In most personal injury cases, the first step upon treatment completion is to submit copies of all bills and medical records in personal injury cases to an insurance company adjuster for evaluation. Insurance adjusters will review all of these documents and will make a determination about whether to place an initial settlement offer on your case – and, if so, the amount of such an offer. Although these initial settlement offers are usually low, it is still important for you, the injured plaintiff, to be aware of certain all-too-common red flags that insurance adjusters look for in medical records in personal injury cases, the effects that these red flags can have on your personal injury case, and the ways of potentially downplaying these red flags in order to maximize the value of your case.
Degenerative Changes
Degenerative changes are essentially osteoarthritic changes that sometimes appear on imaging studies, such as MRIs and x-rays, and which are normally the result of aging. Degenerative changes are commonplace when the injured plaintiff is middle-aged or elderly, but medical studies show that degenerative changes may begin to manifest themselves as early as a person’s twenties. Thus, imaging studies would likely show some degenerative changes on almost everyone.
When injured plaintiffs undergo x-rays and MRIs over the course of their treatment, insurance adjusters like to point to these imaging studies and attempt to show that the injuries sustained – particularly soft tissue injuries – are simply the result of degenerative changes, rather than the subject accident. This is particularly true when other medical records medical records in personal injury cases may demonstrate few, if any, objective findings for the symptoms the injured plaintiff is experiencing following an accident.
Whenever an injured plaintiff’s imaging studies show frequent degenerative changes, your lawyer may need to retain an expert who will testify that despite the presence of preexisting degenerative changes, those conditions were likely aggravated by the injury or injuries sustained in the subject accident, thereby bringing about the increased pain and symptoms.
Moreover, the injured plaintiff and/or the healthcare provider may testify that despite the presence of degenerative changes on an imaging study, the injured plaintiff was not experiencing any significant problems with the subject body part at any point immediately prior to the accident. Therefore, by inference, the subject injuries were caused by the accident; not by degenerative changes.
Prior Accidents and Preexisting Injuries
By the same token, when an injured plaintiff has sustained prior injuries to the same body part, such as in a prior slip-and-fall accident or motor vehicle accident, the adjuster will use medical records in personal injury cases to try to connect the injuries, pain, and symptoms from the current accident to the prior accident or injury. Again, however, testimony from a healthcare provider, as well as from the injured plaintiff, will be necessary to show that despite these prior accidents and injuries, the current accident aggravated or worsened those injuries, thereby establishing causation and increasing the prospect of high damages in the current case.