Decrease Risk Through Compliance Knowledge

James Mathis Latest Text

Minor Impact Soft Tissue
Settling and Trying MIST Cases

Michael Freeman, Arthur C. Croft,
Jim Mathis, & Dorothy Clay Sims

Doctor, you might not think you are at risk but statistics say otherwise. Here is just one example of unforeseen risk.    

 

“Low Balling” can = MIST @ SIU

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—"Low Balling" can result in a Minor Impact Soft Tissue or "MIST" case designation which can be quickly followed by a referral to the carrier's fraud division called the Special Investigations Unit or "SIU". This can potentially result in SIU actions including referral for prosecution, indictment, arrest and/or expensive law suits filed against well-meaning, honest but uninformed doctors. Believe it or not this cascade of unfortunate events can begin with a tow truck driver taking the crash victims vehicle to an insurance contracted repair shop that will try to keep repair costs low which is a first step in insurance loss mitigation. Establishing low damage estimates allows for the low impact rationale which can result in greatly limited care and result in a low adjuster settlement authority level. This is another reason we encourage the use of the MaDPI Crash-n-Click app, so crash victims can have a choice of trusted service providers at a very confusing time. This also helps protect the doctor. It is important to note that once a doctor enters the SIU's computer systems it can be difficult to be removed from related insurance industry fraud watch lists. Carrier apps often encourage the use of surface pictures only, and many repair shops almost never examine under car, check the frame or replace expensive restraint systems as required by law unless it is demanded because that can increase damage estimates which removes the case from a MIST designation.

——Did You Know?

  • 50% of DC’s will face carrier lawsuits often including civil RICO costing million$

  • You can avoid SIU for MIST injuries, over-treatment, etc.

  • False Claims Act F&A prosecutions are #1 reason for doctor indictments

  • HIPAA removed “intent” from fraud statute

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