3 Essential Personal Injury “Rules” of the Road

For many clinicians the Personal Injury arena is oftentimes a confusing, aggravating and frustrating place. Frequent questions and concerns include: What are the latest Personal Injury clinical documentation requirements? "How do I protect my bill?" "What do the auto carriers want from me?" "How do I navigate around in the current med-legal landscape?" and of course the ever-popular "How do I get more Personal Injury patients?"

While you may not actively market or seek Personal Injury patients into your practice, nearly every clinician will end up treating these patients, if only by default. The "rules" of Personal Injury do not have to be arcane and esoteric; a few simple changes can improve your practice and increase your collectability while mitigating your exposure to risk and liability.

Unfortunately, many clinicians only find out about the PI "rules" when their cases approach settlement or are settled, usually many months to a couple of years from the time you released the patient. At that point being blissfully unaware of the "rules" can cost you excessive reduction requests of your bill. But even worse than losing several thousands of dollars (as if that is not the worst) are the lost PI referrals and future revenue.Personal Injury Documentation

So, instead of being reactive, let's take a shot at being proactive and see if we can avoid a few unintended consequences.

We will take a look at 3 Personal Injury "rules" that apply to all states, are fairly constant and when applied can help improve your practice, provide you protection and assist in the payment of your bill.

The first "rule" is include a strong causation statement in each of your Personal Injury patients’ treatment records. A causation statement is mandatory in the med-legal arena to relate your patient's injuries to the accident. Most clinicians see accident causation as obvious, one day your patient was allegedly asymptomatic, then there was an accident/injury and now the patient has symptoms.

Nevertheless, in the med-legal arena a causation statement must be stated clearly, concisely and be supported with the necessary med-legal language.

Causation statements based upon "my experience, my clinical opinion or just because there are injuries, etc." are weak and will easily be repudiated by the defense insurance carrier and their attorney.

Once you have gathered and analyzed all the necessary data, clearly document your causation statement in the assessment or plan section of your daily treatment record. By the way, it is extremely rare that you have all the information to include a quality med-legal causation statement on the initial patient visit.

Another "rule" that will improve and protect your Personal Injury cases is to provide excellent clinical documentation. Shocking!

You already know, Personal Injury documentation requirements are very specific and unlike the documentation required by any other type of patient financial class. Excellent documentation can be made easier when you have the right Personal Injury specific tools and procedures in place.

As an example, during your initial knee-to-knee PI history, an effort should be made to capture all your patients' accident-related symptoms, whether you plan on treating them or not. Having a Personal Injury specific history form or EMR software that allows for this level and amount of documentation specificity will aid significantly in the process. So many clinicians are held back because their EMR does not allow them to document Personal Injury successfully. (probably contrary to what you were told at the time of purchase)

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Accurately recording all conditions, injuries or symptoms, including those that fall outside the scope of your license, in your initial history documentation starts a process so they may eventually be evaluated and treated by other specialists. Your initial history is paramount for setting a foundation not only for your treatment but any necessary accident-related treatment the patient may require in the future.

Just this one documentation error makes it harder for your patient and their attorney to have those symptoms, injuries and/or conditions evaluated and treated later on. Also, when you fail to document or ignore accident-related issues because "I don't treat those" you increase your own risk and liability.

The third "rule" and one that will aid in your collectability, is to provide quality med-legal reports. These can include initial and periodic interim reports but should definitely include a final summary report. In today’s Personal Injury environment it is simply not good enough at the end of your cases to only produce your treatment records and bills to those that are trying to get you paid.

By now you should know one of the jobs of the adverse insurance carrier is to scrutinize all the treating clinicians treatment records and/or case management. Typically this is done in an attempt to find certain issues, inconsistencies, flaws and deficiencies within the treatment records and management.

So what may appear as a small or non-issue to you can raise questions or concerns by the adverse carrier. They then magnify these in an attempt to reduce settlements, cast doubts or intimidate. One of the benefits of your final summary report is that it attempts to dispel the most common med-legal issues and arguments BEFORE they arise.

Keep your final report factual, succinct and explanatory while summarizing all the treatment and management. A final summary report written by the treating clinician carries a significant amount of value in assisting in the settlement process. In case this was of interest, it helps to get you paid!

By the way, I'm not speaking about a narrative report or one that includes literature citations. That type of report does not dispel but only invites scrutiny and challenges.

Personal Injury is a collaborative effort between clinicians, patients and med-legal professionals. Being aware of certain "rules", staying ahead of the Personal Injury curve and applying these concepts can facilitate your patients’ settlement, increase your potential referrals, separate you from your competitors and improve your marketability.


S Scott Tauber 
S. Scott Tauber, DC, DABCO, CPC

Dr. Tauber is COO and lead instructor of the American Institute of Personal Injury Physicians (AIPIP). He received his Doctor of Chiropractic degree in 1984 from Life Chiropractic College and is both a Diplomate of the American Board of Chiropractic Orthopedics (DABCO) and a Certified Professional Coder (CPC). Dr. Tauber is a frequent guest speaker at professional and med-legal conferences, state association events and professional schools and has been published in state and national journals.

JTECH is hosting an encore webinar with Dr. Tauber, Personal Injury & ICD10 - Potential Impact to Your Practice on October 8, 2015. Attendance is $49.

AIPIP Website   Personal Injury & ICD10 Webinar  JTECH Documentation Systems 

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I agree that the personal injury should be recorded meticulously as the patient might need it also should they decide to file a personal injury case. The documentation would be extremely helpful.