Many medical providers have asked me how an attorney analyses an auto accident claim. I have promulgated that successful accident claims can be traced to the initial "diagnosis" and "treatment plan." What do I mean by these medical terms of art and how do they apply to an attorney's strategic plan of action?

First of all, let's review a typical rear end auto accident, which results in a soft tissue sprain and strain of the neck. One of the first questions that an attorney will ask concerns the extent of property damage to the claimant's vehicle and to the other vehicle(s) involved in the accident. If the claimant's vehicle has sustained property damage that is $1,000 or less, many insurance companies immediately conclude that it is unreasonable to believe that the claimant suffered any bodily injury. As a result, many insurance companies, under this scenario, will only compensate the claimant with the reasonable costs for repair of the vehicle. These same insurance companies will take the position that any medical costs that are generated from treatment of the claimant are not reasonable and are therefore costs that should be borne by the claimant only. For the medical provider, you should recognize this situation, and even if the claimant has an attorney, there is likelihood that no money will be realized from a settlement or judgment. You might be left with the alternative of looking directly to your patient for immediate payment as services are incurred, or you may have to rely upon any insurance coverage that the patient has with either auto medical-pay and/or health insurance. As we know, insurance coverage generally has limits (eg. number of visits or monetary) and once these limits have been met, you may have to resort solely to your patient for compensation for treatment.

Another subject of equal importance has to do with the methods of processing a claim for payment. Because of the limits that are mentioned above, it is extremely important that your billing administrator utilize all means available to ensure prompt and complete payment for services rendered. If your patient has been in an automobile accident, you should initially investigate if there is med-pay coverage. I recently had a case where my client was driving a friend's car and was involved in an accident. The medical provider billed the med-pay for the owner of the car that he was driving. The limits of coverage were $5,000, and the bills eventually exceeded that amount. The medical provider took the position that they would have to wait until the case was over before they could recover for the excess bills. Wrong! I contacted the driver's insurance company and determined that he had med-pay coverage, and the provider was immediately paid from that policy.