If you have suffered injuries in an automobile/truck collision and have filed a claim for personal injury, the insurance company of the at-fault party is responsible to pay all medical costs.
All reasonable and necessary expenses are included on the victim’s damage award. Typically, the driver that caused the accident is responsible for paying all the victims reasonable and necessary medical bills related to the accident. As part of proving his or her losses in the case, the injured party will submit all medical bills that occurred as result of the injury. However, just because the injured party received treatment, it doesn’t necessarily mean the jury or insurance company will feel that the treatment was necessary.
Most personal injury claims are settled before they go to trial. In most of cases of medical and chiropractic treatment for injuries resulting from the automobile collision, the insurance company will negotiate and pay a settlement or trial award based upon the facts of the case, the medical/chiropractic records and the amount of liability coverage that the at fault driver has.
It is imperative for the treating doctors to properly document the ongoing treatment of the patient so that the insurance company can understand the injuries, the causation of the injuries and its effect on the patient’s life and the possibility of future impairment.
Proving Medical Expenses after Suffering Injuries
There are several aspects that are critical in protecting improving your injury.
- Documentation of symptoms relating to the accident
- Documentation of how the injury has affected victim’s activities of daily living (ADL)
- Documentation of the causation of the injury (details of the accident) and its relation to the symptoms.
- Proper, specific and verifiable diagnoses
- Detailed records of treatments provided for the documented injuries
- Documentation of objective findings with examination and testing
- Specific, reasonable treatment plan
- Cost and duration of each treatment
- Documentation of the probability of need for future care due to the injury.
Without clear, specific medical records some or all the treatment could be considered not “reasonably necessary “by the insurance company and the claim could be denied or significantly reduced.
One of the difficulties that the treating doctor must deal with is proper documentation of spinal injuries, particularly if there is no obvious injury such as a fracture or laceration without the proper tools.
There are two types of findings in these types of cases:
- Subjective Findings: Subjective data is gathered from the patient telling you something that you cannot use your 5 senses to measure. If the patient states that they have had pain in the neck for the last 5 days following an automobile accident, the doctor cannot know that information any other way besides being told by the patient. Pain is subjective because the patient is telling you what and where their pain he is.
- Objective Findings: This is information that can be gathered using our 5 senses. It is either a measurement or observation. Temperature is a perfect example of objective data. The temperature of a person can be gathered using a thermometer.
Most doctors rely on the patient telling them where the pain is and how severe it is. These subjective findings carry very little weight in an accident case because they cannot be verified by objective testing. The doctor must be equipped and trained to use proper objective testing in evaluating the automobile accident injury and treatment.
If the treating doctor’s records lack objective findings, the patient and/or their attorney have great difficulty in convincing the insurance company or jury that the injuries are real. This can result in the determination that the injury was bogus and treatment was not “reasonably necessary” and will significantly devalue the case.
Our doctors at The Paulk Clinic are trained in objectifying spinal injuries using the latest technology.
These Objective Technologies Include:
Computerized Range of Motion Studies:
Our office utilizes computerized range of motion equipment called Kennebec P.R.O.O.F Preferred. This is computerized equipment and features wireless dual inclinometer measurements that have a 1°/1 mm accuracy. This meets the strict criteria of the AMA Guides to Evaluation of Permanent Impairment Fifth and Sixth Edition. The AMA Guides is the Bible for determining impairment by the medical and legal profession. This technology documents the loss of function of the spine and associated joints and documents the need for continued care or lack thereof. This testing clearly documents limitations and impairment and demonstrates improvement over time using this software. This is a totally objective test in that it does not depend upon patient’s input. This technology is employed on all trauma cases at the beginning of care and is performed periodically throughout the patient’s care.
