to convince a judge or jury regarding the opposite party’s fault in the matter. Another use of factual information is that it can be used to persuade the defendant to accept a settlement, which is better than facing the stress and strain of a trial.
A case involving Norfolk & Dedham Mutual Fire Insurance Company reported in the Insurance Journal is interesting in this regard. The claimant in this case is Mark Silva, a tow truck operator who claimed that he was injured in an accident when Dorothy McQuinn (Norfolk and Dedham’s insured) rear-ended him. Silva’s claim goes like this. On March 9, 2005 Silva was assisting a vehicle stuck in a snow drift in Provincetown, Massachusetts. He had pulled his truck to the side of the road and hooked up a tow line to the disabled car when McQuinn who was driving with her windshield fogged up and with no clear view of the road, rear-ended him. After investigating the claim, the insurer Norfolk & Dedham refused to pay Silva. The Massachusetts Appeals Court upheld a Superior Court decision that Norfolk & Dedham did not engage in unfair settlement practices in its handling of Silva’s claim. The court also reversed the portions of an amended judgment that awarded damages, pre-judgment interests, costs and attorney’s fees for Norfolk & Dedham’s failure to offer post-judgment interest.
What is interesting in this case is that as Norfolk & Dedham started gathering information, they found that Silva’s claimed injuries may not after all, be genuine. They conducted a thorough investigation that helped win a decision in their favour.
- Within 6 days after learning of the accident, Norfolk & Dedham assigned an independent adjuster to investigate the claim.
- They obtained information (through their own claims adjusters and other sources including private investigators, Silva’s workers’ compensation insurer, Silva’s automobile insurer, and Silva’s discovery responses and deposition testimony) that gave them a reasonable basis for regarding Silva’s claim as suspicious.
- They obtained expert opinions from a biomechanical engineer and a neurologist regarding the cause and extent of Silva’s injuries. It was found that the impact of the accident would have generated the same level of force Silva experiences on a daily basis while going about his usual routine.
- The investigation also revealed that after the accident, Silva had towed McQuinn’s car from the scene and also completed the original tow he had been working on when the accident occurred.
- Another important revelation was that within a month of the accident, Silva was observed at his automobile service station and was apparently working a very full and busy schedule.
- Silva waited for a year after the accident to claim disability from performing work as a tow truck driver. He continued to work while claiming he could only do desk work and obtained workers’ compensation benefits while also collecting unemployment benefits.
- Norfolk & Dedham’s investigation also brought to light the fact that Silva’s workers’ compensation insurer had questioned the existence of causation between the accident and Silva’s injuries.
The court found that Norfolk & Dedham had a reasonable basis for resisting liability and that there was no testimony at trial identifying specific steps that they should have taken but did not, in investigating Silva’s bodily injury claim. The Superior Court and the appeals court agreed that Norfolk & Dedham had indeed conducted a reasonable investigation in this matter.
Each personal injury case is distinctive, with different facts to take into account. An attorney and his team would investigate the following things before filing a personal injury lawsuit.
- Any pre-existing conditions that may have a bearing on the way the accident happened or its consequences.
- Evaluation of the documentation, including all medical records, pictures of the actual injury, and photographs of the incident site.
- Speaking to witnesses and obtaining the statements necessary, and ensuring that these witnesses are available to testify if the matter goes to trial.
- Plaintiff attorneys would consider the background of the defendant to learn if he/she has a history of irresponsibility that may be relevant in court.
As providers of medical record review for attorneys we understand that an experienced legal team would prioritize the investigation aspect and prepare the case as if it was going to trial so that they are ready with all the relevant facts if at all the case goes to trial. Immediate investigation and thorough preparation of a case would undoubtedly maximize its value.
