Academy of Chiropractic’s

Lawyers PI Program

#253

From the Desk of:

 Mark Studin DC, FASBE (C), DAAPM, DAAMLP

"A Radical Change in Narrative Policy & Functional Losses"

  

As a result of recent court rulings and feedback from lawyers in many states, I have changed the conclusion in the narratives and how we gather information on functional losses. In the past, it was recommended that you report functional loss and limit it to only 'what had persisted after a reasonable amount of care had concluded.' It was felt among lawyers nationally that what mattered the most was the permanent losses involved and everything that was transient was relatively insignificant. That is what I have been teaching for years. That has changed.

Recent rulings have held that the amount of time of the disability or loss of function is paramount in certifying bodily injury and lawyers nationally are prevailing in pain and suffering due to that functional loss persisting over time.Therefore, I am strongly recommending that we include the initial loss of function, personal, social and family, and certify what has persisted and for how long. 
 
It is now recommended that you have your patients fill out a functional loss assessment prior to the first treatment and include a comparative analysis in the conclusion of your narrative. If you do not have a good functional assessment form, you can get one at http://lawyerspiprogram.com/index.php/forms-a-templates. However, most of you should have one already as it has been a requirement for the concluding examination process.
 
In your conclusion, you should have language that is reflective of the following sample:  
 
Functional losses reported on the first day of care, January 5, 2011
 
Personal Limitations:  “I have become very agitated. I can no longer pick up my infant daughter or play with her at all. When I wake up in the morning, I have neck and back pain so severe that I cannot brush my teeth, comb my hair, or get dressed without severe pain and I require assistance. I can’t reach over my head, stretch my legs or bend. I feel like I’m being stabbed in the back at all times. I am totally unable to have any sexual relations due to the pain in my neck and back. I cannot sleep for more than 2-3 hours when the drugs wear off as a result of the pain and I am unable to do any house or yard work at all due to the pain.”
                                
Social Limitations:  “I cannot go to movies or concerts because I can’t sit for long periods of time without pain. I cannot play touch football, basketball or walk for more than a few brief minutes, as I did prior to the accident, due to the pain in my neck and back.  I am unable to drive secondary to the pain and when in a car, whenever I hear a horn or screeching brakes, I am afraid I’m going to get hit again.”
 
Work Limitations:  “I am an automobile mechanic. I can’t lean over the car due to the pain, therefore, I am unable to work at all.”
 
Functional losses reported that have persisted through a follow-up examination dated February 8, 2012, 399 days later and now deemed permanent after a reasonable course of care has been concluded. 
 
Personal Limitations:  “I have become very agitated. I can no longer pick up my infant daughter. When I wake up in the morning I have neck and back pain. I can’t reach over my head or stretch my legs. There are times when I feel like I’m being stabbed in the back. I am also having difficulty during sexual relations due to the pain in my neck and back.”
                                
Social Limitations:  “When I go to movies or concerts, I can’t enjoy them because I can’t sit for long periods of time without pain. I tried to play touch football and shoot basketball as I did prior to the accident, but I have difficulty due to my neck and back pain and limitations with my arm; I can no longer play. I can only walk for 30 minutes where before the accident I could walk for 2-3 hours. I have a fear when driving in the car. Whenever I hear a horn or screeching brakes, I am afraid I’m going to get hit again.”
 
Work Limitations:  “I am an automobile mechanic. I can’t lean over the car for a long period of time. When I use my right hand to hold tools for a long period of time, I get pain that shoots up to my neck and down to my lower back. I have to stop from time to time and rest so it’s hard to finish repairs in a timely manner. I have also changed my job from a full-time mechanic to a part-time mechanic and a part time service writer, reducing my pay by 30%.”