A concise, accurate analysis of either a specific medically related issue in a claim file or the file's entire medical record.

The Role of the Reviewing Nurse:

The report provides the carrier and the adjuster or defense counsel with a valuable reference tool for the evaluation of claims and accurate reserving. During negotiations it gives the adjuster a quick summary of the medical records to refer to while speaking with attorneys. The report, since it is written in understandable language, allows the adjuster to speak in a knowledgeable, confident manner about the specifics of the medical aspects of the claim.

A nurse file review may contain the following elements:

• Chronological summary of the medical treatment
• Review of any prior injuries or pre-existing medical conditions
• Explanation and definition of medical terminology and treatment
• Outline of future treatment and/or related impairment
• Commentary on the causal relationship of diagnoses and or treatment to the loss
• Suggestions for additional investigation
• Recommendations for independent medical examinations and/or reviews
• Summary of the report and opinion
• Mitigating factors
• Questions that may be used for depositions or trial
• Medical literature citations when indicated
• Illustrations and demonstrations for trial presentations

The reviewing nurse acts as a medical resource for the carrier, adjuster or attorney. The nurse can make the appropriate recommendations for referrals to medical experts when indicated. A nurse acting in this role has a broad knowledge of a variety medical subjects and clinical experience with traumatic injuries.