Pain is difficult to measure. Even hospitals struggle to assess the level of pain experienced by any one patient. That fact underlines the challenge that faces insurers. Each of them must place a dollar value on every claimant’s case.
An insurer seeks evidence of a claimed loss.
What were the claimant’s medical expenses? That would include the cost of doctor visits, time spent in the hospital, treatments, imaging services, medication and medical equipment. A smart patient/claimant keeps track of the amount of money spent at parking lots, after going to a medical appointment.
What factors have contributed to the claimant’s pain and suffering? Beyond the painful sensations, an injured accident victim experiences emotional issue. Those could be compounded by mental injuries. For instance, a claimant might complain about fear, insomnia, grief, worry, inconvenience or the loss of enjoyment of life.
How should an insurer put a monetary value on those things that are hard to measure? Injury Lawyer in Waterloo know that some insurance companies use a formula. In that formula, the painful sensations, along with the emotional issues and the mental injuries get expressed as a number, one that normally falls between 1.5 and 5. That number becomes a factor in the formula. It is used to multiply the value that was obtained by adding up all of the medical expenses.
Not every insurance company makes use of such a formula. Some of those companies study the per diem costs. That alternate approach calls for estimating the cost per day, during recovery, and then multiplying that by the amount of time that has passed. Day one is the day of the accident; the final day is the one when the doctor says that the treated patient has achieved his or her maximum medical improvement (MMI).
Neither of the approaches mentioned above allows for consideration of all the factors that insurers feel are important. For example, none of them call for consideration of the type of treatment that was received by the recovering patient. Still, insurers do feel that the type of treatment should be considered, when placing a value on a given case.
Sometimes a professional doctor administers a patient’s treatment. When that is the case, the case’s value increases. At other times a chiropractor delivers the treatment. In the eyes of insurers, that second type of treatment provider does not have has much value as a professional doctor.
While insurers respect the skills of the professional physician, the skills of a diagnostician receive less respect. Few insurance companies like to pay for expensive diagnostic procedures, without a doctor’s request. The patient’s medical report needs to state clearly the reason that a doctor has chosen to utilize an expensive diagnostic procedure.