Professionals across the claims space rely on reports to assess medical history, provide an expert opinion, or determine liability. When it comes to claims, reports and documentation provide the basis for a fair outcome. Clear, high quality reports result in a more efficient process and often contribute to better outcomes for the patient. Documentation matters, but which reports are the most critical for understanding and resolving a claim? 

Critical Reports for Claims Documentation

Reports are generated to facilitate decision making, evaluation, and arbitration over the course of a claim. Common reports in claims documentation include:

Medical Chronologies

Medical chronologies capture the medical history of the patient via a detailed timeline of events following a claim. Viewing the patient’s health data – which can live across documents pulled from hospital EMRs, family doctor reports, or eyewitness statements – in one place helps legal teams and insurers assess how a claimant is progressing since the triggering incident or accident. These medical chronologies will be examined by the claims adjuster and incorporated into their report. If there is a possibility of a pre-existing injury or condition impacting the claim, the chronology may be expanded to include past medical records going as far back as decades.  

Claims Adjuster Reports

An insurance adjuster is assigned to each claim and  generates reports following the claim that outline policy coverage, liability assessments, and any damage estimates relating to the claim. The insurance adjuster will review how much coverage a patient has, whether this coverage applies in the scenario, and estimate the value of the loss. When working on the file, the claims adjuster may request advice from a third party medical expert to support details of the claimant’s condition. They’ll include findings from these requests in their final report. 

Independent Medical Examination (IME) Reports

IME reports are just one of the evaluation documents containing key medical and claim-related information for a patient. IME assessments outline medical history, patient health information, medical encounters, and provider recommendations. Expert examinations are conducted by physicians who are independent from the case: IMEs are board certified medical professionals who can provide an impartial assessment of a claimant’s medical condition. These medical experts review the patient’s file and their health situation, either validating the claim or providing additional insight. For example, IMEs might assess whether injuries are consistent with the scenario that the patient claims, and with the treatments that they received. 

Having this information available to view in a report format allows for a quicker analysis of what often ends up being a lengthy dossier of documents pulled from many medical institutions.

Litigation Summaries

Litigation summaries offer an ‘at a glance’ look at the case – the name of the case, how the case originated, its procedural history (filings, motions, hearings, decisions), critical evidence relating to the case (IME reports, eyewitnesses, etc). The litigation summary includes possible litigation risks and options (settlement, trial, etc), as well as the parties involved, the jurisdiction, dates, and issue at hand. 

Deposition Summaries

A deposition is a formal statement taken under oath, but outside of the courtroom, where a witness or other party involved in the claim answers questions posed by an attorney. Depositions serve as critical evidence for a legal case, and transcripts of these depositions will live in the case file. Deposition summaries highlight relevant statements made in these transcripts. 

Expert Witness Reports

When a case involves specialized knowledge of a medical issue or industry, a forensic analyst or other medical specialist may provide their expert opinion on highly technical medical or scientific issues. Expert witnesses can be deposed for questioning, or can be engaged to draft an oral or written opinion of the issue to educate the parties involved on the more technical issues in the case. 

Billing Reviews

Billing reviews ensure that the medical or rehabilitation expenses being claimed are priced accordingly with industry standards. Billing reviews help identify possible fraud and ensure that compensation is fair for both parties. 

Clear, Accurate Documentation is Essential for Fair Claims 

For all of these various report types found in the claim life cycle, the creation and configuration of the extensive information into a concise format can be a time-consuming process. This often takes time away from the important task at hand—analyzing and making decisions by these industry professionals.

To save time, custom templates and reports can be configured to meet the needs of most industries, and offer a multitude of benefits for the user. Concise custom reports give an ‘at a glance’ look at a patient or a claim, and the documents contained in them provide important context for a case, depending on the line of business. Looking at depositions, arbitrations, or interrogatories can be time consuming (and expensive) for the professionals involved; being able to see the medical treatments, functional status of the claimant, and details of the injury ensures files are processed quickly and key pieces of information aren’t missed. 

Whether a claim is typical for the industry or unusual in its size, litigation, or level of complexity, documentation is key. Custom reports provide configurable outputs in significantly less time, allowing industry professionals to quickly surface the most relevant information within a claim. By reducing the time spent compiling and reviewing documentation, these reports enable teams to stay focused on higher-value tasks such as analysis, communication, and decision-making, ultimately accelerating the path to fair and timely outcomes for all parties involved.