Computerized Muscle/Strength Testing:
Our office utilizes computerized muscle/strength testing with equipment developed by Kennebec P.R.O.O.F Preferred. This testing involves using wireless dynamometer and compares left with right sides. Over 100 muscles can be tested and does include a Cervical Physical Performance Report. These tests are performed at the beginning of care and during care to determine the level of functional loss due to an injury and documents progress during care to determine improvement or lack thereof. This testing follows the guidelines established by The AMA Guides to Evaluation of Permanent Impairment, Fifth and Sixth Edition. This is a totally objective test in that it does not depend on the patient’s perception or input. By establishing the patient’s baselines, we can accurately and easily quantify functional impairment and soft tissue injury. This testing allows us to formulate a treatment plan designed to return the patient to a pre-injury status or maximum medical improvement and limitations allowing us to document medical necessity, treatment outcomes and provide the reports needed for proper insurance reimbursement.
Digital Radiographic Mensuration Analysis (DRMA):
Many times, this process is referred to as “Digitized X-Rays”. This is a test that analyzes the angles of distance between bones in the spine using a computer and digital x-rays, which are certain type of radiograph. The purpose of the test is accurately document damage to the ligaments in the spine that can be impossible to detect with other forms of imaging. Mensuration has been used by doctors for nearly 100 years to figure out when the patient’s spinal bones are misaligned due to ligament damage as result of an automobile/truck collision. Mensuration compares the patient’s injured spine to a normal spine.
For doctors, DRMA assist with a “differential diagnosis”, which is a process that doctor uses to rule out other sources of pain. Insurance companies like to blame other sources, such as “somatoform disorder”, “secondary gain” and other buzz words that really means faking. Digital Radiographic Mensuration Analysis disproves faking. Since this technology identifies the location and extent of permanent injuries, it helps the doctor decide on a treatment plan targeted at the injured area. It is also helpful for tracking changes in the patient’s condition and for deciding when to make referrals to pain management specialist, neurologist or other surgeons.
This technology is important to patients, doctors, and lawyers. For patient’s, it visually shows them where they are injured. It also helps them to understand that common defenses to whiplash injuries are smokescreens invented by insurance companies.
For lawyers, DRMA provides subjective, visual medical evidence of permanent injury. Simply put, DRMA helps patients prove their injuries are real and allows the attorney to introduce scientific evidence into court, that must be reliable and scientifically sound. Because DRMA has been used in court for decades and has been approved by the American Medical Association, or AMA, it is acceptable for use in court. The mensuration method used most commonly today comes from the American Medical Association’s Guidelines for Evaluation of Permanent Impairment (AMA Quides). It is the gold standard for impairment evaluation.
The references can be found on Page 392, 15.6 DRE: Cervical Spine, Category IV and Page 384, 15.4 DRE: Lumbar Spine, Category IV of The AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition published by the AMA Press.
Outcome Assessment Forms:
Self-Reported Outcome Assessment Questionnaires are completed by each patient on their initial visit and systematically, throughout the course of treatment to determine how the injury has affected her activities of daily living and to determine progress or lack thereof.
Neck Disability Index Questionnaire is a questionnaire, used for spine related complaints involving the cervical spine. It measures the following 10 cervical spine health categories to represent the level of cervical spine perceived disability.
Oswestry Low Back Pain Disability Questionnaire (Revised) measures the following 10 low back health categories to represent the level of low back perceived disability for each category.
Functional Rating Index
The functional rating index (FRI) is an instrument specifically designed to quantitatively measure the subjective perception of functional and pain of the spinal musculoskeletal system and the clinical environment. This index evaluates the patient’s subjective report of his ability to perform dynamic movements of the neck and back and/or withstand static positions.
The functional rating index emphasizes function (realizing that all functions may be influenced by other variables) while concurrently measuring the patient’s opinion, attitude and self-rating of disability. The functional rating index compares favorably to other instruments regarding clinical utility.
The 10 items of the functional rating index used to profile the nature of the dysfunction and pain includes:
3–Personal Care (washing, dressing, etc.)
4–Traveling (driving, etc.)
