Why a PI Case Is Done at Five Weeks

personal injury
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Jaburg Wilk

One of the most common problems that I see working with personal injury attorneys is the thinking that they cannot do much until the doctors have finished treatment. While I appreciate the legal perspective of avoiding the impression that an attorney is practicing medicine, I also know that the true value of a case is established with the first five weeks.

I do respect an attorney who chooses to leave patient care to the doctors. It is always best to stick with what you know rather than what you think you know. Lincoln was right when he said, “He who represents himself has a fool for a client.” That lawyer is nowhere near as much a fool as the one who tries to manage health care for their client.

Unfortunately, leaving it to most doctors who do not have the additional education and experience necessary to properly manage a PI case can be just as foolish. This is not to say that they do not know how to care for their patients. The deficiency lies more in not understanding the intricacies of diagnosing and documenting injuries in motor vehicle crashes.

The first problem I see in most PI cases is that most doctors will list a diagnosis of cervical and/or lumbar sprain or strain. There are several problems with these diagnoses;

  1. Insurance companies work on the assumption that sprain or strain injuries will heal within six weeks.
  2. On the assumption that such injuries have less value, the adjuster will set aside only a $10,000 reserve.
  3. In most cases, there are more serious diagnoses that are missed and not documented

Researchers at Johns Hopkins found that two-thirds of patients involved in litigation with sprain/strain diagnoses were misdiagnosed and had more serious problems including ligament laxity, compression fracture, facet syndrome or herniated discs

To make matters worse the same researchers found that half of these misdiagnosed patients needed surgery. The problem here, beyond the fact that the patient will not get the care they need, is that the adjuster has already valued the case at no more than $10,000 based on the less serious diagnosis.

Once the assumed six-week timetable has passed companies make it increasingly difficult to submit the more serious diagnosis and have the reserve raised to $100,000. When a lawyer waits six months to a year to get all the records on a case it may also be too late to correct the diagnosis and prove the more serious diagnosis is a direct result of the crash.

For me this is the most frustrating thing when working with attorneys on personal injury cases. When I am called in two years after the crash there are things I can often do to improve the case. The one thing I cannot do is to go back and perform the test that should have been done two years ago.

With the American Academy of Motor Vehicle Injuries, I have been teaching doctors to understand how the mechanism of injury will assist them in doing the proper tests to document these more serious diagnoses. I also teach them to do so at the beginning of the case.

Unfortunately, the handful of chiropractors who have done the extra course work in this program are a small percent of those who refer PI cases to the attorneys reading this magazine. If you are fortunate enough to be working with one of these chiropractors, then the odds are that you are getting better settlement officers and your clients are getting better care.

For all the other cases, having a case manager who can communicate with the treating doctor can ensure that the patient is properly diagnosed. When I do this work for attorneys there is no need for me to see the patient. I am able to speak with the doctor to garner enough information to determine which test to do and when to do it.

When the diagnosis is proven, the patient can be referred to the specialist best suited to assess the damage and establish causation. When necessary the patient gets the injections or surgery they need. When indicated they are referred back to the chiropractor for continued conservative care.

Consider the options. If soft-tissue cases are earning settlement offers of $5,000- $10,000 and two-thirds of them have injuries that should have received six-figure offers then everyone loses. When properly managed, the patient gets the care they need and the settlement they deserve. The treating/ referring doctor learns and maintains a better relationship with the attorney who is also getting paid what they are worth.  Dr. Bill Gallagher, DC, CMVI

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