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28/Mar/2020

Dr. Lesko is a new breed of Chiropractor, but what does that mean?

-Must have impeccable credentials and training in the areas related to trauma such as MRI interpretation, Accident Reconstruction, Spinal Bio Mechanical Engineering, Spinal Trauma Pathology, Medical Legal Documentation, Triaging the Injured and more to help render an accurate diagnosis, prognosis, and treatment plan. These credentials must be obtained formally through highly respected medical and chiropractic schools to ensure admissibility in the Courts.

-More than ever, being able to accurately diagnose and reconstruct what happened in a car accident so that he/she can connect causality, bodily injury, persistent functional loss, permanency must have the proper training and credentials to do so. This includes knowing, understanding and documenting the latest medical research related to traumatic injuries, connective tissue injuries, disc definitions, reading and understanding MRI’s, low speed impact collisions, understanding AOMSI (alteration of motion segment integrity) and how AOMSI is much worse than a herniated disc (per the AMA Guides to the Evaluation of Permanent Impairment ratings). In addition, accurate diagnosing and utilizing the research on connective tissue injuries (strain/sprain), and how to properly write a narrative report that demonstratively explains and communicates all of this simply.

-Must be willing to refer the patient to specialists when appropriate such as an orthopedist, pain management, neurologist, neurosurgeon, and have open dialogue with those specialists to best serve the patient’s medical needs.

-Credentials will be admissible in a court of law through Voir Dire, Daubert or Frye hearing. These admissible credentials will allow the chiropractor to opine on MRI findings, Connective Tissue Injuries demonstrable by digitized flexion and extension x-rays, AOMSI, Accident Reconstruction and other critical areas related to injury. This can lower trial costs considerably if only one expert is needed.

-Will not be confused by deceptive defense rhetoric in documentation or the courtroom.

-Will understand and communicate the scientific medical literature clearly showing that pre-existing injuries and arthritis are RISK FACTORS that can cause the patient to sustain MORE INJURY WITH LESS FORCE rather than letting the deceptive rhetoric of the insurance company call it a “pre-existing” injury.

-Will understand and communicate that low speed impact collisions can cause a host of serious and permanent injuries and that the insurance company’s deceptive rhetoric stating that “no damage=no injuries  does not match up with the current scientific literature on the subject of low speed collisions with minimal or no damage to vehicles.

-Must not allow an insurance company DME doctor to discharge his/her patient based on faulty DME examination procedures. This new doctor will push back and write IME rebuttals that will make the insurance company and IME doctor take notice that we will not tolerate unethical tactics on his/her patient and when indicated will render licensure complaints against all DME’s that do not report the truth. 

This is the New Paradigm for personal injury in Texas and the nation. Yes, it’s getting harder for both doctors and lawyers. Yes, the insurance company’s tactics are tough and all too often underhanded and unfair. But … hard work, ethics, proper training, credentials, and knowledge of the scientific facts will allow us to prevail in should you go to trial.

If you would like assistance with a client who is being denied a proper settlement and feel there may be more to the case, please feel free to contact our office at any time for a free consultation.

To view my entire CV, please click here. 

Thank you.


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28/Mar/2020

Why have a doctor treating you that does not understand the condition that you have or, even worse, may be missing your real injuries? Doctors who understand the spinal ligament injury know how to properly diagnose it (X-ray, CRMA, MRI). They know how to properly identify both the severity and the location of this type of injury. If they do not and you are treating with them, in my experience your chances of an optimal recovery can be significantly reduced, which means that you may needlessly suffer for the rest of your life. Before you treat with any doctor for a spinal ligament injury, a sprained back or neck, or whiplash, make sure the doctor knows how to locate, and determine the severity of this injury. How hard is it for a doctor to take some x-rays and send them into a service where highly trained radiologists can perform an accurate spinal intersegmental motion study of the injured of the area? It’s not hard at all; do not tolerate those who do not know what you now know!

Today it is equally as irresponsible to simply hire any personal injury attorney to help you. You are going to be paying them a good portion of your benefits money for what, in many cases, is not so much legal work on their part. They do not charge by the hour in personal injury cases. I am not saying that personal injury attorneys do not work; rather they do not do much legal work and would prefer to become more of a settlement broker than an attorney. I say this because law is practiced in a courtroom, yet it is reported nationally that only 4-5% of any injury cases ever end up in court. 4-5%! I think the actual numbers are closer to 1-2%.

