Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 39 L

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

"This Isn't Easy"

I am sitting here reflecting on my journey over the past 34 years and more recently, over the last 2 years, more specifically, the last month, considering what I have learned about what it takes to become truly successful in personal injury and be considered a trauma expert. I also must acknowledge that it isn't easy...In fact, it is just the opposite because if it was that easy, everyone would have been doing it already and there are so few that even understand what it is that needs to be done. The really, really good are one of those that have taken the steps to be exposed to what is needed. Now all you need to "DO IT".

Years ago, I thought it was all about the "schmooze" and getting the lawyers or any other referral source to "remember you." It was about wining and dining, ballgame tickets, gift baskets and any other reason to be in their faces and get them to like you. I was no different than anyone else and it worked well enough so that I considered that the root of my success and was willing to play the game of I pay (through ethically acceptable gifts...I think) and you refer.

As the song says about New York, "If you can make it here, you can make it anywhere." That holds true for practice and more specifically, personal injury. New York is well-chronicled to be the most difficult state in the country in which to practice and succeed. Historically, the Republican legislature has had a strong affinity towards the insurance industry and after years of being politically involved, I witnessed that firsthand over and over and over. To underscore that, in New York there is a TAP judge which stands for trial apportionment and that judge certifies cases for trial. In my county, Allstate insurance company has a significant presence for both local and national issues and as a result, has always been able to get "their person" elected for this position in the courts. The significance of this is that lawyers have had to go through that judge in order to bring cases to trial and in my region, those judges are exceedingly (apparently) biased and for too many years, they have ruled on the side of the insurance companies. As a result, in order for the lawyers to bring their cases to trial or even settle their cases, they need significant leverage in the standard of documentation from us in the medical community and it has to be exemplary. In addition, in New York, pain and suffering has been legislated out as being a reason for a lawsuit and New York has a very stringent law called "threshold." This law is defined as "permanent and significant impairment of body part or function" and without that standard being met, there can be no settlement or lawsuit.

As the carriers placed more of their judges on the bench, the lawyers in our area stopped referring back to us even with us referring to them. As they told me years ago, the standards of the courts were so stringent that they did not want my cases because even if I came with those cases and all the wining and dining, theater tickets and ballgame tickets, they would not get past the TAP judges. This is a sentiment I now hear around the country from lawyers on a consistent basis. They don't want to be saddled with the standard chiropractic "babble" that they have encountered in our paperwork, historically and currently, from most of our colleagues.

Two years ago, after I'd spent 24 years being directed by lawyers on how to create appropriate paperwork, I can say with a great degree of certainty that the documentation we (myself and 100,000 lawyers) had created is now by far the finest in the nation and meets the standards of the courts in an ever-changing environment. The key, as most of the other so-called experts in our profession overlook, is that it is forever changing and if you do not change with the court requirements, you become a liability instead of an asset and the lawyers will not want to work with you.

Prior to two years ago, I firmly believed that your documentation, specifically your narrative along with appropriate credentials, were the key to success in personal injury. I was right, but so wrong. Here's the point. What I learned is really difficult in both a conceptual and applicative perspective. The point is the documentation and your credentials are nothing more than the key to open the door and once that door opens, everything else comes into play. Yes, your documentation is important and will overwhelm the lawyer with tools that they have usually never seen before and it will get them excited. However, what is your knowledge base behind the documentation? What are your credentials that will allow you to testify on that information? How good are you at overturning the insurance companies experts? How do your credentials stack up against the insurance companies experts? Will courts view you as an expert? What is your knowledge base about the lawyer's process in obtaining settlement or verdict? The questions go on and on.

It is all the above items after the word "however" that will drive your relationship with lawyers and be the arbiter for the level of your success. Two years ago when I did my first IME rebuttal with Ralph Latyschow in New Jersey and we successfully overturned the negative improper report, it dawned on me that we were missing a huge piece of the puzzle in the medical-legal process. When I presented that to over 100 lawyers soon thereafter, that became the focal point of the conversation with the legal community. In addition, the trial lawyers associations started seeking me out as the expert to help resolve the IME problem.

Along the way, there were significant regulatory and legislative changes along with landmark court rulings that necessitated we immediately change how we function in the "medical-legal marketplace" and because of those changes, chiropractic was able to stay in the process. The biggest change we made was going from being credentialed in both MRI and spinal biomechanical engineering to being certified in both of those disciplines with a cross certification between chiropractic academia and medical academia. It is that cross certification which has prevented the courts from disallowing chiropractors from being expert because if they disallow us, they must also disallow medical doctors as we now have the same credential certification from the same academic body.

According to lawyers from coast-to-coast, that strategy is not only considered "genius," but central to the reason many of them will win their cases based upon clinical findings and having a continued relationship with the chiropractic community. In reality, lawyers love chiropractic because of the number of times we see our patients and understand the continuity of care and functional losses over the span of both rehabilitative and chronic time frames. In the past, lawyers have shied away from us as a profession because the defense lawyers would get us as "not being experts" based on a lack of credentials and a lack of knowledge in being true spine specialists. Historically, on a national basis, the courts have agreed and barred too many of us from testifying. This is no longer the case if you have made a commitment to be one of those very few special doctors who has acquired the requisite credentials and knowledge base so that you can position yourself in front of the legal community and the courts.

As I have previously shared with you, in order to be bulletproof in the courtroom you need the following courses reflected in your curriculum:

  1. PI Bootcamp
  2. MRI Spine Interpretation
  3. Accident Reconstruction
  4. Spinal Biomechanical Engineering
  5. Impairment Rating

These are the courses that give the power to your credentials to both testify and refute IME's along with the knowledge base that is required in every forum to be able to explain the anatomy, pathology and functional losses associated with the bodily injuries of your patients. We are changing with the times and as a result, chiropractic is moving up the ladder and in fact, has taken over the top rung in supplanting many neurosurgeons, orthopedic surgeons, neurologists and pain management doctors in a host of medical-legal forums nationally. The net result of this paradigm shift in the medical-legal community equates to many conclusions. In the academic world, it leads to being a teacher. In the legal world, it leads to being expert. In the marketplace, it leads to referrals.

I know it isn't easy, but neither is having a slow office, no referrals and not knowing what to do with your patient when they show up if they are injured. The most common sentiment shared with me by doctors in the field is that their new level of competence and expertise simply has taken the stress away and there's no longer any guesswork. This is the formula for quality patient care by an expert who is the best of the best at what they do.

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