Early Case Valuation from a Medical Standpoint: What Counsel Needs to Know

RAC Audits Excelas Medical Legal Solutions

As highlighted in recent DRI seminars, knowing the details of claimed damages is critical in early case valuation.  Counsel must assess many factors including legal liabilities and potential costs, similar cases and verdicts, claims of pain and suffering, bills, and medical records.  The data contained in those medical records are key in these evaluations but can be costly to obtain and analyze without clear protocols.  For that reason, defense counsel needs a standard process of retrieving and reviewing the medical information to reduce overall litigation costs.  Such a process allows counsel to focus on the legal issues while shortening the cycle of case valuation and ultimate resolution.

Know Who Can Help

Outsourcing the management of medical record retrieval and analysis enables counsel to shift their focus to the high-level legal aspects of the case throughout the stages of a lawsuit.  Excelas employs a team of professionals, including health information administrators, nurses, and lawyers, who specialize in medical information management services.

Our team processes millions of pages of medical records each year and distills these seemingly unrelated documents into concise, customized reports to support counsel’s decision making.  By taking advantage of Excelas’ economies of scale, record retrieval and analysis costs are drastically reduced as compared to handling individual cases in-house.  Excelas’ proprietary software allows for customized reports and our timeliness, cost effectiveness, and efficiency are a result of our standard processes.

Know the Players in Your Case

Early identification of the key players related to the case is essential for determining potential witnesses and preparing for interviews and depositions.  The first steps in this process are record retrieval and organization.


  • Record Retrieval
    • Efficiency is key in retrieving records. There is a distinct advantage in utilizing staff who have insider knowledge as to how health care facilities and providers maintain and release records.  It is important to understand the multitude of electronic, hybrid, and paper medical record systems employed by health care providers, as well as HIPAA privacy and security regulations, and legal requirements.  Utilizing Excelas’ experience with multiple electronic health information systems, records can be retrieved promptly upon request for release or review.


  • Record Organization
    • Medical record organization is the foundation for effective case analysis. Records are sorted by provider and episodes of care, indexed by document type, Bates numbered, and are searchable by OCR.  An organized record is typically returned to the defense firm or in-house counsel in less than 2 weeks.
    • During this process, records are assessed for completeness, duplicates are purged, “wrong patient” documents are removed, or redacted.
    • Counsel is immediately notified of additional providers of care and potential missing documentation identified at this stage to promptly generate new record requests.
    • All documents are available online through the Excelas HIPAA compliant, secure web portal. Each member of the legal team is provided with a unique log in to allow for concurrent access from any location.

As records are received and electronically organized, our expert staff quickly prepare reports which detail all providers (physicians, nurses, therapists, etc.) who had interactions with the patient or resident.  These reports are available to counsel following organization of the medical record and provide a timesaving overview of key players in the case.


  • Provider of Care Report
    • Identifies potential witnesses by name, the date(s) care was administered, the record type and a hyperlink to the source document which contained the reference. The report is fully customizable.  The Provider of Care report facilitates efficient preparation for interviews and depositions, completely eliminating the need to review a record multiple times to identify caregivers and key personnel.


  • Care Calendar/Touch Chart
    • Provides a user-friendly tool to visualize all patient/resident and provider contact categorized on an interactive calendar.
    • Allows for a single click to take the user to detailed information on care provided and hyperlinks to source documents.
    • Facilitates preparation for family meetings, mediation, and trial exhibits, eliminating the time-consuming and costly review of all interactions by an expert.
    • Details of each caregiver’s interactions can be verified by simply downloading the data into an Excel spreadsheet for final review.


  • Staffing Scorecard
    • Staffing levels at skilled nursing facilities can often be a factor in a claim or lawsuit. Payroll based data submitted to CMS can be useful in Identifying any issues in facility’s staffing levels.
    • Efficiently utilizing this publicly available data, the Staffing Scorecard allows for identification of staffing fluctuations and comparisons to other facilities.

Know the Medicine Relevant to Your Case

Insight into the information contained in the medical records relative to the allegations is key in developing an early defense strategy.  Each case is unique; therefore, the format of this early analysis is flexible depending on counsel’s requirements.  Typically available within days of record organization, the Strengths and Weakness Assessment is an executive level, narrative summary by our medical legal analysts of significant medical events that support or refute the allegations.  A more detailed Early Risk Assessment is an appraisal of the clinical events with an objective review of the severity of findings and potential liability.  This report includes hyperlinks to the source documents online.


Based on the decisions made regarding the case value at this stage in the discovery process, more in-depth medical analyses may be required.  If this is the situation, Excelas’ medical analysis team prepares detailed Case Summaries and Medical Chronologies which allow counsel to continue to build the defense.  All reports are customizable based on the critical issues in each case; are prepared in an easy to read, online format; are hyperlinked to the page in the medical record which contains the source information; and are available in an average of three weeks from receipt of records.  The reports may be sorted by topic, record type, care provider or other elements as directed by counsel.  These timely reports build on the early case assessments to facilitate identification of expert witnesses and preparation for depositions and trial.


As outlined above, there are many factors involved in the timely acquisition and management of medical records to support the litigation process.  Counsel must know:


  • The most efficient means to acquire and warehouse the medical records.
  • The key players involved in the care of the patient as documented in the medical records.
  • If the medical records support or refute the allegations.
  • How to decipher and interpret the documentation in the medical records.
  • The most effective method to access and share the documents and reports among decision makers.


The key to shortening the lifecycle and reducing overall litigation costs is knowing who can support the process.  Excelas has that experience and expertise.  Contact us today to discuss your medical information management needs.

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