Casualty Flashcards
Categorized
traumatic or chronic
Exacerbation
injury which preceded the accident but which the accident may have made temporarily worse
Aggravation
cause the injury but aggravated it to a certain degree for a specific duration
Factors to Consider
age
overall physical condition weight
activity level
compliance with medical recommendations
Questions to Ask
What is the alleged injury?
How did the injury occur?
Is there a causal relationship?
Did the injury result solely from this accident?
Is the injury complicated by a prior physical condition?
Where and what type of treatment is the claimant receiving?
Is the claim being inflated or built-up by excessive treatment and charges?
What is the disability?
Is there permanency of disfigurement?
Is the claimant a “malingerer”?
What are the objective complaints versus the subjective complaints?
Medical Authorization
explain what a medical authorization form is to the injured party and email or mail it to them
Medical Reports and Records
foundation of a medical investigation as they include the information needed for a proper evaluation of the injury
ESBI
Early Settlement - Bodily Injury
ESBI
occur during the
first 30 to 60 days
after a loss is reported where the claims professional and claimant agreed to a full, fair and final settlement of the claimant’s BI claim
Qualify for Early Settlement
Coverage confirmed and liability determined (using LIQ if eligible)
Injured party can be claimant or insured driver or passenger (may be UMBI vs BI)
Injured party may be pedestrian
No attorney involvement
Minor to moderate vehicle impact
Inconvenience is not an injury and should not receive an offer
If treating actively with a chiropractor, physical therapy
INJURIES that Qualify for Early Settlement
Soft tissue neck and back
Minor sprain/strain of other body parts (e.g. wrist or ankle)
Bruises, lacerations, abrasions and scrapes
Headache
INJURIES that DO NOT Qualify for Early Settlement
Fractures (arm, leg, ribs, etc)
Disc injuries
Scarring
Closed head injuries
Settlement Options
ESBI
Straight ESBI up to $1,000
Medicals Incurred
Open-Ended
ISO
“in search of”
TLO
“the last one”