Medical record review by eye experts are utilized for a variety of reasons and purposes. Insurance companies rely on medical review by eye experts to investigate claims of disability, insurance eligibility, medical liability, and relevance of an adverse eye condition to an accident. Product liability, wrongful death, criminal investigation, worker’s compensation, environmental law, personal injury, and toxic torts are other areas where examination of the medical records may provide meaningful insight.
Claims of impaired vision are common reasons for obtaining disability. A records review by eye experts may determine the type and significance of vision impairment. For example, a middle-aged dentist developed spots in his vision that were attributed to degenerative changes in the jelly in the center of the eye. The dentist claimed that the resultant floaters interfered with his job performance and jeopardized patient care. A records review by an ophthalmologist was needed to clarify the nature of the problem and the impact of his visual status to claims adjusters so that they would be able to make a determination about disability.
Insurance eligibility is another sensitive area where medical record review by eye experts may be helpful. A man visits his optometrist compplaining of headaches for six months and blurred vision. His optometrist discovers that his best correctable vision with eyeglasses is poor in each eye and recommends that his patient return in two weeks for a visual field test. In the mantime, the patient applies for health insurance. A visual field test shows a defective pattern that is consistent with a brain tumor. An MRI scan shows a pituitary tumor that requires surgical removal. A records review may be helpful is determining the presence of a preexisting condition at the time of his first eye examination.
Medical liability claims sometimes arise when patients have complications or when they do not achieve the goals of treatment. A cataract surgery complicated by a retinal detachment or elevated eye pressure may occur as an unfortunate event. Complications are inevitable in a busy surgical practice and can happen to the best ophthalmic surgeons. One of the key questions on examination of the records by an ophthalmologist is whether the complication arise from a natural event or from negligence. An appropriate review by a qualified expert may help determine if an ophthalmic surgeon met the standard of care at the time of the incident.
The influence of vision on eye injuries is another area that is investigated in claims for personal injury. In one example, a senior citizen slip in a crowded restaurant and claims severe loss of vision in one eye from his fall. Eye examination confirms almost complete loss of vision and the presence of retinal hemorrhage. The claimant is gratified that his statement is confirmed by witnesses and looked forward to a substantial settlement of his claim. A medical record review by eye experts showed that loss of vision in his affected eye preceded by many years his accident in the restaurant. Medical records showed that the claimant suffered a stroke of the retina that led to chronic intermittent bleeding in the eye. A medical record review by ocular experts saved the insurance carrier from paying a claim of over $1 million dollars.
Medical record review by eye experts can provide meaningful insight that can be utilized in litigation and administrative processes.