The world of the personal injury lawyer has also changed.
Myth #1: Insurance Companies Are Fair
The unsuspecting patient/client have been "brainwashed" by years of propaganda that a lawyer is not necessary in personal injury cases: that the client will get a fair deal as a result of negotiating directly with the insurance carrier. Nothing could be further from the truth. Statistics compiled over many years of study indicate quite to the contrary.
Insurance adjusters, when dealing with the unrepresented person, often attempt to steer patients away from doctors of chiropractic to MDs who work hand-in-hand with the insurance companies to lower costs and keep treatment to a minimum.
Myth #2: Three Times Medical Bills
The common perception is that a settlement of a soft-tissue injury case should equal three times medical expenses plus loss of earnings. This is neither the view of the DC nor the attorney handling the case, but it has permeated the mindset of the "average" client/patient involved in an accident.
There used to be an unwritten "rule of thumb" that in a soft tissue injury case, "three times the medical expenses" was one of the tools which could be utilized in arriving at fair value.
Times have changed. Unless the personal injury attorney wishes to have his expectations destroyed on a daily basis, the anticipated offer in modern times is no more than two times reasonable medical expenses: "reasonable" defined as the medical expenses reduced by the deadly peer review.
In comparing the "average" offer for a "typical" soft tissue injury case, the case that would have brought an offer of $10,000 a decade ago, will likely bring an offer of $5,000 today. Here's why.
Suppose that all medical providers' charges (including the DC's) total $3,500. The peer review process (as described above) will result in the insurance adjuster adopting the position that the $3,500 consists of overtreatment, and that the bill should have been no more than $2,500. The adjuster will then apply the unwritten "rule" of two times reduced medical expenses, yielding an offer of $5,000.
In some states, California, for example, the right of a not-at-fault uninsured motorist to place a claim for personal injuries has been eliminated. This further erodes the ability of the victim to collect and obtain appropriate medical care.
The unfortunate result of this massive reduction in payment of claims is to force cases to be litigated which would otherwise not be litigated (discussed below) and/or mandate the personal injury attorney to request significant reductions from the DC in order to have any possibility of settling the case.
Myth #3: DCs Are Respected by the Insurance Industry
While "lip service" may be paid to this notion, the fact is that an adjuster often discounts the value of a case if DC care has been provided, as opposed to the care of an orthopedic surgeon. This author is told that the reason for such prejudice is that the orthopedic surgeon's bill is usually low, while the DC (who is providing valuable hands-on care) tends to "run up" charges.
The truth has nothing to do with quality of care or the needs of the patient. The insurance companies prefer small bills versus charges commensurate with the level of care provided. There is constant pressure by insurance adjusters to force the attorneys to "route" the patient to MDs. The MD will opt for the "Here's a pill and I'll see you in 30 days" approach and charge a fraction of what DCs charge for their services.
Myth #4: The Patient Will Be Provided the Amount of Care Needed
The extent of impact should have little to do with the amount of care prescribed. The difficulty, of course, is that one of the most often-used defenses by insurance companies and defense counsel is that too much care was provided relative to the extent of impact. We all have encountered situations in which what appears to be a mild impact accident has resulted in very significant injuries, while in other accidents there is little damage to the body, but the impact was so severe that the patient shouldn't have walked away alive. Insurance companies continue to promote this favorite non sequitur.
Since the practice of chiropractic and the practice of law are not only professions but businesses as well, and since businesses need dollars to survive and dollars come from settlements, the insurance industry has cleverly forced many doctors of chiropractic and attorneys to conform to the non sequitur. Many DCs now provide care based upon the extent of impact. This author knows one DC who measures the amount of care precisely by the amount of property damage. An $800 impact equals $800 worth of treatment. A $2,500 impact equals $2,500 worth of treatment.
While unfortunate, this approach, not as precisely defined as the cited example, is one being routinely followed.
Myth #5: An Exhaustive Report Counts
The thorough report of the DC fresh off the word processor for which the DC may charge several hundred dollars is professional in appearance and probably unnecessary.
Experienced insurance adjusters have seen thousands of such reports and simply flip through the pages to final diagnoses and the disability statement. All would be better served with an abbreviated report at much lower cost detailing the tests accomplished, the findings, the prognoses and the diagnoses. And most importantly, a specific discussion of residuals not in general terms, but relating the restrictions on the patient's life in personal terms. Language such as "guarded prognosis" is not sufficient.
What is it precisely that the patient cannot accomplish any longer or as well? In this day and age where soft tissue injuries are minimized by insurance carriers, the way to boost value is by emphasizing residual problems the patient continues to experience at time of discharge.
Myth #6: Attorneys Will Do What Is Right and Litigate Unfair Offers
This is no longer accurate to a large degree. If attorneys would litigate most cases where offers are unrealistic, the attorney would quickly have to close his doors. The staple of any volume personal injury practice is the settlement of soft tissue injury cases and the litigating of higher dollar cases involving fractures, surgeries, paraplegia or quadriplegia.
While the "average" attorney will occasionally "keep the insurance company honest" by litigating poor offers, this cannot be done often in the present climate of poor offers.
The unfortunate consequence experienced by most DCs is the constant request for reduction of charges. This is a present fact of life. Without the reduced charges, the attorney cannot effectively settle the case. Without settling most cases, he cannot stay in business.
Conclusion
An expression comes to mind: What does a 1,000-pound gorilla do?
Anything it wants to!
Another way of looking at the situation is to consider the adage: "Them that's got the gold makes the rules."
The insurance companies didn't need no-fault insurance. The collective corporate light has dawned. All they needed to do is exactly what they have done: tighten up on paying anything at all for spurious claims and becoming stingy with respect to payments for good claims.
This has resulted in a tremendous shake-out regarding personal injury cases. The effect has been no less severe on doctors of chiropractic who work with personal injury attorneys handling such claims.
We all know "what goes around comes around."
I'm waiting.