Personal Injury Q&A

Dr. Liberti offers free webinars to teach doctors of all levels how to become involved in personal injury or how to improve their practice at both the clinical and administrative levels. We spoke with Dr. Liberti about the field of personal injury, its benefits, and some of its challenges.

Dr. Frank Liberti, D.C., began his personal injury career by setting several precedents in the field. In the late 1980s, New Jersey passed a law—called the Serious Injury Threshold law—which effectively banned lawsuits for low-impact automobile accidents by instituting a minimum injury threshold.

By 1992, everybody whose industry involved whiplash injuries had been negatively affected by this law. Dr. Liberti decided to fight back, and did copious amounts of research into the issue, eventually uncovering federal guidelines that overrode the law New Jersey had passed. That same year, Dr. Liberti wrote a book on the issue, and set precedent by testifying at the Supreme Court level on how to evaluate low-impact automobile accidents and assess whiplash and personal injuries. He was also invited to address the Judicial College—the only chiropractor to have ever done so—to teach them the ins and outs of the law and the industry. The New Jersey law was invalidated and Dr. Liberti established himself as the premier expert in the field.

Since these firsts, Dr. Liberti has continued to advance the field through training chiropractors in the best practices for personal injury, allowing them to offer these treatments in their own practices. At the same time, he has written several books on the subject, including the forthcoming book Unfair and Unrealistic Low-Ball Settlements Not Accepted.

What are some of the benefits of adding Personal Injury (PI) to a chiropractic practice?

Treating personal injury patients provides the opportunity to prove how effective chiropractic medicine is, and how knowledgeable chiropractors are. These injuries are truly musculoskeletal, which involve nerves, ligaments, muscles and often discs. The 5th and 6th editions of the American Medical Association's Guides to the Evaluation of Permanent Impairment (AMA Guides), places a heavy emphasis on ligament damage, and chiropractic medicine is the best method for treating this type of injury. Personal injury is an intricate part of our profession regarding both the injury types seen and treated, as well as its sub-specialty application. Treating personal injury is like having a "practice within a practice.'

Many chiropractors are afraid of PI because of the paperwork, attorneys, and other administrative factors. But with the tools and software available today, treating these patients becomes simplistic, the paperwork mostly gets handled for you, and this all culminates in fulfillment of practice purpose and financial goals.

Statistics show that PI is an incredibly active field: the National Traffic Safety Administration estimates that roughly 80 million individuals are affected by a low-impact automobile collision each year. These accidents often result in musculoskeletal injuries that need to be treated. If treated correctly, these injuries are reimbursed favorably by insurance companies, and the field is not affected by any of the recent healthcare reforms.

How does a doctor get started in treating PI, and what are some things they can do to ensure their success?

These areas have a lot in common: to both get started in treating PIs and to do so successfully, one has to make a commitment to learn how they are performed at the clinical, administrative, and marketing levels—particularly the first two.

For example, clinically, a doctor must be able to correctly diagnose an injury. When it comes to a minor car crash, there are seven major injury types, and the doctor must diagnose, treat, and represent these correctly on documentation. The chiropractors who understand and incorporate methods to establish the preponderance of evidence and win the "Greater Weight" Challenges, are the ones who will ultimately receive the bulk of referrals from their local attorneys, and establish themselves as the best practice medical experts.

We incorporate the ability to document s.o.a.p. notes not only according to the AMA Guides, but the Injury Model which encompasses the DBI's, DRE's, specific disorders of the spine and spine impairment summary. This thoroughness is what gives the DC the competitive advantage, even over his peers. Today, the injury evaluator must list every affected body part and function involved and the respective issue, as well as the chapter, the table and the page of the Guides according to which he assessed the injury.

At the administrative level, the doctor needs to understand the paperwork, the billing and coding, and the involvement of attorneys in PI cases. Doctors must get the proper education in these areas in order to be the most effective of competitors, and to be consistently and predictably successful at doing so.

The free webinars that I'm offering with JTECH Medical cover these areas for the doctor at every stage of practice experience: from the beginner to the advanced PI practitioner. We will provide a syllabus and dates to any interested doctor.

