1-800-931-7036
Insurance companies have certain preferences, in terms of the treatments used by injured accident victims.
Insurance companies study the bills received by the recovering patient, in order to determine the amount of loss suffered by that same patient/victim.
In addition to noting the total on each bill, insurers check on the nature of the service for which the victim/claimant was billed. If a majority of the bills were for some type of diagnostic procedure, rather than a treatment, then the adjuster would alter the multiplier used in the company’s formula. Of course, that would not be the case, if the results of the diagnostic tests were to indicate the need for an extensive procedure, such as surgery.
Almost all insurance companies use the same type of formula, when seeking to determine the value of a given claim. The total for all the bills becomes one factor in a multiplication operation. The other factor is called a multiplier. It usually ranges between 1.5 and 5, depending on the severity of the claimant’s injury, as per personal injury lawyer in Hamilton.
Insurers prefer MDs to chiropractors or those that offer some type of alternative medicine.
All injured claimants do receive some money as compensation for their injuries. Still, those that have not been treated by an MD find that the value of their claim has been reduced. The adjuster uses a smaller multiplier in the formula that is meant to reveal each claim’s value.
When recovering patients must undergo physical therapy (PT), the insurance company takes a close look at 2 aspects of those therapeutic procedures.
First, it checks to see if the PT had taken place over a prolonged amount of time, and had contributed to a large percentage of the bills. When that has been the case, then the adjuster places a smaller multiplier in the formula for calculating the value of that particular patient’s claim.
By the same token, insurance companies make a habit of checking on the location in which a given claimant/patient received a series of PT procedures. Those companies do not like to deliver a large payout, if a claimant has received a majority of his or her PT in a location other than a doctor’s office.
Some patients do need to spend time at a rehab facility. Each of those facilities has hired someone that specializes in administering PT procedures. Insurers respect the training received by such a specialist.
Yet after the patient has returned home, he or she might anticipate weekly visits from a physical therapist. The insurance companies do not like to pay for such home visits. For that reason, the adjuster handling that claimant’s case would place a smaller multiplier in the formula for calculating the claim’s value.