Personal Injury Review Solutions

ReMed recognizes the importance and value that automated claims data and analytic programs provide to the claims industry. However, at ReMed, we believe many personal injury claims, particularly complex, suspicious or large loss claims, benefit when an “in-depth” medical record review analysis is performed by nurses or physicians who have the necessary education, professional skill set and claim review experience.

The current state of the claims industry involves a high-volume fast-paced environment with an increased workforce of novice claims professionals. At the same time, many personal injury claimants quickly seek legal representation.

Bodily injury claim evaluations and settlements often take a significant amount of time, knowledge and expertise. They can require attention to detail and a sophisticated understanding of biomechanics, standards of care, case management and medicine.

Our clients find that ReMed’s review services offer invaluable information to the claims resolution process that automated software programs cannot perform such as:

• Whether an alleged injury, medical condition, medical diagnosis, medical treatment or surgeries are objectively supported by the documentation in the provided medical records.
• Whether a treating physician’s opinion about accident related causation is objectively supported by the medical records and facts of the case.
• Whether pertinent medical records or bills are missing relevant to a claim decision.
• The identification of contradictory or conflicting documentation found in the records made by the claimant or health care providers regarding the mechanism of injury, subjective complaints, examination or diagnostic findings and medical treatment.
• The identification of lapses in treatment, doctor shopping and claimant non-compliance with treatment recommendations that impact medical outcomes.
• An easy to understand explanation of claimant’s medical conditions, including pre-existing conditions, as they relate to the alleged injuries and provision of past medical care and recommended future medical care.
• Objective recommendations for settlement negotiation based upon individual medical record findings and the current medical literature/medical treatment guidelines.