Medical Review - Burden of Proof

Personal Injury
Medical Record Review

Medical malpractice and personal injury cases are no longer uncommon terms. Over the past few years, the media has highlighted some extremely large verdicts in personal injury and malpractice cases. According to the Journal of the American Medical Association, death by medical malpractice has made it to a shocking third position in the top causes of death list. Whether it is a personal injury or a medical malpractice case, the injured party seeks to be monetarily compensated by the party responsible through a settlement or a judgment.

As per data from ‘2016 Medical Malpractice Annual Report’ by Mike Kreidler, Washington State Insurance Commissioner, claimants received a total compensation of $297.6 million for the 289 claims made between 2011 and 2015, approximating over a million per settlement, where the attorneys earned an average of $408,006 per settlement with an indemnity payment and made 35.3 percent of the total compensation paid to the claimant.

Though these numbers seem interesting, the following challenges are faced by attorneys:

  • Dependency on medical expertise to evaluate the adequacy of a case - The ‘medical-legal’ lawsuits demand to be dealt from a medical point of view which is a necessity that goes beyond an attorney’s professional degrees. A detailed understanding of all the medical attention imparted to the plaintiff is a must.
  • Challenge to prove the medical care provided was not standard - A medical expert can easily review a pile of medical records to frame a medical chronology report and help make identification, location, analysis and interpretation of medical events effortless for attorneys. A summarization of clinical and medical-legal reports facilitates in concluding the exact shortfall in the case. 
  • Establish the Causation and Attribution link - An expert with medical as well legal knowledge will review the medical records to focus more on the extent of injuries or medical condition attributing them to the causative factors like negligence, accident, or a defective product. The determination of causation and attribution with an impartial review the medical events is essential.
  • Concluding on the reward, the plaintiff deserves - Once the above steps are covered and accomplished, the attorneys can use the help of a medical expert to calculate the compensation rewards depending on the extent of the injury and future care required.

Medical Records- Types

Every medical-legal case will have its own identity and course. Understanding where the evidence is insufficient is required. Different types of medical records listed below may be used to overcome some of these gaps:

  • Pharmacy/Billing/Infusion/Prescription
  • Surgery/Anesthesia/Preop/Postop/Consents
  • Visit/Consultations/Follow up/Progress Notes
  • Radiology/Lab/Path Reports
  • Ambulance/EMS/Transfer Notes

Stages and Types of Medical Reviews

Depending on the specific requirements of a particular case, the pattern of reviewing and summarizing of medical records may change. While a personal injury case needs a detailed study of all the events in the medical records, a mass tort case can be handled by a crisp review of product usage, injury identification and a valid connection between them.

Organization of Medical Reviews

An expert when equipped with all the required medical records can start the medical reviews and follow a designed method which involves the following:

  • Detailed reading of medical records
  • Highlighting the important events in the medical records
  • Arranging the medical events chronologically
  • Analyzing the events to identify causation and attribution
  • Validating the drug/device information

Technology-based applications with multiple and advanced features are available to ease these steps.

Presentation of the Medical Review

An effective legal presentation of the medical records can have a strong and positive impact on the success of the case by clearly displaying the strengths and relevant findings. This may include actual bookmarked and tagged medical records as evidence, analytical reports, PowerPoint presentations, graphical images, statistical presentation of billing amounts, follow-up visits, narrative summaries, expert opinion, and future expenses estimations.

This article was submitted by Neural IT. Neural IT provides cost-effective and timely medical reviews for screening potential mass tort cases. For more information, please visit Email us at [email protected] or call +1-844-NIT-TEAM (648-8326).

Disclaimer: The content provided on this website is provided for general informational. It is not intended as, nor should it be considered as a reference for any medical or legal advice.  Information provided should be used at your own risk based on your judgment. You assume full responsibility and liability for your own actions.

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