title = "Medical Claims Evaluation"

content = """
Medical claims evaluation requires specialized knowledge of healthcare systems, treatment protocols, and injury assessment to ensure accurate compensation for legitimate medical expenses while preventing overpayment or abuse.

**Medical Record Review:** Obtain and review all relevant medical documentation including physician reports, hospital records, diagnostic imaging, and treatment notes. Verify chronological progression of care and treatment necessity.

**Causation Analysis:** Establish clear nexus between the claimed incident and reported injuries. Evaluate pre-existing conditions, degenerative changes, and other factors that may contribute to or complicate treatment needs.

**Treatment Validation:** Assess medical necessity and appropriateness of treatments received. Compare treatment protocols against evidence-based medical guidelines and industry standards for similar injuries.

**Cost Analysis:** Evaluate billed charges against usual and customary rates in the geographic area. Identify contractual adjustments, write-offs, and reimbursement limitations that may affect recoverable amounts.

**Disability Assessment:** Evaluate temporary and permanent impairment ratings using recognized systems such as the American Medical Association Guides. Consider work restrictions and earning capacity impacts.

**Future Medical Needs:** Project future medical expenses based on treating physician recommendations and injury prognosis. Account for rehabilitation requirements and long-term care needs when applicable.

**Coordination of Benefits:** Identify and coordinate with other insurance coverages, Medicare, Medicaid, or workers' compensation programs to prevent duplication of benefits and ensure proper primary payer determination.
"""

version = "0.0.1"
