Personal Injury Medical Codes

Ever wonder what those personal injury medical codes are in your medical bills and why they are important to your personal injury

Personal Injury
Personal Injury Medical Codes

case?  For example, a code might look like: “ICD S42.402A.” Those codes actually mean something and can be very important to the success of your personal injury case. For help figuring out these codes, contact our office for a free consultation at 312-848-9783.

Personal injury medical codes

For many years, medical providers and insurance companies have been using personal injury medical codes called “ICD Codes” to document the diagnoses of medical patients. ICD stands for International Classification of Diseases. If you are interested in looking up what the diagnosis is of your injury, check out this ICD website – www.icd10data.com. This is the site we use to figure out ICD codes. The reason behind using codes like this is to create uniformity within the medical world. It’s also used by auto insurance companies – many times to reduce the amount of your claim.

ICD codes were created by the World Health Organization and there have been 10 versions of ICD Codes. ICD 11 codes are currently being created. A huge jump in the number of classified diagnoses/diseases etc. occurred in the change from ICD 9 to ICD 10. ICD 9 had approximately 14,000 classification codes. ICD 10 has approximately 70,000 codes.

The biggest difference between 9 and 10 is that ICD 9’s were generic. For example, this is an ICD 9 code: “812.40 – Closed fracture of unspecified part of lower end of humerus.” Note that there is no indication whether this applies to the left or right arm and does not state whether this is the first medical visit for this issue or a subsequent visit.

Conversely, the ICD 10 code for the same injury is “S42.402A – Unspecified fracture of lower end of left humerus, initial encounter for closed fracture.” The left arm is specifically indicated as is where in the treatment process the visit occurred (initial encounter).

If you were involved in an accident and received treatment prior to September 30, 2015, use ICD 9 codes. For all injuries from October 1, 2015 and after, use ICD 10 codes.

Why are personal injury medical codes important to my case?

Many auto insurance companies use personal injury “calculators” to assess the value of your case. The most known tool is called “Colossus.” Insurance adjusters take your medical bills and everything else about your case and enter it into the software and it comes back with a settlement range within which to resolve your case.

One piece of data that insurance adjusters enter into their software programs are ICD codes. When we do a demand letter to an insurance company, we always document what ICD Codes we want entered for them. That way you can avoid a situation where an insurance adjuster misses a relevant personal injury code.

For example, in a demand letter we might insert the following:

“Emergency Room Visit

Dr. Smith instructed Ms. Jones to take Prednisone and Tylenol for pain and to return to his office in four to five days if her symptoms increased. Dr. Smith also instructed Ms. Jones to undergo x-rays of her thoracic spine which Ms. Jones dutifully did on June 20, 2017, the results of which were negative.

ICD Codes:

  • M62.830: Muscle spasm of back
  • M54.2 Cervicalgia
  • M54.6: Acute right-sided thoracic back pain
  • V89.2XXA: MVA, initial encounter”

Pros and Cons of personal injury medical codes

The idea behind using ICD Codes (and personal injury calculators) makes some sense. It provides uniformity within a system. And using ICD 10 codes provides for very specific detailing of diagnoses.

However, ICD Codes can be a pain to work with. Often, they are not listed on medical bills or in the records and you have to find them yourself online.

Also, ICD Codes are descriptive as to an official diagnosis, but they don’t measure the effect the diagnosis has on a person. In fact, it can hurt your case. For example, if you are diagnosed with a back strain or sprain – a soft tissue injury – you can be sure that the offer from the insurance company is going to be fairly low.

ICD Codes (and/or programs like Colossus) cannot measure the degree of your pain and suffering as a result of an injury. People who suffer strains and sprains can suffer significant pain and discomfort for a long period of time but that will not be reflected no matter what ICD Code you use.

Also, there is no ICD Code for aggravation or exacerbation of an injury. As such, if you had a pre-existing back injury, get rear ended, and this exacerbates your pain and discomfort, there is no ICD Code you can point to in order to explain the situation. The ICD Code will simply document “back sprain/strain.”

