Injury criteria specify qualifying diagnoses, required diagnostic testing, severity thresholds, and documentation standards. Settlement programs and case management orders use them to determine eligibility and compensation tier.
Criteria typically require objective medical documentation rather than self-report.
Alternative Names:
Qualifying Injury Criteria, Medical Criteria
Why it Matters?
Criteria design determines both settlement cost and administrative burden, and objective diagnostic requirements are what prevent a program from paying claims that would not survive litigation. Requiring specific testing, pathology confirmation, or defined severity measures excludes claims resting on symptom reports alone. Negotiating criteria before agreeing a fund amount is essential, since loose criteria can double the qualifying population.
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Frequently asked questions
What do injury criteria typically require?
Why negotiate criteria before the fund amount?
