When most doctors of chiropractic think of personal injury (PI), they feel uneasy. Taking injured patients on medical lien or letter of protection means dealing with attorneys and waiting months, if not years, to be paid. However, in the field of PI, chiropractic is the lead medical specialty.
In a PI case is often the first time many patients experience chiropractic for the very first time. It makes sense that DCs learn how to set up, manage and grow their personal injury segment. This article features three DCs practicing in the PI arena.
John Smith, DC, owns A Better Life Chiropractic in Cincinnati, Ohio. PI represents 90% of Smith’s business. He has a developed PI practice whereby he now works primarily with “friendly” attorneys who pay in full 90 to 95% of the time. Even those attorneys who seek to slash his bills regularly and profitably pay most of Smith’s bills.
Minh Tran, DC, is owner and clinic director of San Jose, Calif.’s Norcal Brain Center, a chiropractic office treating neurological conditions and brain injuries. Tran does not take insurance. Cash-paying patients represent 80% of his receivables, and personal injury patients represent 20%. He now collects roughly 80 to 90% of the bill on 90% of his personal injury bills, a drastic change from his previous recovery, which was well below 50%.
John Hilton, DC, owns KIIN, a holistic chiropractic and craniopathy practice in Los Angeles, Calif. He is a sole practitioner certified in the Sacro-Occipital Technique (SOT) method of chiropractic care and has worked in private clinics in the U.S. and internationally. PI currently represents 5% of his practice. Because he wanted to take better care of his patients’ cases and found he was being taken advantage of by attorneys, Hilton started focusing on educating himself on various aspects of PI about a year ago.
What advice would you give DCs building their PI practices?
Smith: Obtain training specifically in the handling of PI cases. Learn how to develop good relationships with attorneys. Learn how to spot good attorneys and the not-so-easy attorneys. Learn how to successfully negotiate, even with the not-so-easy attorneys. Remember that not all referrals are equal. Just because a law firm is giving referrals does not mean the law firm is easy to work with.
Tran: Knowing the PI process from start to end, including what is expected from the attorney versus the treating profession, is critical. This is how the medical professionals convey to the attorney that they know what they are doing. Attorneys don’t want to work with you if you don’t know what you are doing because you can ruin the case, or at least devalue it. Even when you do it right, you need to know what to do if you are low-balled at payment time.
Hilton: Most providers fear what could happen in the legal realm, so they don’t know when they should push back. They need to know their rights. Before I started studying PI, it was scary and confusing because I didn’t know what could happen legally. I have experienced a situation where an attorney threatened legal action if I did not reduce a bill. No one wants to receive such a threat. So while DCs want to be available for patients who need their services, PI can be a challenging landscape. Many times, if an attorney said they wanted to reduce a bill, I just went along with their suggestion. I didn’t know that I could say, “That’s not appropriate.” I didn’t know that I could simply say, “No.”
How often do you find attorneys try to mislead you or your patients about the law?
Smith: Quite often. Attorneys may try to withhold the disbursement letter, hiding behind patient confidentiality. They also will assert that our fees are too high, without providing credible support. DCs can use third–party sources to establish how their fees are appropriate.
Tran: Pretty often. When they are seeking more monies on a case, they withhold this information, hoping I believe less was recovered. But in reality, MedPay, underinsured motorist coverage (UIM) or some other third–party defendant may be paying more into the case. Or, they will claim pro rata, falsely asserting that medical providers are supposed to collect the same percentage portion as, say, an imaging company, and only from 25 to 33% of the settlement.
Hilton: My first answer is 99% of the time, but I don’t think that is accurate. Yes, many attorneys will try to mislead you, but remember attorneys are not there to educate you. If you make a mistake, they aren’t going to say, “Did you realize that you could do it differently and be fairly reimbursed for your services?” The better answer is that many of them will intentionally mislead providers, and almost all of them will withhold information if doing so means more money in their pocket.
What are the best business practices for stopping this?
Smith: I only refer out to attorneys who respect and pay our bills fairly. I tell attorneys that I consider reductions, but it is not guaranteed. And I insist on transparency about MedPay, PIP and UM coverages. Attorneys will respect you if you refuse to be taken advantage of. Get the right experts to coach you in this area.
Tran: Once you understand how PI works, your confidence will come across in emails and other communications. Attorneys will know that you know what you are doing and are not green. If they get an idea that you don’t know what you are doing, they will try to take advantage of you.