7–Frequency of Pain
The index score is achieved by simply summing up the equally weighted scores, dividing by the total number of possible points, and multiplying by 100%. The range of scores is 0% (no disability) to 100%(severe disability). The higher the number, the higher the perceived dysfunction and pain; the lower the number, the lower the perceived dysfunction and pain.
Many other outcome assessments can be performed based upon the patient’s injury. Some of these tests include Copenhagen Neck Functional Disability Scale, Dizziness Handicap Inventory, Headache Disability Index, Global Well-Being Scale and many others.
These tests are considered objective in that if someone else was to walk into the room and asked the patient to rate their pain with the same questions, they would get the same answer. Thus, this is repeatable and measurable and therefore objective.
Duties under Duress/Loss of Enjoyment Forms
Insurance companies require certain submissions in the doctor’s notes when determining the nature and severity of the injuries as result of an automobile collision.
One of the leading factors that the insurance company considers is what is referred to as “Duties under Duress”. Duties under Duress equals pain while conducting an activity. If the victim has pain during an activity, but does it anyway due to the necessity for the client to continue doing the activity, it must be noted in the doctor’s chart notes. The victim must have experienced pain during one of the prescribed types of activities. The pain with activity must be supported and documented physicians report or notes.
These categories include:
All patients complete these forms on the initial visit and periodically during care to determine how the injury has affected their life and to document improvement or lack thereof in the future. These objective findings are recorded in the patient’s treatment notes, as required.
Proper Documentation Is Required to Maximize the Victims Just Compensation.
In cases that aren’t easily settled or are challenged, the victim may need to obtain an expert to testify that the kind of medical treatment/chiropractic treatment the victim required was necessary to treat his or her injuries.
The at-fault driver can, in turn, also can hire an expert to testify the opposite. Even if expert witnesses are not involved in a case, it is ultimately up to the jury to conclude how much the patient’s medical/chiropractic expenses were “reasonably necessary”. The jury or the at fault driver’s insurance company may argue that some of the medical/chiropractic treatment was not necessary, but require the at-fault driver to pay a portion of the total bill.
Therefore complete, thorough, objective proof of the injury and treatment is vital in proving” reasonably necessary” treatment.
A victim of an automobile collision should be treated by experts that understand the need to objectify their injuries and to afford them the treatment necessary to return them to a pre-accident condition.
Referral to appropriate Medical Specialist and Subspecialist
Depending on the severity of the injury, it is sometimes necessary for patient to be evaluated by medical specialist and subspecialist for treatment and evaluation.
These specialists can include:
Interventional Pain Management Specialist
Orthopedic Extremity Surgeons
The additional services that may be necessary are expensive diagnostics such as MRIs, CAT scans, EMGs, nerve conduction velocity test, evaluations by neurologists, discograms, neuropsychologist evaluations, ophthalmic evaluations, evaluations by your nose and throat specialist etc.
Under certain circumstances, if the injury is severe enough it may be necessary to have other procedures performed including pain management interventions. These could include procedures such as spinal epidural injections, medial branch blocks, trigger point injections, nerve ablations etc.
The cost of these procedures can be several thousand dollars.
If spinal surgery is needed, the cost can run into the tens of thousands of dollars.
If a victim is uninsured or under insured, this can put a significant financial burden on the victim. Remember, the insurance company for the at fault driver will state that they will not pay for any expenses until the cases settled. This leaves the burden on the victim.
Our office works closely with a top specialists and subspecialists that are willing to treat these cases on a lien basis. A medical lien is a contract between the doctor, the patient and the attorney that promises that his medical fees will be paid after the cases settled. This allows the patient to get the care when they need, when they needed it without the financial burden that accompanies these expenses.
Don’t Go at It Alone
Therefore, I encouraged all motor vehicle collision victims to consult with an experienced, reputable attorney about their case to assure that the victim’s rights are protected and that the victim receives proper compensation.