Editor's Note: This is article #2 in a series designed to empower you to take PI cases if you aren't; or achieve better outcomes if you're already doing PI. The first article appeared in the July 2022 issue.
It's bound to happen: You take a case on lien or a letter of protection and wait months (if not years) to be paid.
It can be frustrating. You do your job well and agree to wait to be paid. You cooperate with the attorney. You provide your patient with top-notch care. And then, when all is said and done, the attorney turns around and complains that you overtreated, your bills are unfair and/or inflated, and that you should slash them.
If you are a chiropractor working in personal injury, this has likely already happened to you dozens of times. And if it hasn't, it will! Fortunately, there's a simple four-step solution to this ongoing problem in personal injury cases.
Step One: Be Transparent
Provide an upfront estimate of your fees, along with your fee schedule, to both the patient and the attorney. Include not just your fees, but also your average per-visit rates and a "good faith estimate" of your entire treatment plan for your patient. Have your patient sign a copy of your fee schedule and estimated treatment plan cost. In fact, you might even want to include your fee schedule in your lien agreement.
This transparency is important for a few reasons: First, it keeps you compliant with the No Surprises Act, a new law that went into effect Jan. 1 of this year. Second, it communicates and documents that your patient and the attorney knew your rates, and they still chose to do business with you.
Step Two: Stay in Touch
Send regular reminders letting the attorney and patient know the status of the bill. You can do this by sending an updated billing statement monthly via email, fax or mail to the attorney and the patient during treatment.
In case you need it down the road, keep evidence of your correspondence by copying yourself on emails, filing fax confirmations, and sending letters by certified mail, and then placing that proof in the patient file.
This way, if an attorney makes a post-settlement complaint, you can argue that the attorney and patient were given multiple opportunities to communicate with you prior to settlement. The attorney's failure to do so is evidence that there is no actual or viable issue. It's smoke without fire.
Step Three: Compare Your Fees
Along with your monthly billing statement, send the attorney and patient a copy of your fees as they compare to others within your industry. Here's the great news: Those fees are often lower than the actual averages (for various reasons I won't get into here); but chances are you will find that all or most of your current fees are less than the averages for most chiropractors. May be time to give yourself a raise!
When you send the attorney a fee comparison, they can use it in their negotiations with adjusters and defense counsel to motivate larger and earlier settlements. Now you not only supported your fees, but also became more valuable to attorneys.
Step Four: Stand Up for Yourself
An attorney's post-settlement bill complaint usually is not a reflection of anything you or your staff have done wrong; it's a made-up complaint to attempt a lien reduction. And if the complaint is made after your bills were used offensively to get a case settlement, the attorney is very likely using a deflection tactic if they now come back and say the bills were unreasonable.
If an attorney ever comes back to you after a case has concluded to say that your bills are unreasonable, try saying this:
"I have always been transparent with my fees and charges. Your patient had a choice and chose to go to our office having other choices. You also received copies of the bills way back then, and you said nothing. You are experienced, so certainly you would have spoken up if you truly believed something was amiss.
"You had plenty of chances to speak up. Instead, you submitted my bill in full to support your settlement demand. My bill was used to help get that settlement, and it supported the patient's pain and suffering damages, and established actual damages.
"Clearly, your assertion is false and an attempt to deflect from the real problems caused in this case, none of which is due to our office. We expect to be paid the full amount of the bill. Please issue that payment at this time without any further delay."
If this feels aggressive, remember that "aggressive" is the language attorneys speak. Most attorneys fight and strategize all day long, with the goal of out-maneuvering their competition.
When they use these tactics on you, the good attorneys will be impressed if you stand your ground and demand to be paid the full rate. And in the end, they will send you even more business. After all, the good attorneys want to work with great medical providers who understand personal injury and who can defend the value of their bills at trial or in a deposition.
And the not-so-great attorneys? If you fail to roll over and capitulate, they might not want to keep working with you. And that is cause for celebration, too! Ultimately, you and your staff will be happier and have a more productive and profitable practice if you work with attorneys who respect you and think you are worth it.
Author's Note: The above does not constitute legal advice; readers should contact the legal, business and financial professionals licensed in their states before implementing new strategies.
Michael Coates is the founder of PI Made Easy, which helps medical providers accelerate their success in personal injury. He is a national authority on personal-injury medical lien recovery and negotiations with law firms, For inquiries, email Michael at
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