“Don’t make your injury experience worse by choosing the wrong doctor or attorney to assist you.”
Too many professionals today think of this condition as “just a soft tissue injury.”
Beware Minimization of Your Condition
When it comes to spinal ligament injuries you will hear so many people involved say these unfortunate words: “It is just a soft tissue injury.” This saying is rampant today with many doctors, attorneys, insurance adjusters and insurance executives. It is rampant with those who do not fully appreciate what a soft tissue injury is.
The truth is there are only two kinds of tissues in the human body: Hard tissues, which are the bones, and soft tissues, which are everything else. Every organ your body soft tissue; your brain, heart, lungs, genitals, etc. So, I have better understood when someone says of a spinal ligament injury,” It is just a soft tissue injury.”
I always wanted to say to these professionals:
“If I puncture your heart, scrambled your brain, or damaged your genitals would you really allow anyone to write it off as “just” a soft tissue injury?”
The sad part about this is when it comes to spinal ligament injury, nearly 100% of the time the people that are minimizing the significance of these injuries cannot even tell how the injuries are properly evaluated and diagnosed. Nor can they tell you the list of common symptoms that are attributed to it:
Lower back pain
Shoulder blade pain
Pain radiating into the arms and legs
Numbness, tingling and or sense of weakness or heaviness in the legs or arms
Disturbances and concentration
Disturbances and memory
Ringing in the ears
Bladder or bowel dysfunction
Remember, this condition causes more pain and expense than perhaps any other conditions areas. In a series of studies emerging from the Global Burden of Disease 2010 Project by the World Health Organization, it was clearly determined that the worldwide health burden of musculoskeletal conditions, particularly back and neck pain, are at epidemic levels.
With low back pain identified as the #1 cause of disability worldwide and neck pain the fourth cause.
Do not take this condition lightly and do not work with any doctor, attorney, or any other professionals that does not understand it.
Why Your Injury Is Minimized
To minimize these spinal ligament injuries, called in slang terms “Whiplash”, the insurance industry began a systematic campaign to call this type of injury “Just a soft tissue injury.” This was done in the artificial intelligence systems interface daily by the adjuster managing these claims.
In the early 2000s insurance companies began using programs to reduce medical, chiropractic and osteopathic fees and procedures in two significant ways.
- Systemized claims management computers that replaced humans with artificial intelligence software; one of the first most known being the insurance industry program called “Colossus.” With Colossus, the insurance industry could replace human adjuster’s emotions, or gut instinct with a calculated and emotionless artificial intelligence that spoke a new language and completely changed again when it came to issuing monetary compensation for injuries.
- The new artificial intelligence was combined with development of very intermittent system of “insurance fraud” procedural programs designed to fight abuses. These procedures were successfully used to reduce the insurance cost for spinal ligament injuries, or any injury for that matter.
Spinal ligament injuries are very common in situations like automobile collisions. Everyone in the field was a target for these programs; especially the doctors that were trying to bring attention to just how serious these spinal ligament injuries could be.
Blaming the Victim
To minimize the spinal ligament injuries, called in slang terms “Whiplash”, the insurance industry began a systematic campaign to call this type of injury “just a soft tissue injury.” This was done in the artificial intelligence system interfaced daily by the adjuster managing these injury claims. If you had a back or neck injury, these were just considered a “soft tissue injury,” and therefore they were characterized as minimal with no real need to pay out any benefits.
Attacking the Doctors
Any doctor that was trying to show how these injuries were more than just a “soft tissue injury,” was attacked. They were often accused of fraudulently trying to make something out of nothing for personal gain. Patients were attacked as malingerers (people who were faking injury for money). Some doctors have had serious trouble with insurance companies attacking them as fraudulent providers simply because they find and document the significant injuries that can legitimately require more benefits for the patient.
Today the worst injury you can have may not be from the accident itself, but rather from the second phenomena: Working with professionals, doctors and attorneys that do not understand the condition itself.
They do not understand that it can cause problems for you that may become permanent, painful and progressive, which could have been potentially aborted altogether, with early proper diagnosis and treatment.
Finding the Right Professionals
The key to finding the providers, doctors, and attorneys that understand this condition and can produce great rehabilitation results, as well as document in a way that significantly assists you with getting benefits that you are entitled to is an aligned team that will get the victim better deserved results.
The biggest problem in the medical legal system is 2-fold:
- How to set up a standard system to determine if permanent body damage has occurred within injury.
- The second problem was how to objectively and standardly determine the effect that this identified injury would have only person’s ability to perform basic activities of life without pain, discomfort or suffering.
This monumental task was accomplished in the 1970s when the AMA published the first Guides to the Evaluation of Permanent Impairment. Impairment is defined as: A condition that injures the person’s ability to function.
This book is the” Kelley Blue Book” of human body damage. Every doctor treating injuries and every attorney representing injury cases should be very familiar with this book. They should readily be able to use it to represent to anyone that you have a permanent injury, and the level of negative effect on a person’s life this injury is agreed to have. The word “objective “means anything that can be verified by others. The chair you may be sitting on can be verified to exist by others, but how you feel in it cannot.
When we look at the AMA guides, the stated purpose of this book says it all:
“The primary purpose of the guide is to rate impairment to assist the adjudicators and others in determining the financial compensation to be awarded to individuals who, because of an injury or illness, have suffered measurable physical and/or psychological loss.
