Understanding Injury Diagnoses vs. Complaint Symptoms in Auto Injury Claims

In personal injury law, success often hinges on the finer details. One such crucial distinction lies in understanding the disparity between injury diagnoses and complaints or symptoms, and how this differentiation can significantly impact the outcome of auto injury claims. As insurance AI and claims evaluation software increasingly rely on a distinction between the two, it is imperative for personal injury lawyers to understand the difference and advocate effectively for their clients in the demand letter.

At the core of this distinction is the classification utilized by insurance AI and claims evaluation software. In these systems, injuries are categorized as diagnoses, encompassing specific conditions such as concussions or disc herniations. These diagnoses have had ICD codes at least since the ICD-9 codes, and are futher specified by the present ICD-10 codes.

On the other hand, the symptoms associated with each diagnosed injury, such as headache or radiculopathy are classified as "complaints" in insurance claim software. They are the result of the diagnoses.  While both can be documented in the medical records with their own corresponding ICD codes, failing to distinguish between the two can have profound implications for the valuation of a claim.

Consider a scenario where a client experiences persistent headaches and neck pain following a car accident. While these symptoms are undoubtedly distressing, without a formal diagnosis of concussion or cervical disc herniation, the claim may lack the necessary foundation to command maximum settlement value. This is where the expertise of personal injury lawyers can help represented clients get higher value than non-represented claimants.

In crafting demand letters for auto accident claims, it's crucial for attorneys to clearly delineate between injuries and complaints. By meticulously documenting diagnosed injuries with supporting medical evidence, such as ICD codes, diagnostic imaging or specialist assessments, lawyers can bolster the strength of their client's case and enhance the likelihood of securing favorable compensation.

However, merely identifying complaints without corresponding diagnoses is often insufficient to trigger insurance AI and claims evaluation software. Therefore, it's necessary for personal injury lawyers to advise their clients to seek proper diagnoses resulting from a car crash. This proactive approach not only validates the legitimacy of the client's injuries but also provides a solid foundation for negotiating a fair settlement.

The importance of getting all of the injuries in a claim formally diagnosed also applies beyond the evaluation of noneconomic /general damages, and also applies to the economic / special damage valuation performed by different insurance software.  A commonly used medical bill review software / service is Mitchell International's DecisionPoint software.  In order for the client's past medical treatment to be deemed "reasonable and necessary" there must be a diagnosis that justifies the treatments provided to the client.  If the diagnosis is not made, treatments tied to that injury will not be compensated and you can end up with a settlement offer that is not even equal to the past medical bills.

Understanding the nuances of injury diagnoses versus complaint symptoms enables personal injury lawyers to navigate the complexities of auto accident claims with precision and finesse. By strategically leveraging this knowledge, attorneys can effectively advocate for their clients' rights and ensure that no opportunity for compensation is overlooked.

It's also worth noting that while complaints may be indicative of underlying injuries, insurance AI and claims evaluation software prioritize diagnosed conditions in their assessment of claim severity and valuation of noneconomic / general damages. Therefore, emphasizing the importance of obtaining accurate diagnoses is paramount in maximizing the settlement potential of an auto accident claim or premises liability claim.

The distinction between injury diagnoses and complaint symptoms is a pivotal factor in the evaluation of auto accident claims by insurance AI and claims evaluation software such as Colossus. Liability Navigator and ClaimIQ. Personal injury lawyers must be adept at navigating this distinction and advocating effectively for their clients' rights. By understanding the importance of obtaining proper diagnoses and meticulously documenting injuries in demand letters, attorneys can optimize the settlement value and ensure maximum settlement value for those injured in auto accidents.

Settlement Intelligence helps personal injury lawyers secure faster, higher offers for their clients with its trailblazing AI Demand Letter(SM). Learn more about how you can achieve higher offers at www.settlementintelligence.com.  

This article is by Settlement Intelligence CEO Charlette Sinclair.