Pro Se Representation

Often our clients receive medical bills and send them to us. The medical bills that you receive in the mail normally do NOT include ICD Codes. As such, if you represent yourself, when you obtain your bills, make sure you request bills with the ICD Codes.

If you get injured in an accident and you want to talk to an attorney about your case, or you want clarification about how to use personal injury medical codes, feel free to contact us for a free consultation at 312-848-9783.

Personal Injury Settlement Amount

Personal Injury Settlement Amount
Personal injury settlement amount

My clients who were injured in an automobile or other motor vehicle accident often ask: how much is a reasonable personal injury settlement amount? That is a very difficult question to answer and in typical attorney form, I can only answer “it depends.”

For a broader discussion of the value of a case, see my recent blog article entitled “How Much is my Case Worth?”. In short, it depends on several factors such as the severity of your injury, the amount of insurance there is, and what insurance company you are dealing with, among other factors.

Included in many personal injury settlement amounts are compensation for:

  • Property damage – your vehicle but also your damaged cell phone, clothing etc.
  • Pain and suffering – but how do you measure your pain and suffering?
  • Lost wages – we will contact your employer to verify the amount of money you lost
  • Mileage and other expenses – keep a mileage log for example
  • Medical bills – In Illinois, you can recover for the total cost of your medical bills
  • Loss of enjoyment – you lost time playing catch with your son or daughter due to your injury
  • And more

In my practice, the primary reason my clients are limited in the amount they recover is that the person who caused the accident has a small insurance policy. In the state of Illinois, the minimum policy is $25,000.00 and most people have just that. In addition, not all but many of my clients, unfortunately, don’t have enough uninsured or underinsured (UM/UIM) insurance to protect themselves.

So how does that affect your settlement? Let’s look at two cases my office recently settled. In the first case, our client was able to tap into multiple policies and thus obtain an adequate recovery. In the second case, our client did not have a sufficient UIM policy and her recovery was thus limited.

  1. Bicycle accident settlement $93,000.00+

Our client was riding his bicycle when he was hit from behind. He went down and suffered a fractured wrist, transverse process fractures, and lacerations, abrasions and contusions. The driver of the car that hit him only had a minimum insurance policy. However, our client had a large underinsured motorist policy. As such, we were able to recover against his own policy and obtain appropriate compensation for his injuries.

  1. Motorcycle accident settlement $100,000.00

As a Chicago motorcycle accident attorney, I had a client who was the passenger on the back of her husband’s motorcycle. A car cut them off and they went down. Our client suffered a fractured wrist and an aggravation of a pre-existing injury – a spinal stimulator that was placed in her back was damaged and had to be replaced through surgery. The defendant had a $100,000.00 policy. However, based on the severity of an injury, her pain and suffering and her medical bills, this case could have garnered a much larger settlement. However, our client did not have enough underinsured motorist protection. As such, our client was limited to the $100,000.00. Fortunately, we were able to negotiate down her medical bills in order to net enough to compensate her.

$100,000.00 sounds like an adequate personal injury settlement amount. However, medical bills and attorneys’ fees and costs are paid out of the settlement. As such, the net recovery is much smaller.

Often, when a defendant has a small insurance policy, clients want to sue the defendant personally for their injuries. That is an option, however, in most cases, it is not practicable. Most people who have assets have insurance to protect those assets. If the defendant has a small auto insurance policy, he/she probably doesn’t have many assets to protect.

Practical scenario:

You are injured in an auto accident and you file a lawsuit against the defendant. The defendant has a $50,000.00 auto insurance policy. You win a judgment of $100,000.00. The insurance company writes you a check for $50,000.00 and you try to collect against the defendant for the balance of $50,000.00. The defendant determines he cannot pay you. So, what does he/she do? File for bankruptcy. Practically speaking, that ends your case.

Consequently, in most cases, our clients are limited in their recovery to the amount of the defendant’s insurance policy.

