Academy of Chiropractic’s Doctors PI Program

Narratives #68

From the Desk of :
Mark Studin DC, FASBE (C), DAAPM, DAAMLP

“Combining Demonstrative, Clinical Evidence & Functional Losses in the Conclusion”

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THIS IS HOW I NOW FEEL!!!

I have previously shared with you that “Demonstrative Evidence” is the new minimum standard and the reason lawyers will have “long-termed” relationships with you. If you add that to your training, you become “untouchable” in the industry. While the rest of the profession is still trying to get on the “Colossus Get Rich Quick Bandwagon,” you will be 4-5 years ahead of them realizing that Colossus is such a small piece of the puzzle. 


First, your conclusion is going to be renamed “conclusion/ demonstrative evidence.” It is here you’re going to combine your visual – demonstrative findings with the words that will create the “bridge” to both the clinical and functional loss findings that correlate to the causally related injury. In addition, you’re also going to handle/resolve most of the issues that the defense attorneys are going to pose in hope of being granted a summary judgment for dismissal on most of your patient’s cases utilizing deceptive defense rhetoric.


When considering what to include in your narrative findings, you must look at this from the lawyer’s perspective, exclusive of any “Colossus” type issues. It is here that the lawyers will realize you truly understand their needs and will place you above all other competition. The Colossus information should be in either previous reports and in the body of your “4 Corner” narrative [to learn more about the 4-corner narrative, take the Testifying course] prior to the conclusion. Never lose sight of the fact that although the carrier scans the entire report into their Colossus type software, the attorney exclusively reads only the conclusion. This holds true for approximately 98% of every lawyer in the United States based upon my informal survey of over 100,000 lawyers nationally.


The concepts you need to focus on are age-dating (pre-existing) herniations, asymptomatic herniations, arthritis indicates everything is pre-existing and “no damage crashes” cannot create serious bodily injury as causality. Although there are a myriad of other issues you WILL discuss, the above issues are the majority of denials that trial lawyers have to handle. As a result, you need to be extremely well-versed in MRI spine interpretation, biomechanical engineering, impairment rating, neurology of ligament pathology and all of the other pieces of information working on the trauma team will give you the basics of everything you need.


Our primary spine care symposiums, of which we have done five already [we do 1-2 every year] will help “stitch together” all of the concepts that you will need to discuss and delve into the specifics to help you fully understand and utilize the information. Little things such as Modic one changes, and high signal issues are the very basics to be able to age date the herniation. If this seems a little confusing is because you haven’t been trained in MRI and even if you have taken MRI spine interpretation course online, you need to do a mini fellowship in neuroradiology with Dr. Peyster that will help you fully understand the subject. Being an expert is just that… You have to be the expert and that only comes with training and without the right credentials, you are invisible to a lawyer.


Now you are starting to see why the majority of the chiropractic profession will not be able to compete with you when it comes to personal injury cases. In addition, if you follow the courts you will realize that the standards in almost every state to be considered an expert is escalating and in chiropractic, the New Jersey Court case Lamb vs. Allstate [Superior Court of New Jersey, Appellate Division, Docket #: A-004471-11] has set the standard for chiropractors being an expert. I see the tenants of that argument in almost every state in the United States when the defense is trying to limit the chiropractor as an expert. Don’t think that if you are not in New Jersey you dodged a bullet… AND…If you are in New Jersey, you must be “bulletproof” in your credentials.


Too many in our profession have drank the “Kool-Aide” and still believe that Colossus is the solution. There is nothing above that I stated that is a Colossus issue. Again, it does not mean that you are to ignore the Colossus issues, however it will not impress, excited or get the lawyer’s attention to get them to realize you are the ultimate solution for them to prevail. Every lawyer in this country is “wired” for Verdict over settlement as it is the core of their training and belief system. It is an easy “sell” to get them to understand the Verdict issue, while getting them to understand Colossus that has so many theoretical variables is incredibly challenging and too often falls on deaf ears.


In your conclusion there needs to be four components:

1. Mechanism of injury

2. Imaging findings with the graphic demonstrable evidence inserted above #1

3. Clinical findings that correlate to the accident

4. Cryptic argument ruling out pre-existing issues

5. Functional loss correlation


Here is sample language:


The mechanism of his accident where he was a passenger in the front seat of an automobile that was rear ended clinically correlates to the MRI findings of a large extrusion type herniation at L4-L5 (see picture above) compressing the left nerve root in the lateral recess and into the neural canal on the left. It also explains why his L5 reflexes are diminished on the left, he has loss of power to the hamstrings and quadriceps on the left and has sensory deficit in his left foot as they are all clinically consistent with this causally related herniation. There are also no bone spurs at the same location of the herniation, there is high signal in the extrusion and Modic type 1 changes in the inferior L4 and L5 end plates verifying bone edema all indicating a recent trauma and consistent with the accident dated 1/21/2018. This accounts for his inability to walk or sit for more than 5 minutes without severe pain and why he cannot use his legs as a normally functioning person does.


This has resulted in the following persistent functional disabilities:


It is here where you “get real” with the what the patient can and cannot do. Oswestry and other indexes should NEVER be used unless a carrier specifically mandates them Judges and juries understand, relate and empathize with someone who cannot carry their infant son for more than 10 minutes vs. having a 30 on an Oswestry. KEEP IT REAL!


When neutralizing the pre-existing and causality issues you not only hit the EASY BUTTON for the lawyer, you let them know that are the solution to their biggest challenges… IF… you have the credential behind you… It’s often GAME OVER…You just won!