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Injury Criteria By Tier.

Every case in this program qualifies on three things: how the accident was verified, the severity of the injury, and the coverage behind the at-fault party. This page sets out the injury schedules that define each tier.

How a case qualifies

Three checks. Every case. Every time.

01

Verified at the source

Emergency services responded and transported the claimant from the scene to a hospital or emergency facility. Where EMS records are not available, the police report is used for verification.

02

Injury schedule

The documented injury is measured against one of the two schedules on this page: serious injury, or catastrophic injury.

03

Coverage behind the claim

Whether the at-fault party carries standard or commercial insurance coverage determines which of the two matching tiers the case falls into.

The four tiers

Four tiers. One qualification framework.

Tiers 1 and 3 share the serious injury schedule and differ only by the coverage behind the at-fault party. Tiers 2 and 4 share the catastrophic injury schedule the same way.

Tier 1
Serious injury · Standard coverage

Police Report and EMS Document Verified Ambulance transported with a documented injury on the serious injury schedule. At-fault party carries standard insurance coverage.

20 case minimum
Tier 2
Catastrophic injury · Standard coverage

Police Report and EMS Document Verified Taken directly from the scene to hospital with an injury on the catastrophic schedule. Standard coverage behind the claim.

10 case minimum
Tier 3
Serious injury · Commercial coverage

Police Report and EMS Document Verified Ambulance transported with a documented injury on the serious injury schedule. At-fault party carries commercial insurance coverage.

10 case minimum
Tier 4
Catastrophic injury · Commercial coverage

Police Report and EMS Document Verified Taken directly from the scene to hospital with an injury on the catastrophic schedule. Commercial coverage behind the claim.

5 case minimum
Base criteria

Required on every tier.

  • The claimant has not hired an attorney for the incident
  • Emergency services responded to the accident
  • The claimant was transported to a hospital or emergency facility
  • The claimant sustained bodily injury from the accident event
  • A police report is available
  • The at-fault party carries insurance coverage
  • No settlement has been received on the bodily injury claim
  • The accident falls inside the agreed geographic and campaign criteria
Serious injury schedule · Tiers 1 & 3

Serious injury schedule.

Orthopedic

  • Fractures of any kind requiring treatment, including rib, sternum, clavicle, wrist, forearm, humerus, hip, femur, tibia or fibula, ankle and foot
  • Dislocation of the shoulder, hip, knee or elbow
  • Torn ligaments or tendons, including ACL, MCL, meniscus, rotator cuff and Achilles
  • Crush injury not resulting in amputation

Head, neck and spine

  • Concussion or mild traumatic brain injury with documented symptoms
  • Herniated, bulging or ruptured disc, cervical or lumbar
  • Documented radiculopathy or nerve impingement
  • Cervical or lumbar sprain with objective imaging findings

Chest and internal

  • Pulmonary contusion, pneumothorax or hemothorax
  • Internal injury requiring imaging, observation or admission
  • Abdominal trauma requiring evaluation

External and facial

  • Lacerations requiring sutures, staples or surgical repair
  • First degree or limited second degree burns
  • Facial or dental injuries requiring treatment

Treatment based qualification

  • Any accident related injury requiring surgery, injections, or a prescribed course of physical therapy
  • Any accident related injury producing documented lost work time
Catastrophic injury schedule · Tiers 2 & 4

Catastrophic injury schedule.

Neurological and spinal

  • Spinal cord injury, partial or complete paralysis
  • Traumatic brain injury including permanent cognitive impairment
  • Skull fracture or intracranial injury
  • Severe nerve damage or neurological impairment
  • Speech or language impairment
  • Brain death

Orthopedic and limb loss

  • Multiple fractures or polytrauma
  • Amputation, partial or complete loss of limb
  • Loss of mobility requiring assistive devices

Internal, organ and cardiac

  • Organ damage or loss, including kidney and liver
  • Life threatening internal bleeding
  • Cardiac arrest at the scene or in hospital
  • Loss of bowel, bladder or sexual function

Sensory, burns and disfigurement

  • Severe burns, including second or third degree
  • Loss or significant impairment of vision and/or hearing
  • Facial disfigurement or permanent scarring

Chronic and permanent outcomes

  • Chronic pain syndromes, including Complex Regional Pain Syndrome
  • Permanent disability or inability to work

Fatal outcomes

  • Death at the scene
  • Death after hospitalization
  • Unknown cause of death related to the accident
Not qualifying

What we screen out.

A soft tissue complaint with no imaging, no treatment plan and no emergency transport does not qualify on any tier. Neither does a pre-existing condition that was not aggravated by the accident event, nor an injury the claimant reports without a supporting medical record. Because emergency response and hospital transport are required criteria in their own right, these cases are screened out before the injury schedule is ever applied.