For claims adjusters, medical records go hand-in-hand with managing their cases and making case decisions based on their insurance claim investigations.
March 16, 2023
For claims adjusters, medical records go hand-in-hand with managing their cases and making case decisions based on their insurance claim investigations. To review with the claimant, a claims adjuster must review, organize, and draw conclusions from medical records to verify and determine the extent of liability as it pertains to the case.
Claims adjusters investigate insurance claims to determine the extent of insuring a company or individual’s liability. They review cases by communicating with their claimants, interviewing witnesses, researching police or medical records, and inspecting any property involved in the claim, such as automobiles and homes.
The role is a mobile career, taking individuals anywhere they must go to estimate damage from natural disasters, complete paperwork, deliver consulting, inspections, and more. When it comes to injury claims, this is where the claims adjuster must process medical records and access database healthcare systems to collect important information.
The insurance healthcare claim processing has five main stages, from the report of the injury to the resolution of the claim. These five steps of claims process are are:
Read the full scope of the steps involved in an insurance claim on Northbridge Insurance.
When evaluating a claim, adjusters must request medical records and potentially ask for an independent medical examination (IME). While working on a personal injury case, the adjuster collects all documentation focused on the claimant’s injuries, medical treatments, and in some cases the IME results.
When focusing on the management of a specific case, claims adjusters may ask for additional information. For example, if the claimant has X-rays taken but only gave the adjuster the doctor’s records, they may also request the radiologist’s records. If there is a possibility of a pre-existing injury, the adjuster may seek out past medical records. Claims adjusters often spend manual time sourcing records from various healthcare providers in order to better understand the patient history and may need to source records decades back in order to make an accurate decision in a case claim.
Wisedocs is an integral part of processing medical records for claims that adjusters need to investigate. When an adjuster compiles the data for an injury claim, they can expedite the medical record review process and provide more detailed results and findings for the insurance companies with the use of an electronic medical record review, organizing, and summarizing system like Wisedocs.
For example, an IME firm that partnered with Wisedocs stated,
“[We] had a lot of companies pitch their document sorting software over the years, but none have ever come close to what Wisedocs has to offer.”
Wisedocs provide a prompt turnaround time, processing unstructured medical records within hours rather than days, Reducing the time it takes to process case files by over 80%! Wisedocs’ artificial intelligence (AI) platform can process over 750 pages of medical records and other documents within one hour. Wisedocs also identifies duplicated case file information in any uploaded file and processes extraneous information to help claims adjusters complete the case faster and more efficiently.
If you are a claims adjuster or work in the insurance industry, get in touch with our team for a full demo.
Book a demo to see how you can adopt AI the right way—with expert human oversight that accelerates document reviews, reduces administrative delays, and drives faster, defensible outcomes across claims, legal, and medical workflows.