case audit settlement enhancement

Missed Injury Severity Types

When a patient has been in a vehicular collision, they may never consider that an injury may go undetected, especially ones that can cause severe damage not only to them, but to the claim when an injury is overlooked.

Due to the differences in; examination levels, “Injury Severity Types”, individual physician qualifications and diagnosis methods – there are several key injuries that go overlooked, including in ER Rooms.

The Audit will search for indications of these injuries that may have gone overlooked. If any are suspect, the Audit will follow-up to see that they are diagnosed and represented.

The following 7 “Injury Severity Types” can occur after a vehicular crash, even at low speeds with no property damage and are often overlooked.

  1. AOMSI
  2. Uncinate Process Fracture
  3. MTBI’s
  4. Cervical Chain Ganglia
  5. Auto related PTSD’s
  6. Vertebrobasilar Insufficiency
  7. Muscle Tissue Morphology

An injury to the delicate ligaments of the cervical spine that carries 25% impairment rating and a $66,000 set-aside settlement valuation. Missed 45% of the time, this injury requires special radiographic mensuration analysis according to the AMA for detection.

Uncinate Process Fracture:
A fracture of the upward lateral projection of a cervical vertebra traumatically induced when the head is turned during impact. Takes 2 months to reveal and requires special x-ray positioning.

Mild Traumatic Brain Injuries (MTBI’s) occur even during low speed vehicular collisions that can produce 3 types of MTBI’s that occur 90% of the time with a 50% probability of a cerebral contusion.

Cervical Chain Ganglia Injury:
This injury occurs to the nerve bundles located in the neck and is represented by a plethora of symptoms that have eluded diagnosis and occur when the head is extended and rotated during impact.

Auto Related PTSD’s
The #1 cause of post-traumatic stress disorder (PTSD) is now attributed to auto accidents where there are various forms or levels of the syndrome that can be detected by special assessment and diagnosis criteria.

Vertebrobasilar Insufficiency:
Only in the cervical spine does the vertebral artery serpentine and travel between small openings in the vertebra where it is subject to crimping and cutting off blood flow to the brain when the neck is extended and turned.

Muscle Tissue Morphology:
When the muscle is damaged, there are morphologic changes in the tissues and cells where lipoid substances cause muscle fatty infiltrate to repair the damaged muscle cells detected months later by palpation or seen on MRI.

Having an understanding of the above “Injury Severity Types” and “Trauma Lines” that insurers use to determine settlement valuation is one of the most important components to understand when representing the medical (bodily injury) portion of the accident claim. The audit is designed to search for indications and follow up to diagnose, document and re-admit as new evidence in the audit claim process.