In sum, it is difficult to determine what is a reasonable personal injury settlement amount. That determination is made on a case by case basis. Just because a friend or relative recovered a certain amount in his or her case, does not mean you will have the same experience.

If you need help determining what to demand in a Glenview auto accident case, contact Barry Zlotowicz at 312-848-9783 for a free consultation.

How much is my case worth?

Glenview Injury Attorney

If you’re a Glenview injury attorney, the one question you hear from clients repeatedly is: how much is my case worth? The simple answer usually is – “it depends.”

In short, how much your case is worth depends on a variety of factors including:

  • Severity of injury
  • The type of medical treatment you underwent
  • The permanency (or lack thereof) of your injuries
  • The amount of your medical bills
  • The amount of your lost wages
  • How much insurance there is
  • What insurance company you are dealing with

Severity of injury: This is the tough one in that everyone who has been in a collision believes their case is worth $1M dollars – and a lot of attorneys will tell you that your case is (see below). The truth of the matter is that how much you recover is really a “sliding scale” with soft tissue injuries like sprains and strains or minor concussions on the left of the scale and catastrophic injuries like death on the right.

Type of medical treatment: If you undergo surgery, from an open reduction internal fixation (ORIF) to a minor arthroscopic procedure, your case will be worth significantly more than someone who had a single trip to an emergency room and some physical therapy.

Permanency: If you have a permanent disfigurement, for example, scarring from road rash, a bone that never healed right and sticks out or you will forever walk with a limp, your case may be valuable.

Amount of medical bills: In the 1990’s, you could count on getting 3 times your medical bills in a soft tissue crash. That model does NOT apply any longer regardless of what you find on the internet. But, significant medical bills can be and often are an indicator of severity of injury and in the state of Illinois you are entitled to recover for all your medical bills regardless whether your insurance company had a contract with the provider that required them to pay less than face price.

Amount of lost wages: you are entitled to recover for your verifiable lost wages. This is standard but again, must be verified for an insurance company to compensate you for them.

How much insurance there is: Fifteen percent of all drivers are uninsured, countless more are UNDERinsured meaning they have the minimum insurance policy limits of $25,000.00. If that’s all the insurance there is, then unfortunately, that may be all you can recover against the defendant regardless how severe your injuries are. I was recently contacted by a woman who had a potential exacerbation of a prior leg injury. The first lawyer she spoke to said she had a $1 million dollar case. I asked her, if the defendant only has a $25,000.00 policy, where is the other $975,000.00 coming from?

What insurance company you’re dealing with: If you’re dealing with Allstate, Esurance or State Farm, be prepared to be low-balled. Conversely, commercial policies often pay more for a standard claim

It’s difficult to determine how much your case is worth. If you want a consultation from a Glenview injury attorney, call Barry at 312-848-9783 for a free consultation.

Despite the attention, sports are not the leading cause of brain injuries

Slip and Fall AccidentsBrain injuries cause about 30 percent of the injury deaths in the U.S. each year, and many survivors in Illinois suffer permanent disabilities and must rely on state services to meet basic needs. Any blow or jolt to the head that interrupts brain function is diagnosed as a traumatic brain injury (TBI). A force penetrating or fracturing the skull may also cause a TBI.

Much of the media attention about brain trauma has focused on sports injuries. However, blunt force trauma, which encompasses sports injuries to the head as well as many other sources, comprises only 15 percent of TBIs. Data supplied by the Centers for Disease Control and Prevention indicates that falls and car accidents account for more than 50 percent of the overall number.

Continue reading “Despite the attention, sports are not the leading cause of brain injuries”

Northbrook Personal Injury Lawyer

Northbrook Personal Injury Attorney
Liens in your personal injury settlement

One of the most important and trickiest issues personal injury attorneys deal with is how to handle liens in your personal injury settlement.

