16) For claims involving rehabilitation, what expenses will the insurance adjuster have to review? What are the steps in the rehabilitation process?
The adjuster may have to review original invoices for physiotherapy, medical aids, prosthetic devices, prescription drugs, chiropractic expenses, and dental treatments, to mention a few. The incurred expenses must be reasonable and necessary. Only expenses related to the accident injury are covered. Some treatments or drugs may be questionable and need an explanation as to why they should be included. It is useful to have a compendium of drug information.
The rehabilitation process generally needs a plan of action that may involve assessments, goal setting, planning, training, placement, and follow-up. Counseling and guidance might be needed. Any factors that may inhibit or slow recovery must be identified. Realistic goals should be set for the claimant's progress. Specific services and training may have to be arranged and special equipment may be required. In more serious cases the insured may need training to perform daily living activities. Some adjusters specialize in the delivery of accident benefits.