How to obtain proper medical expense documentation

How to obtain proper medical expense documentation

The importance of you and your attorney obtaining proper medical expense documentation cannot be overstated. If your attorney fails to obtain all of the pertinent medical expense documentation in your case, there are several consequences that may result. One serious consequence is that the value of your case may be severely compromised. For example, if your attorney prepares your settlement request and fails to include a sizeable medical bill, the case could end up being settled for a substantially lower amount.

The following checklist will assist you and your personal injury attorney in obtaining medical expense documentation, which will, in turn, maximize the potential damages in your personal injury case.

1. Obtain medical bills for your personal injury attorney.

Clients themselves often have a better chance of obtaining copies of their own medical bills, especially if they go to the medical provider directly, and in person, to request the bills. A skillful personal injury attorney will often tell his clients that they need a dual check system that requires that they obtain copies of all medical bills themselves (see Item 7 below).

2. Keep a separate record sheet of medical expenses.

An experienced personal injury attorney will give a medical expense sheet similar to the one following this checklist to every client that comes into his or her office. It can not be overemphasized how important it is for you to keep an accurate record of your medical expenses, visits, prescriptions, and other medical documents. It is important for clients to keep an accurate record of medical expenses because such a record will have a direct influence on the amount of their settlement.

3. Your personal injury attorney should write to each medical provider and ask for not only the medical records, but also medical bills.

It is common for a personal injury attorney to write to medical providers for medical information, but it is also important to be certain that the attorney requests copies of medical expenses as well. It is recommended that your attorney send a separate letter, or a copy of the letter, to the account manager of the hospital, physical therapy department, doctors’ offices, or any other medical provider with whom your attorney is corresponding. This duplicate effort is usually more successful because most facilities and doctors’ offices have a separate medical records section that is distinct from the medical bill section or accounting office.

4. If health insurance carriers have paid, your personal injury attorney should contact them and request copies of medical expenses.

Some health insurance companies will pay for medical bills without requesting subrogation. In such cases your attorney must contact the health carrier and request copies of medical bills that it has paid. Your attorney’s letter may trigger subrogation, but it is better to be accurate in the medical bill summary than to take the risk simply to avoid subrogation. If subrogation has been requested by the health insurance carrier, your attorney should be certain to instruct the carrier that they cannot properly protect their subrogation rights unless they provide the attorney with all medical expense documentation. The letter should state that if they fail to provide the attorney with copies of medical bills they have paid, such amount will have to be deducted from the final subrogation payment.

5. If your attorney has difficulty securing medical bills, he or she should contact the account manager or office manager by telephone or in person.

In some medical offices the staff is just too busy to respond to requests for copies of medical bills. If your attorney has difficulty obtaining copies of medical bills, the attorney has the responsibility to contact the office manager by telephone or even in person. The attorney should obtain the name of the account manager, apologize for interrupting their day, and request that the copies be sent to the attorney directly, and ask for a date on which the attorney can expect to receive the copies of medical expense documentation.

6. Your personal injury attorney should maintain his or her own record of your medical bills.

It is important for your lawyer to maintain a running tally of your medical bills along with the dates on which the attorney has sent copies of the medical bills to the insurance adjuster or defense attorney. The attorney should keep the sheet near the running record of medical reports that have been sent to the adjuster, along with the dates on which those reports were sent.

7. Before sending the demand letter or request for settlement, your attorney should check your medical expense records with you to determine whether or not all medical bills have been included.

Before your lawyer submits a demand to the insurance carrier, he or she should send a copy of the running tally sheet of medical bills to you for review so that you can cross-check the sheet with your own expense record. Your lawyer should instruct you to match the medical bills with each visit to be certain you have sent all copies of bills to your lawyer.

8. Your attorney should contact all medical providers before sending out the request for settlement.

The last thing your attorney’s office staff must do before your attorney sends the request for settlement is to contact, by telephone, all of your medical providers to see whether or not there are any outstanding bills that have not been documented. Your attorney should determine the following:

  • Have all of the medical bills been paid?
  • If not, what specific medical bills are outstanding?
  • Has your attorney considered the outstanding bills in the settlement request?

This will save the time, expense, and effort of having your lawyer deal with medical bills after your case has been settled and then discover that a doctor or medical provider has an additional bill that could have been taken care of before settlement.

Form for Medical Expense Records

This form is an example of a medical expense sheet that you can use to keep an accurate record of your medical expenses, visits, prescriptions, and other medical documents.

CLIENT’S MEDICAL EXPENSE RECORDS

Name of Client:

Date of Injury:

Date of Service Medical Provider Purpose of Visit Amount of Bill Date sent to atty
1/12/10 Dr. Tom Jones Recheck knee $65.00 2/2/10
1/20/10 RX Pharmacy Pain pills $14.85 3/l/10
[and so forth]