INSURANCE LIABILITY CASES

In this blog, I’ll be reviewing U.S. annual statistics specific to injuries requiring medical care, as well as the types of insurance claims Barber Medical Legal Nurse Consulting, LLC has the expertise to support specific to case development.  I’ll provide some common examples of insurance liability defense cases, as well as some common defenses.  I’ll close with examples of the scope of work our Senior CLNC performs specific to insurance liability cases. 

2020 Statistics:

24.8 million injuries in the U.S. require medical care

200,955 unintentional injury deaths in the U.S. annually

6 million motor vehicle accidents in the U.S. annually

40,698 motor vehicle accident deaths in the U.S. annually

87,404 unintentional poisoning deaths in the U.S. annually

Annual number of injuries on construction job sites:

1. 266,530 cases involving sprains, strains, tears
2. 128,220 cases involving injuries to the back
3. 211,640 cases involving falls, slips, trips

Types of Insurance Claims Barber Medical Legal Nurse Consulting, LLC Supports (Case Development)

• Commercial liability (business insurance)
• Personal liability (automobile, homeowners, property)
• Workers’ compensation
• Medical Personal Injury Protection (no-fault insurance)

Insurance Liability Defense Case Examples (Commercial and Personal Injury Allegations):

• slips, trips, and falls resulting in orthopedic injury such as rotator cuff injury
• automobile accidents resulting in spine injury such as “whiplash”
• injury from dental procedures such as broken teeth
• food poisoning
• nail salon injury
• injury from urogynecological interventions such as surgical mesh implants resulting in mesh exposure and erosion causing vaginal scarring, fistula formation, painful intercourse, pelvic, back and leg pains

Common Defenses for Insurance Liability Cases:

• plaintiff’s injuries were present before the incident
• mechanism of injury does not correlate with alleged injury
• condition is degenerative, not acute or traumatic
• plaintiff delayed seeking treatment after incident

Barber Medical Legal Nurse Consulting, LLC Supports Insurance Liability Case Development (Scope of Services):

• Interacts with members of each case (E.g., claims representative, defense attorney, insurance company, education division, special investigations unit for fraud or criminal investigation)
• Investigates claim
• Reviews medical documents, medical records, school, and employment records, medical bills
• Reviews police and accident reports
• Reviews photographs
• Organizes records
• Performs medical research
• Performs case analysis and report writing including development of a chronology
• Educates staff to support a successful outcome
• Submits requests for production, interrogatories, preparation of deposition questions for claims department, and defense attorney
• Attends independent medical examination (IME)
• Interviews witnesses
• Obtains a life care plan
• Identifies and locates testifying experts, and medical reviewers
• Reviews and analyzes testifying expert reports and depositions

References:

Association for Safe International Road Travel. https://www.asirt.org/safe-travel/road-safety-facts/

National Center for Health Statistics. https://www.cdc.gov/nchs/fastats/accidental-injury.htm

United States Bureau of Labor Statistics. https://www.bls.gov/iif/

P.S.  Comment and share about your role in insurance liability case development.