Academy of Chiropractic’s
Lawyers PI Program


Build Your Infrastructure #133

 

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


"Gap in Treatment Before Care Starts"

 

At least 2-3 times per year while I was actively practicing, patient initiated care from an accident that occurred 5-6 months earlier and wanted me to bill the personal injury carrier.
 
In New York, the law states that an injured party has 1 year, post accident to institute care. In Florida, the new legislation allows for only 14 days. These 2 scenarios are examples of the extremes in the nation. This is an issue for the carriers and also creates issues for you downstream and it is not always about getting paid.
 
The reason; the lawyers. Lawyers will, 100% of the time want you to causally relate the accident to the current care of the patient and that can create a host of issues.
 
First, you need to verify with your state's department of insurance as to what the regulations allow for in the time after an accident to start care. You do not want to find yourself treating a patient for 5-6 months, only to find out there is no coverage. If you do, please get pissed...at yourself for being a crappy business person. The people that need to know this beyond you is your front desk and billing staff who should qualify each new patient's insurance. There should be a business system in place where there is communication between the front desk and insurance qualifier where your patient can be communicated to either before or during their first visit with coverage parameters.
 
That is good business.
 
Hypothetical; you are on the witness stand and the defense (insurance company) lawyer asks to following:
 
Defense Lawyer: "Dr. Studin, you started Mrs. Jones as a patient on July 1, 2012, is that correct?"
 
Dr. Studin:" "Yes"
 
Defense Lawyer: "Did that patient have neck pain"
 
Dr. Studin: "Yes"
 
Defense Lawyer: You previously testified that the competent producing cause of Mrs. Jones pain was the accident on January 1, 2012, is that correct?"
 
Dr. Studin: "Yes"
 
Defense Lawyer: Dr. Studin, Mrs. Jones works in a factory as a machine operator, is it possible that Mrs. Jones, while lifting or working COULD have caused the same problem?"
 
Dr. Studin: "No, I stated he accident was the competent producing cause of Mrs. Jones pain "
 
Defense Lawyer: "Dr, Studin, I didn't ask you that question, I asked you if her job COULD HAVE caused the same problem, hypothetically?"
 
Dr. Studin: "Yes"
 
Defense Lawyer: " Dr. Studin, Mrs. Jones drives 2 hours each day as a minimum commuting, do you know if she was in another accident in the last 6 months?"
 
Dr. Studin: "No I do not know?"
 
Defense Lawyer: "Dr. Studin, would you agree that in 6 months, a person who has an active lifestyle can injure themselves or a physical occupation daily for 8-10 hours per day can cause Mrs. Jones pain?"
 
Dr. Studin: "Yes"
 
Defense Lawyer: "Dr. Studin, have ever treated Mrs. Jones during the time frame between her accident and starting your care 6 months later?"
 
Dr. Studin: "No"
 
Defense Lawyer: "Dr. Studin, have you been with Mrs. Jones continually for the last 6 months?"
 
Dr. Studin: "No"
 
Defense Lawyer: "Dr. Studin, then you cannot say with a great degree of medical certainty that Mrs. Jones has not had any additional traumas or situations that could have caused the same pain or bodily injury, because she didn't start your care until 6 months after the accident and you were not with her and didn't know her during that time frame, is that true?"
 
 Here, you have no choice...the answer is
 
Dr. Studin: "Yes"  
truth
This is what a good defense lawyer will do in the courtroom. Therefore the most you can say in your reports and to the plaintiff's lawyer is:
 
"The bodily injuries are consistent with the patient's history of the accident dated January 1, 2012."
 
The lawyer will pressure you to write more, but you CAN'T because there really, really is so much that can happen to a patient in 6 months of time. The other side of the story is if...there are significant injuries that could never have been caused by a "non-trauma" scenario what will 99.9% of patients do? In those case, the patient will be in significant pain and I have only experienced 1 case in 31 years where a patient did not receive care as they chose to self medicate as a result of "white coat syndrome." Fear of any doctor.
I would agree that is such a rarity, I would be afraid to even suggest that and submit to you, that any patient with significant problems DO see doctors relatively shortly after the accident; within the first few days, to 1-2 months at the most.
 
Those patients who do self-medicate, usually suffer from side effects from overdosing on over the counter medications, that they seeks help soon thereafter. The "tough ones" who hold out, usually can last 4-5 weeks at the most.
 
Do not let yourself get pressured by a lawyer to say more, because you cannot truthfully say more than that...and this is always about the truth. If you think you can push the envelope, realize that even a BAD defense lawyer can follow the previous scenario and discredit your opinion as an expert because all they need to do is put a seed of doubt in the jury's mind and they win the case. However, this is not about winning or losing a case, because I could care less about winning or losing, I only care about telling the truth in as vivid a way as possible.