In short, if you were injured in a personal injury accident in Northbrook or anywhere else, whether it be an automobile, motorcycle, bicycle or slip and fall accident, it is likely that your health insurance company will file a “lien” against your recovery, which requires that they be reimbursed for medical bills paid on your behalf.

Liens are frequently filed by health insurance companies like Blue Cross Blue Shield, Medicare and Illinois Medicaid, among many others.

Confused?

Many accident victims are confounded by this. They argue, and rightly so, that they’ve paid insurance premiums for years. As such, why should they be penalized for being injured through no fault of their own?

It’s a matter of contract law. While you may not have noticed, it is likely that your health insurance company included subrogation (i.e., reimbursement) language in your health insurance contract which gives them the right to be reimbursed if you are injured by a third party (i.e., the person who caused the accident).

So, if you are injured by someone else’s negligence and your health insurance pays your bills, you will have to pay them back.

How it works

Let’s say you are injured in an automobile accident and you recover $100,000.00 from the defendant’s insurance company for your injuries. The $100,000.00 is then reduced by, among other things, the amount of the health insurance lien you must pay your health insurance company.

Some people have asked, if I must pay my health insurance back, perhaps I should not use my health insurance to pay the bills. That is an option. Many medical providers would be fine delaying payment of the bills pending settlement or other resolution of your case. Why? Because the doctors or hospitals have contracted rates with the health insurance companies. This means, they get paid significantly less than what their retail (for lack of a better word) rates are.

Normally, if a healthcare provider agrees to postpone collection of their bill, they will file a “lien” against the recovery that you and your attorney must sign. However, many providers will not accept a lien or “letter of protection.” For those providers, you may have to make monthly payments to keep your bills from going to collections.

Collections? Yes, when you get in an accident, if you or your health insurance doesn’t pay for the bills, those bills can and often do go to collections companies for recovery. This can negatively affect your credit.

As such, it’s extremely important to manage your bills after an accident. This is also an example of why in the end, it is usually beneficial to have your health insurance company pay your medical bills.

Note that while most of your bills may be paid, you will still be responsible for paying your co-pays and deductible before your health insurance kicks in.

Often your medical bills and/or liens, amount to more than your potential settlement. If this happens, your attorney will rely on the Illinois Healthcare Services Lien Act to resolve your bills. Generally, the lien act states that health care providers are limited in how much they can recover against your settlement.

If you are in Northbrook and unsure how to handle liens in your personal injury settlement, contact my office today for a free consultation. Call 312-848-9783 and ask for attorney Barry Zlotowicz.

All About Illinois Statute of limitations for Personal Injury Claims

If you have an Illinois personal injury case, one of the first questions out of your attorney’s mouth should be – when did the accident happen? It ispersonal injury statute of limitations illinois critical that your Chicago personal injury attorney know the date of your accident as that is the date that the clock starts running on your Illinois personal injury lawsuit!

CONTACT OUR OFFICE 312-848-9783 TODAY.

Our office is constantly asked by clients, friends and colleagues, how long do I have to file a lawsuit for personal injury in Chicago or the whole state? The answer, in general, is two (2) years from the date of the accident! To be specific, and for our readers’ benefit, the exact verbiage of the statute is provided below:

“Sec. 13 202. Personal injury Penalty. Actions for damages for an injury to the person, or for false imprisonment, or malicious prosecution, or for a statutory penalty . . . shall be commenced within 2 years next after the cause of action accrued . . .” 735 ILCS 5/13 202

There are some exceptions to this rule. For example, a minor who is injured in Illinois typically has two years from the date they turn 18 to file a claim for an injury that occurred while they were a minor. 735 ILCS 5/13 211

Also, other “personal injury” claims such as a claim for Illinois medical malpractice have different statutes of limitations. Illinois medical malpractice claims typically expire two years from the date they are discovered but no more than four (4) years after the date they occurred. 735 ILCS 5/13 212

HAVE A QUESTION? CALL OUR OFFICE 312-848-9783.

