There are literally billions of dollars of medical claims litigated in the United Staes every year. In general, personal injury claims are comprised of three most frequent types, which are from most to least common; motor vehicle accidents (MVA's), slip and fall accidents and dog bites. Far, far less frequent we have medical malpractice as well as hospital and nursing home malpractice. We do hear a lot about medical and healthcare malpractice as a form of personal injury but these types of claims and lawsuits are so infrequent in comparison to the top three that they're essentially inconsequential.
I have discussed in articles some of the ways a person can get hurt in the medical system as well as in accidents. In this article I want to actually take a closer look at the claim process itself after an injury has been completed. In a medical or other healthcare (hospital/nursing home) malpractice claim the injured party usually seeks out legal assistance. The law firm will do an investigation to try and see what happened and how it affected the victim. A decision is then made if a claim or lawsuit will be filed.
The above process can also be followed for personal injuries from outside of the medical system. Here, other than the catastrophic injury which most likely would end up going through the same routine as medical malpractice, the vast majority of claims are made directly to the insurance carrier. These claims involve demands for reimbursement for property damage (to the vehicle in an MVA) and damage to the person (PI). Property damage claims have long been streamlined and are resolved very quickly because an adjustor can come out, photograph the vehicle and get a price for the damages. The PI portion of the claim is still handled in a very archaic manner and takes months to years to resolve other than for pure nuisence value payments which are the lowest available. Any victim who is looking to make a claim for a meaningful amount of money will get early and firm resistance. The insurance carriers are in no hurry to resolve these matters because as time drags on the claimants breakdown financially or otherwise disappear in some way. Time has traditionally then been the friend of the insurance industry with respect to PI claims.
There are many ways that the insurance carriers can guarantee the passage of time. In almost every case they will want to have you see a doctor of their picking, which they still refer to, with a straight face, as an independant medical exam or IME. They always want all of your previous medical records which can take months to get and then they want their adjustors and lawyers and medical experts to review the claim. You too should go to an independent doctor of your choice and still more time is used up. This process can and does go on for years. I wanted to use the last part of this article to suggest a better method of handling medical claims for what if there was a system which could ensure a quick no hassle payment to the injury victim and at the same time cover the carriers payout issues?
At MedWitness, Ltd, we have a subsidiary known as MedClaim Informatics, LLC. We have developed an algorithm for all types of injuries to all parts of the body. We have incorporated all of this into the MCI Claim Form which is electronically filled out by the claimant or injured party. In short, a victim-claimant can pull up a claim form from any computer and immediately fill it out. Various medical questions qill appear that are related to the injury being claimed. The software then makes an immediate diagnosis and prognosis and a setlement can be offered within days. There is no further need to get old medical records or medical exams because the software accounts for all of that. So, as far as the claimant is concerned a single form is electronically completed and the claim is ready.
The insurance carrier receives the claim in real time with an objective expert medical opinion attached. The insurance carrier can then offer a settlement within guidelines without needing to take all of the time and steps it used to take. It saves its money then not on delaying the injured party but on increased efficiency. Eliminating the need to procure medical records and have over flooded claims departments finally read them saves time and money. Going paperless also saves money. Offering a quick settlement under these circumstances results in the claimant be willing to take less, and thus the carrier to pay less, for fast payment and resolution of the claim. Both sides also save attorney's fees.
In the future you might see this phasing in with some of the more progressive carriers. Most carriers are very resistant to change. They are conservative non risk takers at heart and they have the political reality to deal with that the current adjustor teams in place who do not want anything to be done which might place their jobs at risk. Like everything else going on this is going to be a concept that will probably hit first with a company that has the foresight to see what's coming. Not only will the company save money on the paperless claims process and on storage and payouts but it will be able to add to the bottom line with increased profits from premiums when more people switch to them as first movers. The train is coming and the question is which carriers have their ears to the tracks. The first mover here will have an enormous advantage over its competitors. Finally, there will be the issue of accumulating data from all of this for underrighting purposes for the carrier itself as well as the industry in general. The value of the proprietary data to the first mover carrier will dwarf all other assets within five years.