Medical Record Review

Dr. Zunkeler performs independent reviews of medical records and diagnostic imaging studies for insurance companies and legal professionals on behalf of both plaintiffs and defendants. Dr. Zunkeler has more than 18 years of experience in evaluating neurosurgical cases from the aspect of causation, conformance with the standard of care in neurosurgery, and neurosurgical case and complication management in an out-patient setting and in the hospital, both in and out of the operating room. In addition to evaluating neurosurgical cases for both defense and plaintiff attorneys in civil and professional liability litigation, Dr. Zunkeler performs independent record reviews in workers’ compensation cases.

What should you expect from a record review?

A careful review of a complete set of medical records and relevant imaging studies can provide an experienced reviewer with valid insights about the appropriateness of medical care provided to a patient. Written reports, based on a record review, often address the following:

 

1. Appropriateness of medical or surgical care.

2. Presence or absence of pre-existing or subsequent medical conditions and the degree of relatedness to the patient's current complaints.

3. Relatedness of medical or surgical care to an occurrence, i.e. a 'loss', an 'incident,' or an 'injury.'

4. Causation or lack of causation of reported signs and symptoms relative to a claimed 'injury,' 'incident,' or 'loss.'

What are the potential shortcomings of a record review?

Even the most careful and complete review of medical records and available diagnostic imaging studies only takes into account the documentations of other providers and any existing diagnostic data, including diagnostic imaging, if such data are available.

 

Although a record review is sometimes sufficient for the reviewer to form and express a number of valid opinions, record reviews sometimes cannot replace the experience of a face-to-face encounter and the information obtained by the examiner directly from the patient through a history and physical examination during an independent medical evaluation (IME). If necessary and feasible, an IME visit can be scheduled later, i.e. after a record review has been completed.

Our Services