Academy of Chiropractic’s Lawyers PI Program
Lawyers Meeting #14
From the Desk of :
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
“The Digitizing Hook”
Nathan Laubach from Pennsylvania wrote:
I just wanted to share my experience this morning with you. In a nutshell I feel like I hit a home run with the largest personal injury firm in the northeast of Pennsylvania...19 PI lawyers under one roof. I had a new MVA patient recently come to the office on a "drive-by" referral. I saw on her intake her attorney was one of the lead partners in this firm. I followed your formula.... after gathering her pertinent objective studies (NCV/EMG, MRI, and AOMSI study) I contacted the lawyer and told him I had "significant information about his client". The attorney then said "mail it to me". I held ground like you recommend and he conceded to meet with me. At the meeting I lead with my CV like you advise...his posture immediately changed. I followed that up with a case review, i brought my laptop and went over the MRI images with him...the questions started coming fast and furious. "what is the difference between compression and abutment?", "what is the difference between a bulge and herniation?" what is it mean when a disc is "black" on MRI vs. "white"" ...etc. etc.
I handled every question with ease, not a stutter. Next came the X-ray digitization... after I reviewed the details of that (impairment rating, Dr. Peyster, and such) He looked at me and said "I've been doing this work for over 35 years, I've never seen this before...the level of expertise you are bringing to me is unprecedented" Now his posture really changed. He leaned back in his chair and started opening up to me about all of his "problems".... pre-existing arthritis, age dating herniations, differentiation between degeneration and trauma on MRI, etc. etc. He didn't mention a single "problem" on his mind that you don't cover in your program. You can guess what came next.... the bi-weekly fliers. He agreed to accept my info every 2 weeks but he wants me to come to his firm and present the AOMSI material and a general overview on how to interpret MRIs to all the partners of his firm. He offered to cover all my expenses for missing a day at the office if I was willing to do so...I obliged...I'll let you know how it works out. Prior to working with you in your program I wouldn't have even called the attorney to do a case review let alone insist on it being face to face. Thanks for making the game fun again.
I lectured in Massachusetts to a group of attorneys and discussed the entire package. During the presentation, Dr. Broderick, the primary sponsoring doctor got 2 referrals before the presentation was over. 2 hours after the presentation, 2 lawyers called him at 11:30 pm and made an immediate appointment for the doctor to visit them the next day. The other 35 lawyers in the room all gave the doctor a piece of paper that said “Please call me to make an appointment to visit me this week.”
The answer is Voir Dire, Daubert, certifying as an expert, understanding how to pre-date herniated discs, overturn arthritis arguments, have a team of medical specialists at your fingertips and be able to digitize for ligament laxity and AOMSI.
As soon as I finished writing the above paragraph (literally one minute ago), a doctor called from Idaho with a layer on a conference call to ask about digitizing. The lawyer said “I am a former defense counsel for State Farm and I understand what I am up against. My client had a negative x-ray and MRI report and the doctor has given me a report from Dr. Peyster showing laxity of ligaments. I already have a normal report from the local radiologist, how can I ever prove bodily injury and win this case?”
I spend the next 10 minutes explaining digitizing, ligamentous laxity and AOMSI and he “got it”. However…the next question was “Who is going to testify in either deposition or trial?” The doctor on the phone said…me. We then went through a full “credentialing type hearing” no different than in court to see if the lawyer COULD accept this doctor as an expert. At the end of the conversation, all the lawyer wanted to know is if the doctor could digitize other body areas that were injured and will consider doing this for every client he has.
In every scenario, in every state, the story is the same. Causality, bodily injury and persistent functional loss with credentials to back it up. We have now “upped our game” significantly with digitizing because it one area that CANprove bodily injury in the absence of a herniated disc.
This is huge for the legal community and critical for your patient because it changes your diagnosis, prognosis and treatment plan in the absence of herniated discs.
Once you have the expertise to bring to the legal community avenues to prevail (based on the presence of pathology) in the absence of a herniated disc, you have now tapped into an uncharted area that will add significant new patients to your office. You become the solution for the entire legal profession.
X-Ray digitizing backed by your credentials is one such area and if you add that to your MRI credential it becomes…game over at a much higher level!
How do you communicate this to a lawyer? Although the verbiage is part of the “magic language,” for the sake of redundancy, here is how I explain this to a lawyer:
“Whether your clients have positive MRIs or not I’m still going to consider digitizing your patient’s x-rays to determine if there is ligamentous laxity. This is one area that will drastically change my diagnosis, prognosis and treatment plan and can potentially positively affect your case. From a diagnostic perspective, a positive test renders the diagnosis of laxity of ligament. From an insurance perspective and “Colossus type” algorithms, whole person impairment is considered 25% of the value of the claim.
When one considers levels of impairments the medical community defers to the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th Edition as the industry standard. When utilizing this standard as an example, should someone have an amputated leg it will render an impairment rating of 25 – 28% whole person impairment. The same type of impairment schedule is used for spinal related problems. For instance should there be strain/sprain that renders the 2 to 3% impairment, a herniated disc will represent an approximate 6 to 8% impairment.
When analyzing laxity of ligaments in the spine should a test be positive that renders the same 25 – 20% whole person impairment that an amputated leg renders because laxity of ligament is a significant diagnosis for impairments and is certified as so by the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th Edition.
Should there be a positive test, which according to Dr. Ray Wiegand a researcher form St. Louis who has been published or presented scholarly papers on this technology 17 times has reported that approximately 60% of whiplash cases show positive results for laxity of ligament. The diagnosis of laxity of ligament answers many questions for doctors in the absence of herniated discs for patients with significant pain and biomechanical instability. It also resolves many medical – legal issues for the legal community by rendering demonstrative evidence for serious bodily injury in the absence of a herniated disc.
I utilize a medical neuroradiologist, Dr. Robert Peyster, who is Harvard trained and has been published over 70 times to analyze my patient’s images to determine if there is ligamentous laxity. I am also credentialed and certified in spinal biomechanical engineering as well as impairment rating should the test the positive and you need an expert to testify.”
Please note that no one tool is the answer. It is the totality of who you are and what you offer. Different patients need different tests, have different injuries and different lawyers have different needs and requirements and learn at different levels. When you evolve with more knowledge and better credentials, you will continually spiral upwards. This is the reason that our doctors, over time increase their income between 24%-61%...and it all based on increasing your clinical excellence!