uster Questions Template Setup Instructions

Purpose

To guide adjusters in systematically completing claim evaluation questions, ensuring their responses align with Genesis-extracted data, including key findings from the police report and detailed provider-level costs for medical specials. The newly added Liability Status field in the Claim Details section of the Genesis Demand Summary (GDS) ensures transparency and accountability by dynamically updating based on adjuster input.

Claim Information

  • Claimant Name: [Insert Claimant’s Full Name]
  • Claim Number: [Insert Claim Number]
  • Adjuster Name: [Insert Adjuster’s Full Name]
  • Date of Loss: [Insert Date of Loss]
  • State: [Insert Governing Jurisdiction]
  • Initial Offer: [Insert Adjuster’s Initial Settlement Offer]

Notice to Adjuster: The Genesis Claims Audit System extracted and cross-referenced the entire demand package, which totaled X pages. All extracted values were validated against the attorney’s demand and confirmed accurate. This ensures accountability, as Genesis processed the same demand package as provided to you. Please ensure your responses are consistent with the extracted data provided below.

Progress Tracking

  • Progress bars indicate completion status for each section.
  • Dynamic updates as sections are completed.
  • Estimated time per section included (e.g., Liability: 2 minutes).
  • Errors highlight incomplete sections (e.g., “Error in Liability Section – Flagged for Review”).

Section-Specific Instructions and Questions

Section 1: Liability Confirmation

Purpose: Ensure adjusters confirm or justify liability findings based on the police report and state-specific laws. Their input determines the Liability Status in the GDS Claim Details.

Questions: 1.1: Liability Overview

  • “According to the police report (Page X), the investigating officer noted: ‘[Insert Liability Causation Language].’ Do you confirm this assessment?”
  • ☑ YES ☑ NO

1.2: Liability Percentage

  • If YES to 1.1:
  • “Confirm your assigned liability percentage in favor of the claimant:” Adjuster Input: ______%
  • Example: 100% in favor of the claimant (default if police report findings are confirmed).
  • If NO to 1.1:
  • “Input your assigned liability percentage in favor of the claimant and provide justification for the discrepancy.”
  • Adjuster Input: ______%
  • Adjuster Justification: ____________________________.

1.3: Consistency with State Laws

  • “Is your assigned liability percentage consistent with state-specific comparative/contributory negligence laws?”
  • ☑ YES ☑ NO

Outcome in GDS:

  • If YES to 1.1: The Liability Status updates to “Adjuster Confirmed 100%”.
  • If NO to 1.1: The Liability Status updates to “Liability Challenged (e.g., 80% Claimant / 20% Plaintiff)”. Adjuster justification is saved in the audit trail for attorney review.

Section 2: Independent Medical Examination (IME)

Purpose: Determine if an IME was conducted and its implications.

Questions: 2.1: IME Details

  • “Was an Independent Medical Examination (IME) ordered?”
  • ☑ YES ☑ NO
  • If YES:
  • “Specify the type of IME assessment:”
  • ☑ In-Person Assessment
  • ☑ Remote Assessment (e.g., Telehealth)

Section 3: Software Use

Purpose: Capture whether software (e.g., ClaimIQ) was used in valuation.

Questions: 3.1: Software Details

  • “Was any software used in the valuation of this claim?”
  • ☑ YES ☑ NO
  • If YES:
  • “Provide the name of the software:” Adjuster Input: ______________________

Section 4: Medical Specials

Purpose: Ensure adjusters validate or justify medical special values.

Questions: 4.1: Medical Specials Overview

  • “Have you reviewed the listed medical specials and ICD-10 codes?”
  • ☑ YES: Adjuster proceeds to the table.
  • ☑ NO: Notify the adjuster that this section must be completed before continuing.

4.2: Medical Specials Table
Adjusters complete this table:

Treatment Provider

ICD-10 Code(s)

Genesis Billed Amount

Adjuster Value

Reason for Discount/Denial

[Provider Name]

[ICD-10 Code]

[Billed Amount]

[Input]

[Input: Reason]

Total

N/A

[Total Amount]

Auto-calculated

N/A

Section 5: Pain and Suffering (P&S)

Purpose: Compare adjuster valuation against Genesis’s calculated multiplier.

