Narrative Reports

When to Use a Narrative Report

 
We recommend that claimants almost always include some type of typewritten medical information to accompany to computer coded medical records and/or handwritten records. That is the first clue as to when to use the narrative report: if you are asking the adjuster to evaluate your claim on the basis of handwritten records and/or computer coded records that indicate diagnosis and treatment codes, then you need to supplement the record with a narrative report.

Why? Because it is human nature for an overworked adjuster to spend more time with a nicely typed record than trying to decipher some doctor's scribbling. And it is human nature to for the adjuster to better understand and to relate to a claimant when she reads about the effects of the injury in words, as opposed just seeing computer codes.

So be sure to use a narrative report from your doctor, unless you lucked out and selected a doctor who prepares a typewritten narrative of each visit.

When should you submit the narrative report? We think that if you have progress notes that are typed into your record by the doctor's office, you should submit them just as soon as you get them in order to keep the adjuster informed of you treatment. If you are submitting an overall wrap-up narrative letter, then send it along with your demand package; you will want the adjuster to obtain the best view of your claim from the outset.

What about using a narrative report later in the negotiation phase, when you are stuck on a specific point? Let's say that the adjuster just does not "buy" a part of your demand that relates to treatment. Maybe she thinks the accident did not cause such problems because you had a prior accident. Or maybe she is not going to pay a wage loss because she does not think your condition was serious enough to keep you from work.

In these instances, you can move past the problem area with a narrative report from the doctor that addresses that specific question.

How to Obtain a Narrative Report and What Will It Cost

 
The easiest and cheapest way to obtain a narrative report is to sweet-talk the doctor into making some typewritten notes in your record. If you can discuss with her what area of care or pain you want addressed, or how the insurance adjuster wants proof that the accident caused your pain, or proof that you should be off work, then your doctor just might put down in writing exactly what you need right there in your medical record, and you will have a very good document to send along to the adjuster. It doesn't hurt to ask, does it? Absent that arrangement, you are going to have to go through a somewhat formal request process to ask for a narrative report and to specify what topics you need to be addressed.

Why should you have to pay for the report? Well, the doctor has billed you to date only for treatment and minimal recordkeeping, but she has not billed you for expressing her opinion in a legal forum. Although you are not actually now in court, still, narrative report writing could be considered to be called forensic medicine, or the practice of medicine in the courtroom: the doctor is not employed to cure, but she is expected to testify or to influence the determination of the finder of fact (jury or arbitrator, for example). Her narrative report is the first step toward testimony, so it will be a billable event to you.

How much should you pay? That depends upon who is asking for the report, the purposes of the report, how much file review is necessary to make the report, and the complexity of the topics and care discussed in the report. We believe that the doctor is going to charge an attorney the "full boat" price for the report, but if you ask for it, she will reduce her charges substantially. For example, a general practitioner might charge an attorney $350 for a letter that lays out all of the injury mechanism and attributes it to the accident, and which further goes on to discuss prognosis and recommendation for future medical care. Such a letter will be crafted to leave the doctor some wiggle room, but at the same time it will be a valuable tool in achieving a fair settlement.

The patient will not get such a thorough report in response to his request, but he will not have to pay much more than $100 (if that). It would be unusual for a general practitioner MD or a chiropractor to charge you more than that. But if your doctor is a specialist in the medical (orthopedist, neurologist, etc.) or dental (TMJ specialist) practice, then you can expect to pay more for a narrative report-perhaps in the range of $250 to $350. This is another area where a little time spent discussing the doctor's report fee with the head nurse, office manager, or doctor will pay a dividend.

This may seem like quite an investment, especially if the injury has caused a loss of income. But you can achieve a substantial financial advantage in your claim by investing in a narrative report because it will usually be pointed and strong ammunition that has more of a tone in your favor than straight medical notes in your record. The medical record notes are usually just notes, without taking any side; by contrast, the narrative report is usually written in a tone to support the patient's claim.

By this we do not mean that the doctor should be expected to become an advocate for the patient's monetary recovery. It is just that small topics, such as causation (i.e., did this accident cause your present symptoms?), are usually not fully addressed in the medical records, but will receive a full paragraph in a narrative report. It is up to you to specify which topics you want addressed in the report, and you will include those in your letter. Here are a number of topics that one might include in a request for a narrative report.

• Diagnosis
  
• Causation to This Accident
  
• Prior Accidents Not Relevant
  
• Impact of Pre-existing Injuries or Pre-existing Ongoing Treatment
  
• Clinical History
  
• Treatment and Changes in Condition
  
• Need to be Off of Work
  
• Medical Prognosis
  
• Future Medical Care Required (e.g., requirement for 6 months of treatment, or necessity of a surgery, or an appliance, etc.)
  
• Future Problems to be Expected in Daily Life, Both at Work and at Home
  
• Susceptibility to Injury in Future (e.g., due to small disc protrusion, or weakness of scar tissue, etc.)