Why DCs have the upper hand with health care and personal injury
AT ITS CORE, PERSONAL INJURY (PI) cases are about determining fair compensation for harm caused by another. The evidence side of PI focuses on support (or contradiction) of either liability or damages. When determining liability and damages, medical providers are key to determining something that we refer to as the “gold” in PI: pain and suffering resulting from the PI incident.
The process of PI and evidence-based chiropractic treatment
Medical providers — as well as accident reconstructionists, medical injury evaluators and other experts — provide analysis, reports and testimony used by insurance adjusters, attorneys, arbitrators, mediators, judges and juries to evaluate a patient’s personal injury action.
Consequently, the ability and extent of support from the medical provider, whether as a treater or expert (or both), is critical in PI. It stands to reason, then, that the more evidence-based the medical treatment is, the more helpful a chiropractor becomes to the patient and his or her personal injury attorney.
After all, evidence-based treatment allows easier and more third-party support and confirmation when challenged. This means evidence-based chiropractors not only provide the strongest foundation for medically related issues, but they also get the best personal injury referrals from top PI attorneys. The extra bonus for evidence-based chiropractors is that PI has built-in collaboration between medical specialties.
Too often chiropractic and its health benefits are dismissed by MDs: the “more dollar” doctors. This is only because they don’t take the time to really understand chiropractic and the incredible pain relief and wellness care it offers. But this lack of understanding is less prevalent in PI, where chiropractors are generally part of a health care team.
Indeed, you are often the health care quarterback, generally the first medical specialty seen in many PI situations. It is you acting as the referral source to a network with aligned medical specialists, such as imaging, pain physicians, orthopedic, and neurologic and neuro-psychology specialists.
The medical and business reality is this: If you aren’t evidence-based, the MD side will be less inclined to align with you. To understand all of this, let’s take a step back and look at the two primary components of a personal injury case: liability and damages.
The key questions a personal injury case seeks to answer are these:
- Who, if anyone, is liable as a matter of law for the damages sustained by the patient, and the extent of that responsibility?
- Was the patient harmed as a result?
- If so, what is the extent of that attributable harm and the change in the patient’s quality of life now and potentially in the future?
The case, then, boils down to this: Who is responsible (liability)? And what is the extent of the harm caused (damages)?
Liability is the legal term for “responsibility.” Generally, a patient’s attorney is attempting to convince a jury, a judge or an insurance adjuster that another person or entity is responsible for the accident.
In the case of a car accident, for instance, a city government might be liable if the patient’s attorney can prove the traffic lights were not working. Or another driver might be liable if the patient’s attorney can prove that the offending driver caused a car accident by violating traffic law.
You get the point.
Evidence-based chiropractic here comes into play often with your intake documentation. Collecting evidence the right way is important. For instance, do you have your patients diagram how the PI incident occurred? Do you have patients use Matchbox cars to demonstrate how the accident occurred, and even videotape it? If so, stop now! A golden rule for every evidence-based chiropractor to follow is this: Don’t allow diagrams of the accident.
Or do you have patients circle injured body parts or assign a 1-10 pain scale rating when they are sitting in the lobby? If so, stop now! Your parents might be providing “evidence” without a full understanding of what they are doing and why. They may circle most of the body or assign everything a “10” because they think they need to do so to help the case. They might assign everything a “2” because they want to show they are tough. Either way, insurance adjusters and defense attorneys will use this as evidence that the patient is lying, or evidence that the patient isn’t injured that badly.
Here are a few tips for collecting evidence the right way:
- Just like your patients should not diagram accidents, you should not as well. Hospital records, police reports and photos of car damage in a motor vehicle collision (MVC) can give great insight. Get them when they exist. When you talk to your patient, it’s okay to ascertain if the MVC was a rear, front or side impact. It’s also okay to ask for information about how the patient’s head and body moved. If you see cuts or bruising on your patient, take your own photos for the file (with the patient’s approval, of course). Leave the rest to the attorney, who will handle liability issues. You are a neutral player, focused only on the patient’s health.