The AMA Guides are made so that anyone can look up the identified injuries to any body part, and see what the agreed upon negative consequences are as communicated in the form of an impairment rating. In the case of a ligament injury that creates excessive motion of the spinal segment that is ratable by the AMA Guides, the book states that the injury can cause a negative consequence to 25% of your activities of daily living.
A negative consequence of 25% of your activities of daily living is reported as a 25% whole person impairment, which means 25% of your daily activities may be negatively influenced by this injury.
While this is not a perfect system, it does prove that the condition exists, will negatively impacts your life and it is a worldwide agreement. The key to this is that it is not the treating doctor stating this–it is The American Medical Association.
Any doctor or injury attorney that is not fluent in impairment rating and the AMA’s permanent injury assessment is not doing a complete job. This lack of knowledge can seriously reduce a patient’s compensation benefits, causing you not to be fairly compensated for your injuries.
Getting Your Condition Fully Documented
The essential point in this: You should always work with a doctor that knows how to find and diagnosis this condition. I believe that this injury (spinal ligament injury) is so important, so well documented in how to find it, that any doctor that misses this injury is doing a poor job.
The insurance industry is often made out to be the bad guy in the injury environment. It has been my experience that this is always not the case. In a lot of cases, poor documentation by the treating doctor is the cause of many issues. The insurance employees are professionals that know the basics of what the insurance company needs for documentation. Insurance companies today still use artificial intelligence to adjudicate claims, which means that the adjuster who is going to completing a claim for you will be asked a series of questions from a computer. Computer Sciences Corporation that owns the Colossus insurance software program states on their website about this software:
Your adjusters can quickly interpret medical reports and look up the definition of injuries, treatments, complications and permanent impairments using AMA 5th edition data. Through a series of interactive questions, Colossus guides your adjusters through an objective evaluation of medical treatment options, degree of pain and suffering, degree of permanent impairment to the claimant’s body, and the impact of the injury on the claimant’s lifestyle. After the Colossus consultation, a summary of the claim is provided, including a recommended settlement range.
Understand, that for the adjuster to easily answer the questions that the computer is asking them, the answers must be in your doctor’s notes. The attorney also must stay the same documentation facts if they are involved in the claim resolution process. Here are some typical questions.
- What are the injured parties documented injuries? All injuries are coded with an international coding system language Called the International Classification of Disease 10th Edition (ICD10).
- What are all the care procedures that were delivered to the insured by any healthcare provider? These are also coated in all your medical records with international procedural codes.
- Do the injured parties have any permanent injuries identified with a Permanent Impairment Rating? This is the way the insurance company knows that she has some sort of permanent problem; if there is no impairment rating, there is no permanent problem.
Determining Your Rightful Injury Benefits
- Quantifying the Impairment. If you have a permanent impairment it will ask you how much? This is in the form of the number, such as 2%, 10%, 25% etc.
- Loss of Enjoyment. If you have a permanent injury it may ask if this permanent injury now keeps you from doing any kind of activity that you could perform prior to the accident. This is called “in the loss of enjoyment factors.” These are things that she can no longer do as result of your injuries. It is very important that they are included and well documented in the doctor’s notes. The insurance company needs to know what she now cannot do, but she could do before the accident.
- Duties under Duress Factors. The adjuster will also be asked if there are any activities that she can’t do but only under duress since the injuries occurred. These are called “Duties under Duress Factors.” Things that are now uncomfortable to do, but you can still do, they are simply interfered with due to discomfort that is a direct result of your injuries.
- Future Care Expenses. If you have permanent impairment the software may also ask the adjuster to indicate if there are any documented future care needs that will be required to manage your permanent injury.
These factors are necessary for the claims adjuster to allow for the benefits you are rightly entitled to. Unfortunately, these factors are not included in many doctor’s records.
In summary, your doctor must report his basic similar documentation:
- Proper codes for all your injuries and care
- In any permanent damage must be reported with an AMA impairment rating.
- Anything you could do before the injury and now cannot do as result of your injuries, called Loss of Enjoyment of Life Factors.
- Anything that you could do pain-free prior to the accident and now can be done only under duress, called Duties under Duress Factors.
- If you have permanent injuries identified, all the future care your doctor advises that you may need must be formally documented by your doctor and reported to your attorney.
Unfortunately, in most cases both the doctor in the attorney are missing this basic information. That is why it is so important to find the right doctor and attorney that understands both your injuries and your document needs.
Finding the Right Doctor
The right doctor understands the spinal ligament injury and knows how to properly diagnose and document it. They know how to properly identify both the severity and the location of this type of injury. Before you treat with any doctor for a spinal ligament injury, a sprained back or neck, or whiplash, make sure the doctor knows how to locate and determine the severity of this injury.
Do Not Take These Injuries Likely
I really hope that you will take the time to apply what you have learned here. Do not take the spinal injuries lightly. Find a doctor that knows or specializes in this type of injury and then follow everything they say to do, to the letter. Ask questions.
Thank you for sharing this time with me.
Special thanks to Jeffrey A. Cronk DC, JD
CEO American Spinal Injury and Impairment Consultants
Written by G Phillip Paulk, DC
Certified by American Spinal Injury and Impairment Consultants
Jeffrey A. Cronk DC, JD CEO
American Spinal Injury and Impairment Consultants