Accident cases

[painfree23]

I don’t want anything to do with these accident cases but these patients will sometimes seek me out for “treatments”. I don’t want to deal with the lawyers etc, patients say “they will just pay cash” or lie and say “they aren’t suing anyone”. How do you avoid these cases from entering the clinic or getting involved at all?

This isn’t about why I don’t want to be involved so please don’t tell me the moneys good etc.

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[callmeanesthesia]

Do what I do - tell them the truth: “your imaging is normal - thankfully it looks like you avoided any spinal injury. I recommend PT. Oh, the PT didn’t help? Must not have been a good fit for you. Try a different place.”

 

[wendalltwolf]

This is why I like doing IME’s for simple MSK or back pain after a car accident. You really get an inside look at the whole lawyer-chiro-PCP enabler dynamic.

 

[tmvguy03]

If they ever, EVER, bring up an "accident", be it MVA, fork lift dropped birdseed on them at Home Depot, whatever- I empathize with their pain complaint but always tell them (and document) something to the effect of "This pain sounds like its really having an effect on your life. I am happy to help manage these symptoms, but there is unfortunately no way to make a causal statement about (accident) and your current symptoms"
When I get letters from patients lawyers, I send the notes. If they want a deposition I say sure, pay upfront, and know that I will in NO WAY make a causal statement about the "accident" and current symptoms.

 

[jonnylingo]

If they ever, EVER, bring up an "accident", be it MVA, fork lift dropped birdseed on them at Home Depot, whatever- I empathize with their pain complaint but always tell them (and document) something to the effect of "This pain sounds like its really having an effect on your life. I am happy to help manage these symptoms, but there is unfortunately no way to make a causal statement about (accident) and your current symptoms"
When I get letters from patients lawyers, I send the notes. If they want a deposition I say sure, pay upfront, and know that I will in NO WAY make a causal statement about the "accident" and current symptoms.

This.
I say I will treat the pain, but to make a causal determination takes special training which I don't have. But I know a good Occ Med doc...

 

[Ducttape]

also, dont call it an accident.

call it a motor vehicle collision. the term accident can be construed to provide implications - lack of attention for example.

 

[painfree23]

If they ever, EVER, bring up an "accident", be it MVA, fork lift dropped birdseed on them at Home Depot, whatever- I empathize with their pain complaint but always tell them (and document) something to the effect of "This pain sounds like its really having an effect on your life. I am happy to help manage these symptoms, but there is unfortunately no way to make a causal statement about (accident) and your current symptoms"
When I get letters from patients lawyers, I send the notes. If they want a deposition I say sure, pay upfront, and know that I will in NO WAY make a causal statement about the "accident" and current symptoms.

Wow. I love it . This is what I was looking for. Thanks .

 

[myrandom2003]

How do you handle the billing for this? When they sneak through the door?

 

[painfree23]

How do you handle the billing for this? When they sneak through the door?

Bill their regular insurance . It’s usually after the fact I find out anyway.

 

[jsaul]

When they say - why can't you say that the accident caused it if I had no pain before the mva... what do you say

 

[buddababa]

When they say - why can't you say that the accident caused it if I had no pain before the mva... what do you say

i say that would be fraud or that's lying.

 

[painfree23]

i say that would be fraud or that's lying.

Why?

 

[soccrwz]

Why?

Standard is more likely than not, this gets fleshed out during depo usually. Payment is usually under LOP

 

[painfree23]

i say that would be fraud or that's lying.

Standard is more likely than not, this gets fleshed out during depo usually. Payment is usually under LOP

Ur saying u say it’s fraud if u say the accident caused the pain because the standard is more likely than not??

 

[Laryngospasm]

You can’t usually state with certainty, the phrase “more probably than not” is what the attorneys want to hear from you to help get settlements. Note you will get called to a deposition if there is any question.. I.e. it’s not really obvious. If it is really obvious they will just settle.. often for the insurance maximum. You will get treated like crap by the oppositions attorney in direct proportion to the size of the potential settlement and how much they are being paid. This will go to court sometimes years later.. although often will get canceled the day before. Which is very frustrating.

