Dr. Bill Gallagher 2013-03-06 00:41:56
Does the Doctor Make or Break Your Cases? Dr. Bill Gallagher, DC has been in practice 25 years with half of that here in the valley. He practices Directional Non-Force Technique and his research for the technique has led to improvements of adjustments in all areas of the body. Besides his private practice he is the founder of a non-profit that helps schools and organizations stage a Run Drugs Out of Town Run for kids. He can be reached at 480-664-6644 or firstname.lastname@example.org Between what you learned in school and the skills you have developed as a negotiator there is still a limiting factor when it comes time to settle a personal injury case. The thing that will make or break any case is the information the doctor provides to you. Insurance companies have their cost containment measures programs that will calculate the value of a case. Regardless of which of the 80 programs your client is facing the thing that they have in common is the information they use to score a case, the information from the doctor. Combined there are 43 decision points and value drivers of which 30 are medical and 13 are legal and administrative. Each of these that the insurance adjuster enters into their program translates to points and the points translate into dollars. The more points the more dollars. Since the bulk of those points, 30 of the 43 come from the doctor the strength of your case depends in great part on how well the doctor documents everything. Precise Diagnosis For a personal injury case where everything may come under greater scrutiny a generalized diagnosis is worth far less. Most doctors will document headaches but few will be more specific. In the scoring systems used by insurance companies a headache is worth points, a traumatic headache is worth more points and an occipital headache is worth even more than a frontal headache. Likewise with a shoulder sprain/strain injury that is so common when the seat belt locks the diagnosis should identify which of the three major ligaments are sprained and which muscles have been strained. The 30 decision points and value drivers for the doctor include not only the injuries but documenting the intensity, frequency, radiation and more. If these are not included then the diagnosis will not be supported and as such not considered by the insurance company. Precise Language There are terms that have been used for years that if used today will de-value your case. Three terms a doctor should not use and you should not include in your demand letter are whiplash, soft tissue injury and disc protrusion. Whiplash is better broken down to the parts, especially ligaments that have been damaged. A diagnosis of whiplash allows the insurance program to address one diagnosis. Breaking it down to its parts; ligament laxity, muscle spasms, occipital headaches . . . creates a list of problems that will have to be addressed and scored by the program. Soft tissue injury likewise is a generalized term that will create less value than being specific as to which soft tissue structures have been injured. Finally, a disc protrusion in most insurance company programs will have less value than a bulge or herniation Next year when the ICD-10 diagnosis codes come into play there will be greater specificity built into any diagnosis. The doctor you want to work with is the one who is not waiting until next year. Preponderance of Evidence When presenting a claim any attorney will want to hold the preponderance of evidence. Likewise the doctor should want to know exactly where the problem is so that the appropriate diagnosis, treatment, supportive therapies and bracing can be provided. X-rays can rule out a fracture and may indicate ligament damage. A flexion/extension study may demonstrate ligamentous instability. A CRMA study (Computerized Radiographic Mensuration Analysis) will measure the extent of the ligament damage and if there, will provide a 20 to 28% impairment rating. The more specific the testing, the better your case will be. The last thing that should be included in any case you take to an insurance company is a whole person impairment rating per AMA Guides 6th Edition. This one will not only add points but will also make it more difficult for the insurance company to devalue the case. Greater Weight Challenge The AMA Guides clearly grant the greater weight to the treating doctor who has had the most face to face time with a patient. Next in line is a specialist who can overrule a treating doctor’s finding only if their findings are not properly documented and supported. Above all the greatest weight goes to fact over opinion. Separating objective findings from subjective will tip the scales in your favor. To find out what else you need from the doctor email me at email@example.com or call me at 480-664-6644.
Published by Target Market Media . View All Articles.
This page can be found at http://digitaleditions.walsworthprintgroup.com/article/CHIROPRACTIC+THERAPY/1337161/149408/article.html.