U.S. insurance companies have taken a new look at soft tissue injuries, a result of the millions of dollars paid out in benefits each year. The actuaries have decided that the industry will save money if they litigate questionable claims for soft tissue injuries. Larger insurance companies have taken into account numerous factors and have come up with a range for settlement. They believe that plaintiffs will have to prove damages to juries if they want more compensation than the predetermined settlement range. Low-end insurance companies litigate most soft tissue claims with specials (medical bills) around the $2000-$3000 range. In my experience, many patients' claims fail because the primary treating doctors have not adequately documented their patients' injuries. If you are going to treat PI patients, you have a duty to adequately document their injuries.
Soft tissue injuries are difficult to prove, and records rarely demonstrate objective evidence of injury. Because of this, a thorough history is the most important aspect of the clinical record. In an automobile collision-related injury, it is imperative that the history answers these questions:
For some reason, doctors often do not ask their auto accident patients about pre-existing injuries and prior treatment. A pre-existing problem is not as detrimental as you may think. There is a saying in the law: "You take your plaintiffs as you find them." Document pre-existing injuries.
Finally, if the patient delayed seeking treatment, document the reasons. The patient will eventually have to answer this question, so it is better to clearly state the reason in the initial office visit. Afterward, if you have to testify in court, you will be glad you recorded the information.
Here are a couple of examples of case histories I have reviewed. These are examples of what not to do. (I have changed the names of patients and dates of their involvement to protect their privacy.)
Example 1: A 20-year-old female was in an accident in June 1995 and went to the DC in December 1995. She did not receive any treatment in the interim. The extent of the history provided was: "Automobile accident, June 2, 1995, low back and neck pain."
How could the chiropractor, six months after the fact, state within a reasonable degree of certainty that the patient's back pain and neck pain were caused by the accident?
Example 2: A 24-year-old woman involved in an automobile accident saw her chiropractor. The DC used computer-generated form notes. The history section of one form stated: "Patient has had no history of prostate surgery" and "patient has no history of prostate medication."
Why should a jury, insurance claims representative, or another chiropractor trust anything in these records? What do you think the claims representative thinks about the individual doctor or chiropractic as a whole? What if this was the first chiropractic claim for the claims representative? How is the patient's attorney going to handle these records on examination? In the end, the patient will be the one hurt.
Remember, everything that comes out of a DC's office reflects on its owner and the profession.
Guy DiMartino,DC,JD
Merrillville, Indiana
gdimartino@hwelaw.com
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
