Academy of Chiropractic’s Lawyers PI Program
From the Desk of :
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
“Reporting Future Care”
Disclaimer: Colossus is a registered trademark of Computer Science Corporation and is used here for purpose of identification, description of comment. It is also used as the generic name for the myriad of programs used by various carriers.
In reporting future care there are many factors that come into consideration and an experienced lawyer will clearly understand, while a novice lawyer in personal injury must be taught. Both will help you create solid relationships with lawyers and you will be doing your patients a significant service.
In creating the future care section I sought advice from a PhD in economics, a vocational specialist, multiple lawyers and an insurance claims analyst. Each of the above specialist has very specific requirements as they all are part of future care process with the understanding that everything originates from the doctors report. Without the doctors report in the medical – legal – insurance process there can be no certification for future care. In essence, it begins with you.
You must create a section called “FUTURE CARE” just before the conclusion and it has 4 very significant purposes:
1. Patient: it informs the patient that based upon their permanent condition that future care will be required and it is often for a lifetime.
2. Vocational specialist: it allows the vocational specialist to come up with a lifetime plan to help guide the injured to an occupation based upon the limitations and long-term prognosis of those limitations.
3. Lawyers: there are federal actuarial tables based upon age that will render equations to determine “future dollars” on what that person’s life is worth based on how long they are expected to live. This will allow lawyer to determine the full economic loss an accident has created in a statistical format.
4. Insurance: Colossus considers future care in its assessment as it could cause further impairment. In order for Colossus to consider future care, one of three categories must be documented:
Possible: 0-49% possibility of occurring
Probable: 50-75% possibility of occurring
Definite: 76-100% possibility of occurring
Please note that COLOSSUS will automatically include only the probable and definite future treatments into its calculations.
Sample language is as follows:
The causally related injuries are permanent, and the patient will DEFINITELY need chiropractic treatment for the above stable joints at a frequency of a minimum of 2 times per month at a fee of $150 per treatment in today’s dollars, (or at today’s costs of care) for a minimum of $300 per month on an ongoing basis for the remainder of this patient’s life. If it were not for this accident, this patient would not need this future treatment.
In addition, the patient will DEFINITELY need medical supervision (re-evaluations) at a frequency of 4 times per year at a fee of $250 per evaluation and rehabilitation on an ongoing basis for the remainder of this patient’s life.
Mr. McDonald was also prescribed a lifetime home exercise regimen that must be adhered to support the damaged soft tissue supportive structures in his spine.
NOTE: the dollar amounts are not suggestions, simply space fillers and you need to determine the actual frequency and fees based upon both clinical necessity and the documented usual and customary fees in your geographic region.