Academy of Chiropractic’s
Lawyers PI Program
From the Desk of:
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
"Initial Narrative -
Protocols that will Change the Industry"
Over the years, 30 to be precise, I have correctly held that initial reports or narratives are basically useless to lawyers and a simple phone call communicating with the lawyer will suffice until you have documentation of what has persisted after a reasonable course of care has concluded. First, let’s get to the point of me saying that I was correct, well, maybe, okay, I was right, but...when positioned differently can have a very positive impact. Not on the case for the lawyer, but on your relationship with the lawyer and getting him/her to recognize that you are truly an expert.
A question that has been asked repeatedly is how do you get the lawyer to engage with you at a higher level and faster? I have never been big on patience and waiting for success to come to me and I don’t expect you to be either.
Dr. Bill Owens, who now consults for the MD Referral Program, and I have been working on a series of protocols that will get the lawyers to recognize you early in the process as an expert and as a result, will want to work with you much sooner for their future clients. We spoke to many lawyers and then market tested the system to ensure that it worked and it does...in a big way!
Understanding the a few basic principles are critical in the success of this program. The first is the "BIG 3" as I have dubbed them: Clinically correlating 1) causality 2) bodily injury and 3) persistent functional loss. We have discussed this numerous times in many previous consultations and it is the core of the philosophy you need to understand in order to ensure success in the medical-legal industry.
Second, you have to have your team developed with medical experts that you work with. Lawyers will not work with a "Lone Ranger" as they know it is irresponsible healthcare and a bad place for their clients' legal issues. Whether you are a solo practitioner or work in a group environment, it doesn’t matter; you need your team.
Third, you have to understand the chronology of symptomatology (Consultations #14 & #173). Without understanding that concept, you will have a difficult time making this work.
Fourth, you need to have a narrative format that has been approved by 40,000 lawyers nationally.
Fifth, your CV must be in an admissible format and you must be credentialed.
I am not asking you to create or re-create your initial evaluation because this is not an evaluation report. THIS DOES NOT GO TO THE INSURANCE COMPANY. Again, it is not your initial evaluation report. That is a separate document and it stays in your files. Eventually, the carriers will subpoena all of your records and this will be a part of those records. You are not withholding any information, just not sending it without a formal request.
This document is constructed in the same exact format as the final narrative, but is limited to the initial information with the following opening statement and conclusion that never changes. Please note everything in italics needs to be specific for your patient based upon clinical necessity.
The following is an initial report regarding Mr. Mark Studin concerning a motor vehicle accident on January 20, 2011. This is a preliminary report to help you assess your client’s condition and understand what is being considered in his/her care with respect to the bodily injuries sustained in the accident.
You then go into your "prior approved by me" narrative format, omitting what you do not yet know. If MRI’s, x-rays, EMG/NCV’s, etc., are being considered, then please document that in the TREATMENT section as follows:
The following treatment orders have been rendered: Conservative chiropractic care for a period of 3 months with re-evaluations every 45 days. Full spine x-rays, cervical and lumbar MRI’s have been ordered to rule out further bodily injuries and an upper extremity EMG/NCV will be considered if the clinical signs ensue beyond 30 days.
You do not add any functional loss in this report as it is moot as a result of no care having been rendered yet, nor do you include any future care, gaps in care or arthritic issues. That is for the final narrative.
The concluding language is as follows:
Based upon clinical findings, I will be performing a follow up examination and subsequent report approximately 4-6 weeks after the end of active care. This will allow Mr. Studin to reintegrate back into his repetitive lifestyle with physical and emotional stresses that he will chronically experience for the balance of his life. With no active care to counterbalance those stresses, his post-care evaluation will elicit clinical findings reflecting those stresses that will not be present while under, or just at, the end of active care.
Should findings be present clinically, the goal of the documentation will be to correlate causality, bodily injury and persistent functional loss. Should none of the above persist, we will inform you as well.
The initial narrative should be performed as soon as the patient has his/her first evaluation and given to the lawyer. Preferably, this should be a face-to-face meeting, however if that is not possible, you can e-mail it or fax it over to the lawyer. Our experience is that once the lawyer starts to see that you speak his/her language, he/she will understand that you are an expert in medical-legal issues and it will open the door for future referrals without ever asking. Do not forget the rules; there is no asking/begging for new patients. Lawyers will send them only because you are the best-of-the-best and your work is admissible.
As always, include your CV with the report. Your ultimate goal is to get into the lawyer's office to educate him/her and his/her staff monthly on the 2 new educational fliers created. Here is the DOWNSIDE: It is a lot of work! Therefore, do not plan on writing this report with every lawyer on every case forever. Once the relationship is created, ask the lawyer if he/she still needs this level of documentation. Usually the answer is no, as all he/she needs to argue a case is the final report. The purpose of this report is get the lawyer's attention so he/she can learn as much about you as he/she does about the client.
If you find it overwhelming, start with a few. However, how many new PI cases do you get weekly? Are 3-4-5 reports per week too much? I would think not and it is a powerful motivator! This is a huge step and the language is critical as the lawyer WILL READ IT, especially the opening paragraph and the conclusion.