MOI is the mechanism whereby there is a transfer from the environment to the person. It refers to the way damage to skin, muscles, organs and bones happen. Healthcare providers use mechanism of injury to help determine how likely it is that a serious injury has occurred. Different points of impact leads to different mechanisms […]

Insurance Services Office (ISO) – ISO Claim Search provides a full view of the loss history of a claimant, enabling adjusters to identify preexisting or subsequent injury or disability from auto and general liability losses. Adjusters can confirm prior or subsequent losses with overlapping injuries or disabilities, which can support termination of benefits on an […]

INJURY EVALUATION DETAILS (IED Tabs) With BI, everything happens in the Injury Evaluation Detail (IED) tabs. The following is a breakdown of the information needed in each tab. Specials Tab This tab the Claim Processor will input the medical providers and amounts charged as this information is received. CP will not put the amount considered […]

While there is no requirement that the hospital prove the negligence of the injury-causing party, the hospital does have a burden to prove that its charge was not more than the reasonable and regular rate for services billed. Without such proof, the hospital does not establish its alleged cause of action on a hospital lien. […]

Hospital Liens (Statutory) ensure the victim receives aid and that the hospital will be reimbursed for its services, thus reducing hospital cost. Criteria for an Application of the Hospital Lien: The Hospital Lien Statute applies to all hospitals, both public and private; It places a lien on all rights of action: suits, claims, counterclaims or […]

There are two types of auto insurance claims. When you’re in an accident you will either file a claim with your insurance company or with the other party’s insurance company. If you file with your insurance company, you are a first-party claimant in a first-party claim. If the other party’s insurance assumes liability on their client’s […]

First party claims are contractual; meaning that they arise out of a contract (the insurance policy) between the insurance company and the policy holder. They may be claims against the policy-holder’s own Medical Payment coverage or Personal Injury Protection coverage, also referred to MPC and PIP respectively. These policy provisions pay up to the policy […]

A detailed account of events that occurred before, during and after the time of loss. Includes such details as the location of the accident (street or parking lot), weather condition, condition of the road, direction of the vehicles involved, rate of speed, any witnesses to the scene, the purpose of the trip, etc. These details […]

Range of value (ROV) is set for both economic (Special) and general damages (pain and suffering) by determining the lowest to the highest amount of money considered for compensation. To determine what a claim is worth, you must first know the types of damages for which you may be compensated. Usually, the liable party for […]

Is a rule of law applied in accident cases to determine responsibility and damages based on the negligence of every party directly involved in the accident. For a simple example, Eddie Lead-foot, the driver of one automobile is speeding and Rudy Airhead, the driver of an oncoming car has failed to signal and starts to […]