- Second, have patients fill out forms detailing where their bodies hurt in your presence, so they have a full understanding of what they are doing and why, and to have a full understanding of the meaning of numbers assigned (if you are using pain scale ratings). Otherwise, savvy adjusters and defense attorneys will use your documentation to attack your own patient’s credibility, the extent of the injury and your treatment or bill.
Let’s move on to the area where your evidence-based chiropractic is primarily involved: damages.
Damages refer to the harm caused, and the extent of harm caused by the PI incident. This includes “special” damages, which include car damages, medical expenses incurred, and lost wages due to inability to work.
It also includes “general” damages, the compensation gold in PI, which is about the patient’s “pain and suffering,” centered on the effect on their past, current, and future suffering and negative changes to the patient’s quality of life.
Pain and suffering damages are the jackpot in PI.
Evidence-based chiropractic here comes into play with your treatment: what you do, how you do it, how often, the extent it helped, and what more may need to be done, including referrals to specialists. Keys to great evidence-based care will be determined by the quality of your diagnosis, the specific codes used, the treatment applied and the documentation.
Is your treatment, documentation and billing of PI patients nearly identical? If so, you will be accused of making cut-and-paste approaches.
Are you unable to refer to specific evidence-based protocols and standards that support what and why you did what you did, as well as the extent to which you did it, and for how long you did it?
Don’t be on an island.
You may be asked to provide deposition or trial testimony, either as a treating physician or as an expert. Many PI attorneys seek to combine the two, which can save them out-of-pocket advances. Your ability to stand by your approach, treatment and bills can make all the difference.
A few tips here as well:
- Treat each patient as a unique individual, and be sure this shows in your approach, treatment, documentation and billing that is specific to that unique patient, as it should be.
- Identify and lay out “medical necessity” for all your treatment. Do nothing more, and nothing less, as medical necessity is the foundation of evidence-based care.
- Tie together your diagnosis, your treatment plan, your treatment codes, your actual treatment, your documentation of it all and your billing, so they are consistent, medically supported and evidence-based. Can your approach, treatment, documentation and medical billing survive the critical eye of other medical experts, sometimes hired guns? It better.
- Identify any pre-existing injuries that involve any of the areas of the PI incident. Document them. Look for prior imaging or evidence of specifics. You can apply evidence-based approaches to pre-existing injuries into valuable information to demonstrate the impact of a present PI incident on a fragile patient. For instance, a pre-existing injury may explain why a patient is experiencing acute pain, and this may lead to greater awards in pain and suffering.
- Don’t forget to use the “S” (subjective) in SOAP notes the right way for PI. Use activities of daily living to demonstrate the impact of the accident, describing journey for the return to health of your patient. This is both science and art. Since non-medical people (adjusters, attorneys, judges and juries) are reviewing your records, you can tell the patient’s health care story in a way common folk can easily understand while still being evidence-based.
Why evidence-based care wins
Chiropractors do not need to be told that the culture at large continues to degrade the validity of chiropractic care. Yet, research pointing to the validity of chiropractic care is plentiful.
Far from being a pseudo-science, chiropractic care reduces the need for opioids, treats depression, reduces pain, manages headaches — the list goes on and on. For many decades, though, evidence supporting chiropractic care was reserved to just empirical data. After all, the medical industry responsible for research and clinical trials did its best to suppress chiropractic. Those who knew and believed in the value of chiropractic care had no other method of treatment than relying on empirical data.
However, the evidence exists. The support for it all does exist.
Chiropractic is the rare practice segment that regularly has others looking at records and billings, and with critical eyes. It is fairly easy to separate the bad, good and great in terms of PI.
Do PI right and avoid the wrong. And remember: When you are evidence-based, you have the advantage in PI.
MICHAEL COATES is a national authority on personal injury medical lien recovery and the founder of PIMadeEasy.com, which educates, coaches and trains medical providers and their staff to accelerate their success in personal injury. If you have questions, please reach out through his free Facebook group, PI Made Easy Insiders, at facebook.com/groups/pimadeeasy.