physician writing up a medical narrative for a motor vehicle accident victimPersonal injury claims or cases that arise from accidents in Massachusetts require the injured party to prove fault, their injuries, and damages. When it comes to an accident victim’s injuries and their severity–putting liability aside–expert opinions play a vital role in detailing injuries, treatment, and much more.

When most hear “expert opinion” the first thing that comes to mind is an expert testifying in court. Sure, in many Massachusetts personal injury trials, a variety of expert witnesses may testify, including medical experts. However, prior to a case making it to trial, expert opinions may be made in writing. A medical professional may outline details of an accident victim’s injuries as well as their treatment, disability impairment, if any, and prognosis in a written document referred to as a medical narrative.

Overview of Medical Narratives for Personal Injury Cases in Massachusetts

A medical narrative, arguably, may be the most important document produced in a serious personal injury case with catastrophic or life-altering injuries and can play a pivotal role in maximizing settlement offers. A medical narrative is a summary from a treating physician or other physician, practicing in the same field as the injury suffered by the client, outlining the client’s injuries, treatment to date, and future prognosis. A well drafted medical narrative also typically provides an impairment or disability rating according to the American Medical Association (AMA) guidelines. 

Some treating physicians may not be willing to draft a medical narrative after a motor vehicle accident. In that situation, another physician specializing in the same medical field may be used to prepare the medial narrative. Either way, the doctor drafting the narrative report will always review all the medical records, operative reports, diagnostic tests and physically examine the accident victim in order to comprehensively prepare the medical narrative report.

The medical narratives should be signed by the authoring physician “under the pains and penalties of perjury”. This means that the doctor’s narrative report is being drafted and executed under oath. Having the narrative report signed under oath is a prerequisite to its admissibility at trial, if needed.

In many cases, a client, who has suffered serious injuries, inevitably accumulates a mountain of medical reports and diagnostic testing results. Rather than go page by page in explaining a client’s injuries and treatment, a medical narrative is focused on the important aspects of the injury and treatment. It encompasses all the major facts of the case in a clear and concise format. Furthermore, it provides for the patient’s (injury client's) prognosis of his or her injury. Prognosis is defined as a doctor's opinion or judgment projecting future treatment, medical costs, likelihood of recovery, etc. In layman’s terms, it’s where the doctor predicts how an accident victim will recover and what may be required to recover from an injury.

Medical narratives are not cheap. On average a medical narrative may cost around $1,000 and can be much more costly depending on the physician, their expertise, and specifics of the client’s injuries and treatment. At Mahaney & Pappas, LLP, our injury attorneys pay for expenses, including the costs of medical narrative reports, as incurred on our personal injury cases in Massachusetts up front for our clients.

How Medical Narratives Are Used in Serious Accident Cases

In Massachsuets personal injury claims, a medical narrative is used in the negotiation phase of the bodily injury claim. They are classically submitted to the at-fault party’s insurance company as part of the accident victim’s demand for settlement.

A narrative report from a qualified board-certified physician stating that an accident victim’s injuries are causally related to the accident, that treatment has been fair and reasonable, the likely or necessary treatment needed in the future, and, most importantly, a percentage of disability or impairment can be a powerful tool to use in negotiating a fair and just settlement for a client. They provide objective evidence and substantiate the severity of an accident victim’s injury. Generally, medical narrative reports result in larger settlements.

When personal injury lawsuit is filed in Massachusetts, a medical narrative can also be used at trial in Massachusetts Courts. The medical narrative’s admissibility falls under M.G.L. c.233 §79G, which provides, in part, “any report of any examination of said injured person … subscribed and sworn to under the pains and penalties of perjury by the physician … shall be admissible as evidence of the fair and reasonable charge for such services or the necessity of such service and treatment, the diagnosis of said physician, the prognosis of such physician, the opinion of said physician as to proximate cause of the condition, the opinion … as to disability or incapacity…” Medical narratives admitted into evidence are also very influential pieces of evidence for juries to consider in determining a fair amount of compensation to award a plaintiff.

Why Medical Narratives Are Vital in Accident Cases With Serious or Catastrophic Injuries

Our office regularly employs the use of physicians to author narrative reports outlining the extent of injury and loss of function. For example, one of our client’s slipped and fell in the parking lot at a commercial establishment in Marlborough, MA. She suffered a serious shoulder injury and required surgery. Prior to a scheduled ediation, our office obtained a medical narrative from a qualified orthopedic surgeon. The narrative outlined her impairment from the accident as follows: “it is my opinion based upon a reasonable degree of medical certainty that she has reached maximal medical improvement and this in regards to the right shoulder, going to table 15-5 she would have a 37% upper extremity impairment and going to the left shoulder this would be a 28% upper extremity impairment, then going to table 15-11, this is a 22% whole person impairment for the right shoulder and for the left shoulder a 17% whole person impairment.  It is my opinion based on the combined values she would have a 35% whole person impairment which in my opinion is directly causally related to the accident that occurred on …”.  Given the client's age combined with the orthopedic doctor’s whole person impairment rating, we were able to negotiate an excellent settlement for this client. 

Medical narratives may also be used in Massachusetts scar cases. In a recent scar case we handled, a resident of Ashland, MA was rear-ended on I-495 in the Town of Foxborough. The rear-end collision caused our client to strike his head on the visor resulting in a large, full thickness laceration to his forehead. At the emergency room, the laceration was irrigated and closed with 5 sutures. Unfortunately, the scar was very prominent on his forehead, which there is no way to hide. We retained a qualified Massachusetts plastic surgeon, who reviewed our client’s medical records and conducted a physical evaluation of his scar. The plastic surgeon’s narrative report stated that our client suffered a “centrally depressed, curved measuring 3cm x 3mm”. The surgeon also opined that the scar was permanent and that a scar revision procedure may reduce the scar. An estimate for the scar revision procedure was also provided. The medical narrative was extremely helpful for, not only securing the full bodily injury policy limits of the at-fault driver’s auto insurance policy, but also for obtaining a significant amount from our client’s underinsured motorist portion of his auto insurance policy.

Hire a Local Injury Attorney to Assist With Your Medical Narrative

At our law office in Framingham, Massachusetts, we have worked with countless medical professionals in a wide variety of personal injury cases. Our experienced injury lawyers routinely use medical narrative reports as part of our handling of accident cases. In our opinion, to have a serious case and no medical narrative is irresponsible. Most times, the use of medical narrative reports have pushed the settlement offer well above what was initially considered.

Charles S. Pappas
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Massachusetts injury lawyer & workers' compensation attorney serving accident victims in Webster & Framingham.