Lastly, be aware that there are differences in personal injury claims if filed against a governmental or quasi-governmental entity like the CTA. In general, a notice of a claim against an Illinois governmental entity must be given within one year of the accident.

In sum, statutes of limitations can be confusing. As such, it is essential that you contact a competent Chicago personal injury lawyer to assist you in determining the appropriate statute of limitations for your claim.

Disclaimer: The information on this webpage has been provided by the Chicago Legal Group for general informational purposes only and should not be considered legal advice. Do not rely upon this information when making legal decisions. Nor does this information and/or transmission of this information create an attorney-client relationship between CLG and the recipient.

Understanding The Role Of Illinois Injury Attorneys

what do injury attorneys do in illinoisIllinois injury attorneys handle thousands of Chicago personal injury cases every year. If you’ve been injured or suffered a loss due to someone else’s negligence and are considering a lawsuit, you’ll work closely with a personal injury lawyer in Chicago or, in the case of the loss of a loved one, an Illinois wrongful death lawyer. Understanding just what is involved in this type of lawsuit and everything that your lawyer has to do in order to represent you is the first step toward resolving the problem. Most people think the majority of the work done is in the courtroom like we see on television programs. The reality is that the vast majority of legitimate claims settle prior to going to trial. If you have a good Chicago personal injury lawyer, he or she will work your case as if you are going to go to trial but with an eye on settling the case prior to trial.

Determining What Type Of Chicago Personal Injury Case To Pursue

Cases generally fall into one of two categories – negligence or intentional torts. An intentional tort includes any case where the defendant intentionally caused the injury or injuries. In other words, the person or persons being sued deliberately committed the act that resulted in harm. These can be difficult cases to pursue because your attorney has to demonstrate that the defendant’s act that led to the injury was intentional. Still, an experienced and skilled Illinois injury attorney can pursue this type of a case effectively. Some of the most common types of intentional liability cases include battery, false imprisonment, defamation, and/or abuse. In most cases, if you’re the victim of a criminal act that resulted in an injury, you may also be able to sue for damages in civil court.

A negligence lawsuit is different – in a negligence lawsuit, the case hinges on whether the person or persons being sued exercised appropriate care and consideration for the safety of others. Your attorney won’t have to prove that the act that resulted in your injuries was deliberate; he’ll only have to prove that the action was careless and contributed to your injuries. This is based on the assumption that every individual owes a reasonable amount of care toward protecting the safety of others. The vast majority of Chicago automobile accidents are negligence cases – in other words, you will allege that the driver who is at fault failed to exercise reasonable care when driving his or her automobile resulting in the Chicago car crash. Slip and fall accidents and Chicago medical malpractice cases are other common types of cases where a plaintiff will allege negligence.

An Illinois wrongful death lawyer may file a lawsuit on your behalf alleging either an intentional act or that negligence contributed to the death of a loved one. If you’ve lost someone you love, be sure to hire an Illinois wrongful death lawyer who is experienced at pursuing these types of cases. Paul Wolf, the attorney affiliated with the Chicago Legal Group has extensive experience with Illinois wrongful death cases.

The Many Roles Of A Chicago Personal Injury Attorney

Your Chicago personal injury attorney will wear a variety of hats during the course of pursuing your case. In addition to understanding and applying the law, he/she will have to have an understanding of the complexities of your situation and the accident or malpractice in question. He will be an investigator – talking to all the doctors, nurses, witnesses, and other professionals connected with the event leading to your injuries. He will be an instructor – consulting with experts who can recreate the scene, engineers who can testify as to whether the accident could have been avoided, or others who will lay the groundwork for your lawsuit.

Many experienced attorneys become advocates for their clients as well. They may talk to physicians, physical or occupational therapists to determine and obtain the best possible medical and other care for their clients. Choosing an Illinois injury attorney who will help you find the best treatment possible can make your recovery easier.

If you’ve been injured in an accident, contacting us is the first step toward recovery. The best Chicago injury attorneys will not only represent you in court, they will guide you throughout your recovery to ensure the best possible outcome.