Chiropractor Pitfalls

Five Ways Chiropractors Ruin Their Patients’ Personal Injury Cases

Chiropractic bills and records have always been under assault by the insurance company, but the process is getting much worse. With more reliance on computer models and programs that scan medical bills and records, insurance companies are using chiropractors to attack their patients’ personal injury claims without them even realizing it. Mistakes or problems in the chiropractic records have become a primary attack on plaintiffs during settlement negotiations and at trial.  The following is a list of the most common attacks we see as it pertains to chiropractic medical and billing records:

1. Typographical Errors

I am routinely shocked at the number of mistakes in medical records from hospitals, large orthopedic offices, and even chiropractic offices.  These often small mistakes have a huge effect on the patient’s personal injury claim because the insurance company and their lawyers are going to present those mistakes as absolute fact to a jury.  The patient might testify that he or she has never had another car accident, but if the records notate that the patient had an accident in April of 2019, instead of the correct May of 2019, then the insurance company is going to present the patient’s failure to disclose her “April accident” as fact to the jury.  The chiropractor can save a patient’s case by taking an extra minute to ensure that the patient’s history, past treatment, and dates are correct.

2. Copy and Paste Records

Insurance companies love attacking chiropractors and medical providers who copy and paste the same History, Examination, Assessment, and Plan sections into the records for each date of service.  Insurance company lawyers have started pointing out to jurors how these sections are often repeated without any notated change in the patient’s condition.  Insurance lawyers often insinuate that the chiropractor is “lazy” or is “money-hungry” and cares more about their bill than patient care through their “form records.”  Assuming that the patient is receiving some benefit from the treatment plan, the medical records should reflect the improvements in the client’s condition throughout the course of that treatment.

3. Pain Scale Number Discrepancies

I believe that chiropractors often fail to properly explain the pain scale to their patients.  For example, a patient who is able to walk, talk, and carry on a conversation should never have their pain listed as a “10 out of 10” on the pain scale.  For example, a chiropractor can help the patient provide a correct response by explaining to a patient that a “10 out of 10” on the pain scale is equal to childbirth.  Childbirth, for example, is a good benchmark that most people can understand when rating their pain.  Similarly, a patient’s pain should not be a “2” then increase on the next visit to a level “8,” as such an increase signals to the insurance company that the patient likely suffered a new injury.

4. The Word “Chronic”

Using the word “chronic” in any context is damaging for a patient’s personal injury claim.  Insurance companies employ computer programs that scan thousands of pages of medical records in search of buzz word. One such word is “chronic.”  “Chronic,” when used in medical records, is argued by insurance lawyers to mean “pre-existing” even if it is meant to mean “chronic pain since the accident.”  “Chronic” and “pre-existing” have become synonyms in the legal industry.  Unless you are intending to describe your patient’s condition as pre-existing the accident, the word “chronic” should be avoided if at all possible.

5. Billing Errors

Lastly, I understand that how certain procedures or treatments are coded can greatly affect the compensation rates for chiropractors, but sometimes, the way that the treatments are coded can have a large effect on a patient’s injury claim.  For example, assume you had a patient who has been treating with your office for back pain before a collision, but no neck pain.  Then, that patient gets in a car accident and has new neck pain complaints.  The insurance company is likely going to request all prior records for the patient.  If the prior billing codes show “manipulation – all regions of spine,” then that client now faces the argument her neck pain predated the collision.  Similarly, after a collision, coding your bills as “manipulation of all regions of the spine” when the patient has only neck pain complaints can jeopardize the compensation for your full bill.  Coding procedures properly can protect your patients ‘ injury claims and your bill.

 

We see most often those five pitfalls where chiropractors can have a large effect on patients’ personal injury claims.  By making these minor adjustments and putting safeguards in place to ensure that the records and bills are both accurate and correct, you can help your patient receive all the compensation that they are justified to received.

If you have any questions about your bills and records, or how we could help one of your patients, please do not hesitate to call at 678-935-6000.  We are happy to provide any guidance or suggestions.

Health Insurance

Health Insurance Car Accident Letters

Individuals call my office frequently after receiving a letter from their health insurance provider asking for more information regarding the cause of their injuries. Few people know why they are receiving this letter or how they should respond. The letter could come from Aetna, Blue Cross Blue Shield (BCBS), United Healthcare, Kaiser, Humana, Cigna, Coventry, or one of many others. Allow us to explain why your health insurance company is contacting you, and why you need an experienced personal injury lawyer to help you respond properly to the health insurance car accident letter and prevent the loss of your health insurance coverage.

When the insurance company sends you a letter asking about the cause of your injuries after an accident, they are seeking to collect information to enforce their right of reimbursement or subrogation rights under the terms of your insurance contract. You might not remember signing an insurance contract, but you likely agreed to the terms when you applied for the health insurance coverage. One of those terms you accepted likely requires that you pay back your health insurance provider from a settlement if you are ever injured because of someone’s negligence. Health insurance car accident negotiations are almost always best left for an attorney.

Most insurance contracts contain a health insurance car accident right of reimbursement. This means that any time your health insurance company pays for your medical treatment related to a car accident, slip and fall, dog bite, or some other injury, you are responsible for reimbursing them from any settlement or jury verdict for the amount they paid. This applies even when the settlement is minimal. Failure to pay back the health insurance company means that they could have sufficient grounds under the law to drop your coverage!

Do not think you can just hide the information from the insurance company and they will not find out. The negligent party’s insurance company will likely report any settlement. Plus, the terms of your health insurance contract likely also require that you cooperate by providing injury and settlement information. Failure, by you, to provide the information as required could cause you to lose your coverage.

Having an attorney guide you through the health insurance car accident process critical. These health insurance car accident subrogation rights are extremely complicated. For example, if you receive health benefits through your employer or the employer of your spouse, you might be violating federal law by not cooperating and reimbursing the health insurance plan. Federal law is very strict on which employer funded plans are legally entitled to be reimbursed. Only an experienced attorney can tell you which employer’s plans have that right.

Certain government health plans have even stricter and more complicated requirements. Medicare, Medicaid, the V.A., and others all have their own specific requirements. Medicare’s processes are the most complicated. Failure to follow all of the federal requirement with Medicare could cause you to experience a denial of Medicare claims.

You need an attorney that will not just settle your case, but will also ensure that all health insurance car accident rights of reimbursement are handled so that you do not face a future loss of health insurance coverage. You might think that you can save some legal fees by handling your own case, but failing to comply exactly as the law prescribes for your specific health plan could have devastating consequences.

Our firm routinely handles cases with health insurance car accident reimbursement implications. We take all of our personal injury cases on a contingency fee basis, which means that you do not have to worry about paying any legal fees from your pocket. We simply take a percentage of the settlement. Unlike some other lawyers, we do not take any additional amount for resolving any potential health plan or government right of reimbursement or subrogation issue. We consider this an added benefit for our clients as a thank you for hiring our firm. We will fight to ensure that the amount you are required to pay back is as low as possible and give you peace of mind knowing you don’t run the risk of losing your coverage.

If we can help you with a personal injury matter and the potential complications associated with health plan rights of reimbursement, call us at (678) 537-1209 or contact us on our webpage. We would be happy to answer your questions.