Musculoligamentous injuries, or “soft tissue” injuries, to the lumbar spine are often questioned as to the severity of injury and the need for treatment by claims adjusters. A Bloomington back injury lawyer offers some insights as to how claims adjusters view these injuries.
A claims adjuster evaluates injury claims in several ways:
- Location the initial examination took place
- Diagnosis vs. treating medical
- Duration of treatment
Location of the Initial Treatment Factors
During the evaluation process, according to a Bloomington back injury attorney, the adjuster notes if the initial medical treatment took place in the physician’s office or in a hospital emergency room by a physician. If the initial medical examination took place in a hospital emergency room, the adjuster is more likely to recognize the gravity and extent of the injury especially if any part of the treatment is rendered in a physical therapy center or hospital.
According to a Bloomington back injury lawyer, hospitalization is generally convincing evidence to adjusters that there actually was a significant injury even if the hospitalization was only for observational purposes.
Distinguishing Between Diagnostic and Treating Medical Expenses
Adjusters view “diagnostic medical” expenses and what is termed “treating medical” expenses in separate ways. They usually do not question the need for treating medical expense. A Bloomington back injury lawyer says adjusters give less weight to diagnostic medical expense during the evaluation process. But in doing so, adjusters sometimes overlook the fact that the soft tissue injuries sometimes require a more long-term diagnostic evaluation to distinguish the possibility that the pain complained of is from other reasons as opposed to a strain or sprain.
Factors of Duration of Treatment
The length of medical treatment for the claimant is another major factor adjusters consider, according to a Bloomington back injury attorney. Since significant injuries would naturally require longer periods of medical treatment than would minor ones, it follows, therefore, that the longer the duration of treatment required, the greater the value of the claim. This reasoning is difficult to dispute but the conclusions drawn are sometimes invalid. This is particularly true when the duration of treatment is used as an indication of the severity of the injuries.
A Bloomington back injury lawyer points out that musculoligamentous injuries quite often require little active medical treatment and frequently the prescribed treatment regimen by physicians involves self treatment of rest, heat and analgesics at home.
Adjusters could view this lack of concentrated medical treatment in such cases as “proof” that, in fact, there really was no injury. Even if physical therapy is prescribed for these types of injuries, adjusters may label this as what they call a “build up,” meaning the claimant undergoes unneeded medical treatment in order to incur unnecessary medical expenses, knowing a settlement offer will be, at least in part, a function of medical bills incurred.
As you can see, claims adjusters are especially wary of musculoligamentous injuries filed by claimants. For a consultation on your specific case with a Bloomington back injury lawyer, contact the office of McCarthy Rowden and Baker at 800-373-6050 today.