Academy of Chiropractic

Quickie Consult 1203
Infrastructure 252 I

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. -Mark Studin 2006

"Apportionment Process with 3 Cases"


Dr Studin: It seems there's an ongoing confusion about apportionment So let me give a little bit of background about apportionment and then we're going to talk about your case, a apportionment means you're resigning What portion of bodily injury is to what case, in order to do that, you need to use your markers, is there high signal in the disk? Are there bone spurs? is there a motique one changes in their input to DEMA, those are your typical markers to see what's going on, what we do typically is you take a blank piece of paper, you've put two lines on it, divided the page up into three courts. Column one is symptoms, column two, imaging findings in column three, your clinical findings, including things like muscle testing, range of motion, EMG, NCV, all the functional stuff. And then what you do is you get different colored pens. So you'll take a red pen and you'll connect the symptom to the imaging funding to the functional finding for accident one. And then you take a blue pen and you'd do the same thing for accident 2. And then you see what overlaps and then you'll see what's new and what's old. And then you go back to your markers, and the history to be able to apportion. And if the accident's really close to each other, I would just do, you really have to make a clinical decision to get, you're not going to have a marker because it's too close in time. If it's far apart away, it makes the further report away, the easier it makes it. And sometimes you just have to put your clinical rationale why. Now with that being said, what's the scenario with your patients?

Guest Dr: I have a patient that was in a recent accident in 2019, In 1999 he was in a previous accident, which he was not treated by me and I have no records on.

Dr Studin: What would you expect to see in any bodily injury from 1999 until now in the spine?

Guest Dr: I'd be generative changes.

Dr Studin: Yeah, a lot of bone spurs. It's just been 20 years.

Guest Dr: His last treatment for that accident was in 1999 he was in a second accident in 2015.

Dr Studin: he was in a third accident in 2015 so you said he was seen in 2019?

Guest Dr: No. he was in an accident in 1999 another accident in 2015 and the accident I'm treating now in 2019.

Dr Studin: so we have three accidents.

Guest Dr: on the second accident, and he was treated for basically the same thing he had. Hip pain, sacred iliac pain, neck and back complaints.

Dr Studin: the second accident is 2015, So he had similar problems that he had in 1999 Which is hip and back and neck complaints. Low back and neck. So let's talk like doctors hip, lumbar, cervical. there anything new between 1999 to 2015?

Guest Dr: I'm going to say complained about growing pains.

Dr Studin: I'm not interested in symptoms. Any radiological findings that showed something new?

Guest Dr: No.

Dr Studin: So there's really nothing demonstrative. Now has he had treatment since two since 1999 to 2015 for any of those problems?

Guest Dr: he had. He came in for an exacerbation of those similar symptoms in 2018.

Dr Studin: between 1999 and 2015 Did he have any treatment?

Guest Dr: He had treatment in 2015.

Dr Studin: but nothing before that, not since 1999?

Guest Dr: no.

Dr Studin: So he didn't have any problems. So it's safe to say that it was permanent and stationary from 99 and everything from 2015 was pretty much new cause he had no treatments since 1999 for 20 years?

Guest Dr: Yes.

Dr Studin: So you've established that everything in 2015 was new, but you have no imaging findings to discuss, correct?

Guest Dr: Correct.

Dr Studin: We're the MRIs in 2015? Now 2019 he gets in this third accident. Do you have MRIs for that?

Guest Dr: Yes.

Dr Studin: Are there motique one changes to show inflammation? Is there high signal on the outside showing that the nucleus proposed went from the inside out?

Guest Dr: I don’t recall.

Dr Studin: See, these are all the things you need to know to be able to apportion. you're confused because you're not following the rules of utilizing the markers to determine what's new or not. You just can't go by symptoms. And I don't trust the patient to say that these are my symptoms last year or three years ago or four years ago. Because patients also do things like carry grocery bags and pick up kids and play sports and do stupid things at work that have nothing to do with the accident. So you need to look at an image to see what you can causally related on the image. Other than that, you cannot certify anything than just very recently because you don't know what happened in that intervening time to be able to apportion. And it's more than apportion. This goes to causality and what an attorney needs is causality, bodily injury, and persistent functional loss. But without causality, lawyers have nothing. So what you need to do, so apportion even before that, you have to be able to establish causality. And then once you establish causality, then you can get into apportion. Do you understand?

Guest Dr: Yes

Dr Studin: So you've got some work to do now. Now go back to the drawing board and send me a document about two things. Show me that it's causally related and show me the apportionment, nothing else. 

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