Questions: 5.1: Pain and Suffering Overview

  • “Genesis calculated a benchmark multiplier of [Insert Multiplier] based on [State]’s historical practices. Have you evaluated and assigned a value for Pain and Suffering?”
  • ☑ YES ☑ NO
  • If YES:
  • “Input value for Pain and Suffering:” Adjuster Input: ____________

Section 6: Whole Person Impairment (WPI)

Purpose: Confirm whether WPI ratings were considered in valuation.

Questions: 6.1: WPI Overview

  • “Has a WPI rating been assigned to the claimant?”
  • ☑ YES ☑ NO
  • If YES:
  • “What is the assigned WPI percentage?” Adjuster Input: _____%

Section 7: Future Medicals

Purpose: Ensure adjusters account for or justify future medical costs.

Questions: 7.1: Future Medicals Overview

  • “Have you evaluated and assigned a value for Future Medicals?”
  • ☑ YES ☑ NO
  • If YES:
  • “Input value for Future Medicals:” Adjuster Input: ____________

Section 8: Aggravation of Pre-Existing Conditions

Purpose: Address claims involving aggravation of pre-existing conditions.

Questions: 8.1: Pre-Existing Conditions Overview

  • “Have you evaluated and assigned a value for Aggravation of Pre-Existing Conditions?”
  • ☑ YES ☑ NO
  • If YES:
  • “Input value for Aggravation of Pre-Existing Conditions:” Adjuster Input: ____________

Section 9: Mileage

Purpose: Ensure mileage reimbursement is accurately included or excluded.

Questions: 9.1: Mileage Overview

  • “Have you included the mileage reimbursement in your evaluation?”
  • ☑ YES ☑ NO
  • If YES:
  • “Input value for Mileage:” Adjuster Input: ____________

Section 10: Lost Wages

Purpose: Validate or justify lost wage calculations.

Questions: 10.1: Lost Wages Overview

  • “Genesis extracted lost wages totaling [Insert Amount], based on verified work absence from [Start Date] to [End Date] at [Hourly Rate]. Have you included Lost Wages in your evaluation?”
  • ☑ YES ☑ NO
  • If YES:
  • “Input value for Lost Wages:” Adjuster Input: ____________

Steps to Populate Adjuster Responses Back to the GDS

  • Prepare Adjuster Responses:
  • Review the completed Adjuster Questions Template.
  • Extract key data, including:
  • Adjuster-provided values for relevant categories (e.g., Medical Specials, Pain and Suffering).
  • Justifications for discrepancies.
  • IME-related decisions (if applicable).
  • Align with GDS Categories:
  • Match adjuster input with corresponding Parent Categories and Subrows in the GDS.
  • Populate the Adjuster Input Column with the exact values provided by the adjuster.
  • Use the IME Status Column to reflect findings or shield treating physician opinions if no IME was conducted.
  • Handle Discrepancies:
  • Add a ❌ in the Validation column for any mismatch between Genesis Data and Adjuster Input.
  • Summarize adjuster justifications for discrepancies in the Notes section of the GDS.
  • Recalculate Totals:
  • Adjust Subtotal, PIP Subtraction, and Total Rows in the GDS based on updated values.
  • Final Validation:
  • Cross-check all updates against supporting documents and ensure all calculations align.

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Adjuster Questions Setup Instructions for Re-Populating the Genesis Demand Summary (GDS)

Purpose

To guide adjusters in completing claim evaluation questions systematically and ensure their responses are accurately integrated into the Genesis Demand Summary (GDS) without requiring structural changes. These instructions streamline the process by mapping adjuster responses directly into the GDS while maintaining consistency and clarity.

