All good sleuths know that what is missing tells a story and raises a red flag.

Our clients ­ — particularly insurance adjusters and defense attorneys ­ — understand the importance of medical records when they’re looking for the truth of an injury-related claim.  Whether a claim or dispute involves a head injury or some other trauma, our clients know that one of the biggest hindrances to a complete, comprehensive review and analysis of a personal injury or malpractice case is missing or incomplete medical records.

That’s because missing or incomplete medical records make it very difficult to give a complete and accurate review.

There may be lots of reasons for missing and incomplete medical records.  For example:

  • The records weren’t requested correctly…or requested at all
  • There was conflicting medical care or an intervening injury
  • Certain information about pre-Date of Loss conditions, work history, or other injuries could impact or even counter the current allegations or narrative.

Finally, a missing record might have been deliberately omitted because it documents a base-lined/pre-DOL medical picture that is contrary to the narrative from opposing counsel.

For example…

Let’s say you’re an adjuster working on a claim involving an injury with a visit to an emergency room.

  • In this scenario, an incomplete medical record could be the Emergency Department record where only the ED physician’s notes are provided for review, but there aren’t any RN notes, radiological reports, lab test, treatments or discharge notes.
  • Hospital records provided for review may only include the MD’s progress notes, but not any operative notes, RN notes, radiological reports or treatment notes from ancillary services such as physical therapy.

Ask yourself, What do these missing or incomplete records have to say…and why are they missing or incomplete?  Information should be consistent, certainly through the same ED visit or hospital stay.

Medical records may be purposefully omitted for a variety of reasons. A key takeaway is that for whatever reason, be aware that it does happen and that missing record(s) could negatively or positively influence the case depending on what side you are on.  The entire record should be submitted so that all objective and subjective data can be properly analyzed.

What to do about missing records

Here are some best practices my team and I use when we encounter the red flag of a missing or incomplete medical record:

  • Cross reference all medical information and physicians; are the physicians’ known, treating or ordering physicians?  Know their roles within the context of the claim
  • Match billing statements to narrative; look at dates, descriptions and codes
  • Look for timeline gaps
  • Look for provider names referenced in the narrative, BUT there are no medical records from that provider
  • Watch the tenses of the narrative; is the info in past or current tense?

You might also want to refer to a couple of prior posts we’ve published on this topic.  Here’s one specifically dealing with emergency room records, and another about the emergency room in general and injury-related records.

Add it all together and you get a possible path toward the truth of a injury claim.

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The new year is a good time to take stock.  2018 has been a year of historically significant growth for MKC Medical Management.  That includes…

  • New clients and cross-border assignments throughout North America, many involving catastrophic-injury insurance claims or litigation defense
  • More growth internally, with the expansion of our team to 11 experienced Registered Nurses and Case Managers
  • Continued thought leadership in the form of panels, publications, and presentations ­– as well as lots of lunch-and-learn time –­ focused on the trucking industry, municipalities and statewide agencies, insurers, law firms, and the other key industries we serve

We’re poised for even greater service to our markets in 2019.  We’ve established ourselves as unique in terms of our size, our experience, and the breadth of the services and products we deliver.

This is also a great time to say thank you!  When I started this business over 20 years ago, I had no idea that we’d be where we are today.  It’s happened because of a lot of hard work AND because of countless times when a client, peer, or colleague has stepped up for us.

So…thank you.  Happy Holidays and a safe and healthy New Year!

KARI