 

[ateria radicularis magna]

You can’t usually state with certainty, the phrase “more probably than not” is what the attorneys want to hear from you to help get settlements. Note you will get called to a deposition if there is any question.. I.e. it’s not really obvious. If it is really obvious they will just settle.. often for the insurance maximum. You will get treated like crap by the oppositions attorney in direct proportion to the size of the potential settlement and how much they are being paid. This will go to court sometimes years later.. although often will get canceled the day before. Which is very frustrating.

This sounds like a strange world. Tell me more.

 

[nvrsumr]

If pushed by a patient I say the mechanism of injury will not change your treatment so no reason to include.

 

[wendalltwolf]

I’ve always used “related to” for phrasing with anything litigious. We get too used to the “secondary to” wording from our training.

 

[cowboydoc]

I’m concerned good physicians refusal to make a reasonable statement creates a vacuum readily filled by seedy actors.

I do a fair amount of medico-legal. (~5-10% of practice) It’s not hard to opine that “It is more likely than not the condition for which I treated Ms. Smith was aggravated by MVC on (date) based on available records.”

I understand not wanting to get involved, particularly in complex cases, high dollar situations, or with less than reliable pts. It seems some reasonable people get unknowingly dragged into a chiro/$5000 OON ESI/lawyer vortex that could have been helped by a good doc who would be willing to charge a reasonable fee for some insurance questions.

Of course, it’s easy for me to say in a state with a less lucrative PI situation. The tenor is far less contentious for me than what some describe on the forum.

 

[painfree23]

I’m concerned good physicians refusal to make a reasonable statement creates a vacuum readily filled by seedy actors.

I do a fair amount of medico-legal. (~5-10% of practice) It’s not hard to opine that “It is more likely than not the condition for which I treated Ms. Smith was aggravated by MVC on (date) based on available records.”

I understand not wanting to get involved, particularly in complex cases, high dollar situations, or with less than reliable pts. It seems some reasonable people get unknowingly dragged into a chiro/$5000 OON ESI/lawyer vortex that could have been helped by a good doc who would be willing to charge a reasonable fee for some insurance questions.

Of course, it’s easy for me to say in a state with a less lucrative PI situation. The tenor is far less contentious for me than what some describe on the forum.

Do you always say “more likely than not” it was caused by the MVA?

 

[buddababa]

Ur saying u say it’s fraud if u say the accident caused the pain because the standard is more likely than not?

Your question is loaded. If the mri the day before the accident is perfect and after the accident with a huge disc herniation and a compression fracture, then you can say 100% that the accident caused the pain however, its really a case-by-case basis, so I cannot give you a definitive answer on how to go about responding to your attorney for your cases

 

[Agast]

I get a couple of these cases, usually people who aren’t comfortable with the set up their lawyer is pushing them towards and they are familiar with our group. We agree on a fee ahead of time and the lawyer sends the funds. Haven’t had a problem yet. The sketchier ones will gladly stay with the lawyer-chiropractor-pain doctor dream team.

 

[cowboydoc]

Do you always say “more likely than not” it was caused by the MVA?

Not at all. I’m a ref. Call ‘em as I see ‘em.

For example, did an IME last week and indicated the lady’s facet tx was reasonably attributable to her mvc, her lifelong migraines with subjective worsening had no objective evidence of worsening from mvc, and WC has no business holding the bag for that tx.

I will say, we are trained to believe our patients, and I default to believing mine. Early in my career, I got burned a couple times. Now, I think I’m better at identifying BS. I will say something like a) likely related, b) not likely significantly exacerbated, c) I find no objective evidence of a problem, d) I’m not able make an objective opinion.

edit: fixed autocorrection for clarity.