Re-Populating the GDS Table

1. Claim Details Section

Before the GDS table, include the Claim Details section to provide identifying information. Populate the following fields:

  • Claimant Name: Include the full name of the claimant.
  • Claim Number: Enter the unique identifier assigned to the claim.
  • Date of Loss: Specify the date the incident occurred.
  • Adjuster Name: Provide the name of the adjuster handling the claim.
  • State: Indicate the jurisdiction where the claim is being processed.
  • Initial Offer: Record the initial settlement offer provided by the adjuster.

This section ensures clarity and context for all parties reviewing the GDS table.

 

2. Adjuster Input Column

Populate the Adjuster Input column with values provided by the adjuster for each numeric category:

  • Medical Specials (parent category and subrows)
  • Pain and Suffering
  • Future Medicals
  • Mileage
  • Lost Wages

Steps:

  • Map adjuster-provided values directly to the corresponding categories in the GDS.
  • Include subrow-level details for Medical Specials, such as individual provider names and amounts billed/adjusted.
  • Ensure values match the format provided in the adjuster’s responses.

3. IME Status Column

Populate the IME Status column based on adjuster responses to IME-related questions:

Rules for Populating IME Status:

  • If no IME was conducted, display Shielded for the following categories:
  • Medical Specials (parent and subrows)
  • Future Medicals
  • Whole Person Impairment (WPI)
  • Re-Aggravation of Pre-Existing Conditions
  • If an IME was conducted, specify the type (e.g., “In-Person,” “Remote”) and ensure it applies only to categories affected by the IME.

4. Validation Column

The Validation column confirms matches between the following:

  • Attorney’s Demand and Genesis Data columns.

Validation Rules:

  • Display ✔ if the values match.
  • Display ✘ if there is a discrepancy between the two columns.
  • Display N/A for subjective or non-numeric categories (e.g., Pain and Suffering).

For subrows:

  • Discrepancies are flagged at the parent category level only (e.g., Medical Specials Total), unless specifically required.

5. Total Row

Aggregate numeric values from parent categories only (excluding subrows) into the Total row:

  • Sum up values in the Attorney’s Demand, Genesis Data, and Adjuster Input columns.
  • Flag any discrepancies in the Validation column with a ✘.
  • Add a summary note in the Notes column to explain discrepancies.

Category-Specific Integration Instructions

Medical Specials

  • Populate the parent category with the total billed and adjusted amounts.
  • Add subrows for individual providers, including:
  • Provider name
  • Billed amount (Attorney’s Demand and Genesis Data)
  • Adjuster-provided value
  • Shielded status if no IME was conducted.

Pain and Suffering

  • Use the attorney’s multiplier-based value for Attorney’s Demand and Genesis Data.
  • Enter adjuster-provided values in the Adjuster Input column.
  • Mark as N/A in the Validation column since this is subjective.

Future Medicals

  • Populate estimated costs in the parent category and include subrows if itemized in the demand package (e.g., therapy, surgery).
  • Apply Shielded status if no IME was conducted.

Mileage

  • Populate travel reimbursement values if claimed.
  • Ensure page references align with supporting documents.

Lost Wages

  • Use verified work absence details (e.g., hourly rate, total time) to populate amounts.
  • Enter adjuster-provided values directly in the Adjuster Input column.

Formatting and Presentation

  • Parent and Subrows:
  • Indent subrows under parent categories for clarity (e.g., Medical Specials).
  • Shielded Status:
  • Clearly display Shielded in the IME Status column for applicable categories when no IME is conducted.
  • Consistency:
  • Maintain uniform formatting for numeric and non-numeric categories.

Final Checklist

  • Adjuster Input: Ensure all adjuster responses are accurately mapped to the GDS.
  • IME Status: Verify that Shielded status is correctly applied where applicable.
  • Validation: Confirm that discrepancies are flagged at the parent category level.
  • Total Row: Cross-check aggregated totals and flag discrepancies.
  • Presentation: Ensure proper formatting and alignment for ease of review.

By following these updated instructions, adjuster responses can be seamlessly integrated into the Genesis Demand Summary (GDS) without requiring further modifications to its structure.

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