When the claim is accepted as compensable, proper documentation will prove the basis for acceptance and reduce the chance for second guessing or challenging aspects of the case.
Proper documentation of contested claims will develop the facts and testimonies for defense of the case.
Documenting a File:
Files are documented by the following items:
- Statements, either Written, Oral, or Recorded, with full comprehensive containment of fact.
- Witness statements, either Written, Oral, or Recorded.
- When obtaining oral statements make careful notes as to what is said discussed and explained. Prepare a full report of the conversation and post it to the file at once. Document date, time, place and reason statement was only done orally. Record all telephonic discussions. This is a common practice for many businesses It is acceptable with proper legal advice before the conversation starts.
- Medical Records, confirming or contesting facts for causal relationship.
- All past medical records that have a bearing on the claim.
- Independent Medical examinations or Consultations.
- Medical Case Managers as necessary with Utilization Reviews as needed.
- Personal & Physical backgrounds as well as lifestyles of the claimant.
- Independent Investigative Reports from Other Sources such as Police, Fire, EMT units, OSHA,
- i.Safety Inspectors, Union Representative, and Newspaper Articles.
- Personnel records (especially if any negatives are present.)
- Past claim records from Employer, Insurance Company, Claim Units, as well as Central Index Bureaus and Insurance Services Offices.
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“How Do I Get My Adjusters To Follow My Account Handling Instructions?”
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