Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 235

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.

“You Are Not Everyone's Bitch”

I have received multiple calls regarding requests from insurance companies and their lawyers to send amended reports.First, you have to understand the playing field and your responsibilities. You have the plaintiff's lawyer who is the legal representative of your patient and then there is the defense lawyer. The defense represents the insurance company. It is usual, customary and ethical to be employed by either party, at their request, based upon an agreement between both parties. 
Working for the defense usually places you in the IME category and for the plaintiff, makes you either the treating doctor or an expert on the case if you didn't treat. It is highly unusual to be both the IME doctor and the expert or treating doctor on the same case. In over 30 years in the game, I cannot recall one instance where I knew of a doctor working both sides of the fence. The other thing to understand is that many lawyers will do most anything to win a case and it has been my personal experience that defense lawyers go further in attempting to win their cases. If you watch the money trail, you will understand the incentive for just their one client, the carrier.
Your patient gets hurt and retains a lawyer. That lawyer works for that 1 client hoping to do a good job, so the client refers other clients or friends and family to that lawyer. The likelihood of that client having another accident case is fair to good.  What's the likelihood of the insurance company having another accident case for the defense lawyer to represent? The question is rhetorical because they have 100's to 1000's and it is a 100% guarantee. It's like having a roll of nickels in front of a 5 cent bubble gum machine...You are going to get bubble gum! (I was going to use the $100 bill and the hooker example, but that would be sexist and according to my daughters, makes me a pig, so I won't use it!) The only thing the defense lawyers have to do to secure their futures is win their cases; they don't have to worry about all the marketing efforts to get new clients as it is automatic if they win. If you simply follow the money trail, you will always understand the system.
The latest tactic of defense lawyers and carriers once they receive a narrative report from the treating doctor or expert through either the courts or the plaintiff's lawyer sharing documentation on a case as is legally required, is to contact that doctor independently and request more or appended information. This is done to bolster their argument in defending the carriers to gain the edge to prevail. This is done well before a trial is being considered, so as not to infract the rules of the courts, but once you have put "pen to paper," your words are memorialized and admissible in court. 
Here is Mark's rule for Mark which you may choose to adopt for yourself. If a defense lawyer or a carrier contacts me regarding my opinion, I immediately call the plaintiff's lawyer and have a discussion regarding their needs. This is not about my getting paid or asking for a letter of medical necessity for treatment. This is usually about the disability status or the long-term effects of the patient's bodily injuries.  Once I communicate with the patient's representative, it is a rarity that I comply with the request of the defense lawyer or carrier unless subpoenaed. If I so choose, after a conversation with the plaintiff's lawyer, I charge the carrier or their lawyer $2,500 for the amended report as it is based upon my expert opinion and not as the treating doctor. For that amount of money the carrier will usually pass on the request, but they will try as that is the "tactic du jour."
I am sure (positive) there will be other tactics, but are not everyone's bitch and you are not required by law to work for free. If you don't believe me, just look at the profit and loss statements of the insurance carriers. They are not wealthier than many countries total net worth because they are lucky, they are masters at manipulating the game.

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