Medical records

Medical records and bills

One of the most important steps in making an insurance claim or preparing a dog bite lawsuit is gathering the medical records. "Medical records" include:

Ambulance "run" records
Paramedic (fire department) "run" records
Emergency room records (frequently maintained in a separate location at many hospitals)
Hospital records, including examinations, consultations, nurses' notes, test results, operative reports, admission and discharge summaries, and more
Private physician records of exams, treatment and consultations
In-home nursing records
Physical therapy records

The medical records are kept separate from the medical billings. The billings must include the standard codes for descriptions of services, the dates of treatment, and the itemized charges on each date. The billings also must show the gross amounts charged, as opposed to the net charges after receipt of payments or application of discounts.

How the medical records and bills are gathered

Medical records must be gathered by an experienced copy service that knows where to look for them. The copy service will provide a certified copy of the records that can be introduced into evidence in a court case, and insurance companies will accept as being correct and complete.

Copy services are difficult to deal with, however, because they usually are slow and the work is not exactly stimulating for the employees. Therefore a lot of supervision is required. Mr. Phillips retains a nurse for each claim, whose duties include supervising the gathering of the medical records and bills as well as analyzing them and writing a comprehensive summary and analysis of them (discussed below).

Copy services charge a significant amount to copy records. This cost is advanced by the attorney who handles the claim, and is recouped from the settlement or judgment if any.

Analysis of medical records

After the copy service gathers all the medical records, they are analyzed by the nurse retained by Mr. Phillips. The nurse writes a comprehensive summary that is suitable for the insurance claim. Mr. Phillips independently reviews that medical records and bills, as well as the analysis by the nurse.

Prognosis reports

Serious cases require future medical services and associated treatment costs (as well as disability and loss of income during the period of recovery, and increased pain and suffering from the impact of the services and recovery). The medical records pertain to past services rendered, but rarely contain a "prognosis" (i.e., a reasoned prediction about a medical condition). It is Mr. Phillips' job to recognize the medical issues that require a prognosis report, so that the insurance claim will be complete and the settlement (if any) will provide a sufficient amount of funds to cover the future effects of the dog bite injuries.

A prognosis report may include the following points:

A brief history of the patient's condition
Treatments and tests required in the future
The costs of treatments and tests performed in the future
Operations required in the future, such as scar revision
The costs of the operations, including the surgeon, anesthetist, assistants and surgical facility
The probable outcome of the treatments and operations expected to be performed in the future
The success rate of the treatments and operations expected to be performed in the future
Possible complications of the treatments and operations expected to be performed in the future
The length of time probably required for recovery from the future treatments and operations
Disability to be probably expected as a result of the future treatments and operations

It is important to understand that a physician who writes a prognosis report is expected to relate what might occur based on reasonable medical certainty -- not complete certainty. Medicine is as much an art as a science. Anything might possibly happen, but the law is not interested in remote possibilities when fixing compensation for a victim. The law needs to know what is probably going to happen, based on reasonable medical certainty.

Medical records

Medical records and bills

How the medical records and bills are gathered

Analysis of medical records

Prognosis reports

Legal Briefs menu

What people write to Attorney Phillips...