To this end, I suggest speaking from a place of abundance and not scarcity, even if you don’t have abundance yet. If you are desperate, attorneys will smell that desperation, and they will walk all over you.
How do you stand up for what is right by insisting on full payment of your bills?
Tran: I’m firm on this. I tell attorneys my profit margins are not as high as the profit margins at an MRI facility or a medical doctor’s office. I state the facts: “I am not going to take a loss on treating your patient.”
I explain the minimum I need just to pay the overhead associated with the case. Breaking even isn’t acceptable to me as a businessperson. I tell them what I am expecting to get out of the treatment, which is generally 80% of the bill, minimum, and I prefer to be fully paid, just as they do. When I educate them and explain that I will otherwise be losing money because my profit margins are not high, it makes sense. Most attorneys understand this because they are also in business to make money.
Hilton: I learned one statement that has been incredibly helpful, “I will reduce my bill by the same amount as you reduce your bill.” And then, of course, I need to make sure that I am asking the right questions, in writing, so they cannot lie about what they have received or will receive without being guilty of misrepresenting the facts.
What has been the most difficult part of building your personal injury segment?
Smith: The most difficult part has been learning the law and learning how to properly negotiate reduction requests so I am not being undervalued or disrespected. That said, once I gained knowledge, I also gained confidence. Attorneys that might have bullied me in the past are not getting away with the shenanigans they previously pulled.
Developing strong interpersonal relationships with attorneys who appreciate the way I manage cases has been vital. I developed processes around this and received training from my coach on how to handle “value drivers” so I am seen as the best option for PI referrals.
I learned how to better negotiate my bills, and I learned to cut ties with law firms that inappropriately handle reduction requests.
Tran: Initially, documentation was a challenge. I needed to learn how to write the right things down accurately and honestly, in a way that did not impede the case and instead added value. The other part of PI was learning how to deal with attorneys who tried to cut my bills. I like making people happy, and I’m an introverted guy. I can be a little bit of a people-pleaser, so I had to learn how to stop being a pushover because it came at my own expense.
Earlier in my career, I had about 165 unpaid cases. One attorney wanted to cut my bills by reductions of 75 or 80%. I’ve completely reversed that now, and I’m much better at standing up for what is right thanks to the processes I’ve put in place and the coaching I have received.
Hilton: Before I started my journey to get educated, personal injury was this elusive, nebulous field that I couldn’t see into. I had no idea how to get the information I needed from the attorneys, and they seemed to have all these little tricks to keep me stuck in the dark. There was no real training when I was in school.
What are some of the pros DCs might not have considered?
Smith: In PI, you have the freedom to diagnose and manage treatment for patients properly and thoroughly. Other types of healthcare, such as Worker’s Compensation, Medicare, Medicaid and standard health insurance, often imposes inappropriate restrictions regarding patient treatment, type of treatment and how much of it is approved. In PI, and when documented properly, this is not the case. As long as medical necessity is documented, the DC has the authority to properly manage the patient’s treatment to the best of his or her ability and judgment.
Tran: If you build the right connections, your personal injury relationships can be two-way, prosperous relationships where you enjoy a constant stream of high-value and high-quality patients. Long-term, when you are trying to build a practice, you need relationships. Your marketing streams can dry up, and so can your funnels, but connections last longer.
To that end, I suggest talking to attorneys person-to-person instead of just sending emails. When you have open and transparent communication, you both begin to understand the other person’s business model. It humanizes you and allows you to build more concrete relationships.
I have developed a number of relationships with attorneys who understand that without us, without our notes and without our documentation, they would not have gotten the resolution. There is a mutual understanding, and so there is very little negotiation because there is an agreement that everyone in the case deserves their fees; from the attorney to the treatment provider.
Hilton: There is a growing community of medical providers who are learning to stand up for themselves, which means there are more good people making a difference in the industry. This is good for everyone except the unscrupulous attorneys. When we, as DCs, are trying to improve our understanding of the personal injury industry, we are naturally forging a balance of power, and the byproduct is fairness. This is helping the entire field of chiropractic, and even more importantly, as more DCs are willing to take personal injury cases, more patients are receiving the care they desperately need.
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 contact michael@pimadeeasy.com and through his free Facebook group, PI Made Easy Insiders.