How are doctors paid for PI cases, and why might some doctors receive different amounts, or not get their fees covered by independent medical evaluators?

The insurance companies determine the payout for cases based upon certain decision points. For PI, there are 43 decision points that must be met, of which 30 are medical, and 13 are administrative, economic, and legal. So, the doctor is responsible for a large majority of the decision points that result in being reimbursed and determining the value of the case.

Currently, the average number of decision points being met for minor automobile accidents is only nine out of 43, and most of these are being missed by the doctor. This discrepancy can be attributed to clinical issues with documentation, representation, and matching the injury types, and impairments to the loss of function and loss of enjoyment of life and duties under duress.

In addition, the insurance companies use a type of filter system of injuries, where the symptoms must match the diagnoses (which can easily run into double digits), and the treatment, prescriptive devices, and services must be supported by specific objective and diagnostic tests that also support the plan.

Parameters have been set by the insurance company in these areas, and the injury type, diagnoses, diagnostic tests, and treatment plan all need to align with the percent of whole person impairment, duties under duress, and loss of enjoyment.

What roles do objective tools and software play when it comes to treating personal injury patients?

In strict compliance and accordance with the latest editions of the AMA Guides, the nerve injury is of great significance, and this is good news for the chiropractor due to our understanding of such injuries. AMA protocol calls for the use of monofilaments for dermatome involvement, and the use of electronic muscle testers to establish myotome involvement. Since the AMA places such emphasis on radiculopathy (nerve disorders), today's chiropractor must step up to the plate and equip himself with these minimal diagnostic tools. A chiropractor treating PI without a muscle tester is like a dentist practicing without a drill: to treat PI correctly, you simply must have these objective tools.

Insurance companies use sophisticated software that reviews cases to see if they meet the decision points. In turn, I created a s.o.a.p. note system that a chiropractor can use to ensure that he/she progresses logically and methodically through a PI exam, catching every symptom, and meeting each of the 30 medical decision points that the insurance companies use to reimburse and determine claim value.

What is your approach to treating PI cases? What are some of the successes doctors are finding by using your approach for their PI cases?

My program ensures that you methodically move through a PI treatment, matching injury type with diagnoses, loss of function under duress and loss of enjoyment, percent of whole person impairment, specific disorders of the spine, spine impairment summary, AMA Guides, 5th and 6th Edition, DBI and DRE Categories, diagnostic tests, and treatment—all with ease and simplicity. Otherwise, one would have to study these areas for months of continuing education; instead, we now have a S.O.A.P. system that can document it all in under two minutes.

Effectively treating your patient also goes hand-in-hand with receiving positive settlements from the insurance companies. When you diagnose, treat, and represent the injury correctly, you ensure that you fully treat the patient, and also provide quality documentation that meets the requirements of the insurance companies to the patient and attorney. This is called establishing the preponderance of evidence: meeting evidentiary burdens of proof that soft tissue injuries meet injury thresholds, which wins the Greater Weight of evidence challenges, and eliminates varying medical opinions.

Doctors also can gain the competitive edge by solving the attorney's problems. When it comes to PI cases, there are always two opinions. Using my approach, today's chiropractor can learn to become the opinion of choice by establishing the preponderance of evidence through an adherence to the AMA Guides and the protocol listed above.

Using this approach, we are documenting injuries to the fullest, winning the "greatest weight of evidence challenge," which significantly enhances settlement value, speeds up the process for case settlements, handles litigation obstacles, and reduces or eliminates independent medical evaluation denials.

These factors make the chiropractor the sought after doctor by both patients and attorneys in their community

What do you see for the future of the PI market?

There may be individual states and political environments that attempt to suppress the industry; however, this will have little to no effect on PI. There are more cars, more people, and more accidents than ever before, and this will only continue to increase.

This is a niche, untapped market, which statistics show is continually increasing. Currently, this market that will never go away is being tapped by only the fortunate few. There has never been a better time in the history of our profession to practice PI.

For more information about Dr. Liberti, please visit his website at    JTECH Medical

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