What is Legal/Liability Nurse Review?

Legal/Liability Nurse Review is designed to assist the claims adjuster and defense attorney in evaluating a claim and developing a defense strategy. Legal/Liability Reviews can be used for auto, liability, workers’ comp and medical malpractice. There is no difference between a Legal Nurse Review and a Liability Nurse Review, they are one in the same.

Since Coventry specializes in three types of reviews, those are the ones that will be covered in this article.

Review type Scope of Service
Legal/Liability Nurse Review Full scope review including chronology, summary of medical history, recommendations and negotiation points
Chronology Review Narrative timeline of medical events
Consultation Customized to respond to a specific question or educational need

Legal/Liability Nurses perform the following activities:

  • Interpret and review medical records; identify missing records
  • Screen records for tampering
  • Identify conflicting descriptions of the accident, medical treatment or progress
  • Define adherence to and deviations from standards of care
  • Identify pre-existing/co-morbid/non-related conditions
  • Evaluate appropriateness of medical treatment – excessive, duplicative, and unrelated
  • Address causation/ mechanism of injury

Here are some real-life examples of successful outcomes Coventry has had with reviews of this type:

  • We provided documentation and data allowing our client to challenge an alleged fall and ice related injury by researching the weather in that locale for that timeframe. We discovered the weather had been mild; there was no ice.
  • We discover inconsistencies in dates of injury and dates of service. In one such example a claimant went to the Emergency Room the day BEFORE his reported date of injury.
  • We have challenged claims of food poisoning based on the microbiology of the alleged infecting organism.

Legal/Liability Review is a valuable tool in the assessment of claims. Many potential customers are unfamiliar with this tool and are unaware of its power. We look forward to hearing in the comments below if a Legal/Liability Nurse has benefited your organization in the past.

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