Since you are going to be paying them a good amount of your money out of any of your benefits, you should hire an attorney that understands both your condition and what the insurance company’s documentation needs are, and they should be able to explain both to you. They also need to understand what the common testing procedures are for these injuries. They need to be familiar with injury coding so as to make sure that all of your injuries are properly listed in their final demand report. They need to include your impairment rating, your loss of enjoyment of life (LOE) factors, and any DUD, Duties under Duress factors from your permanent injuries.

If these BASIC things are not in their final report to the insurer for your settlement request, your chance of getting a fair benefits package are slim to none in my experience. Your medical records are yours and you can get a complete copy of them any time you want to. Remember it is stated that 40% of diagnoses are wrong and this can cause you injury, and in some cases a lifetime of avoidable pain and suffering. If you think something has been missed or is missing in your file you can ask your provider to correct it.

When you hire an attorney, they are working for you. Anything in their files, including their demand package or settlement report, is yours. You can ask your attorney to review it with you at any time, and I highly recommend that you do. Have them thoroughly explain everything that is in it and, if the above stated items are not in it, have them explain why? Remember they are working for you – you are their employer. If you want something reported to the insurer by them, you have every right to demand it.

Doctors and attorneys are paid very well. They may whine that this is not the case, but usually they whine from some of the nicest neighborhoods in America. In my professional experience, it is okay that they should be pressed to be highly effective. The truly good doctors and attorneys will not mind at all. In fact, they will appreciate an educated consumer.

I really hope that you will take the time to apply what you have learned here. Do not take these spinal injuries lightly. Find a doctor that knows or specializes in this type of injury and then follow everything they say to do to the letter. Ask questions, but follow their instructions, as they have usually put many before you successfully through this process!

I want to conclude with my thanks for taking the time to read this through to the end, giving me the opportunity to provide you with insight that can truly help either yourself or the people that you care about. Thank you.

I also want to thank the truly gifted doctors that have persisted through the storm of misinformation that has existed, and instead stayed the course and truly provided great results for the many patients that suffer through these injuries!

I want to thank the attorneys that have stayed current on both the significance of these injuries and what the insurance industry documentation needs are. These are the attorneys that do NOT interfere with patient care, but rather become a huge support to both their client and the doctors that serve that client.

Lastly, use the information in the report to help you choose your medical and legal help wisely. Your health and finances can be detrimentally affected – perhaps permanently with the wrong choices – so choose as wisely as you can and always ask questions! Remember these professionals are working for you!


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28/Mar/2020

The insurance industry is often made out to be the bad guy in the injury environment. In my experience this is usually not the case, even though they, too, have caused huge issues in this area. When it comes to your benefits, documentation is key! Who are the bad guys then? They are the professionals that do not know the basics of what any insurer needs for documentation. Insurers today still use artificial intelligence to adjudicate claims, which means that the adjuster who is going to complete a claim for you will be asked a series of questions from a computer. Computer Sciences Corporation owns the Colossus insurance software program, and this is what their company states about that program on their company website:

Your adjusters can quickly interpret medical reports and look up definitions of injuries, treatments, complications and permanent impairments using AMA 5th edition data. Through a series of interactive questions, Colossus guides your adjusters through an objective evaluation of medical treatment options, degree of pain and suffering, degree of permanent impairment to the claimant’s body, and the impact of the injury on the claimant’s lifestyle. At the conclusion of a Colossus consultation, a summary of the claim is provided, including a recommended settlement range.14

Understand that in order for an adjuster to easily answer the questions that the computer is asking them, the answers have to be found in BOTH your doctors’ reports and your attorney’s report. In other words, the attorney also must state the same documentation facts if they are involved in the claim resolution process. Here are the typical questions.

  1. What are the injured parties’ documented injuries? All injuries are coded with an international coding system language called and International Classification of Disease 9th Edition code (ICD9). The proper codes are entered in into the system, which means your injuries get entered as long as they were identified and properly coded. Look up any injury on the Internet and you will see that it has a corresponding ICD9 code. Sprain of the cervical spine is listed at 847.0, so that would be entered into the computer if you had this injury. If the doctor noted ligament laxity as an injury you would see the code as 728.4.
  2. What are all the care procedures that were delivered to the insured by any health care provider? These are also specifically coded in all your medical records with international procedural codes.
  3. Does the injured party have any permanent injuries identified with a Permanent Impairment Rating? This is the way the insurer knows that you have some sort of permanent problem; with no impairment rating, there is no permanent problem.
  • If you have a permanent impairment it will ask how much? This is in the form of a number, such as 2%, 10%, 25%, etc.
  • If you have a permanent injury it may ask if this permanent injury now keeps you from doing any kind of activity that you could perform prior to the accident. This is called “any loss of enjoyment of life factors.” These are things that you can no longer do as a result of your injuries. It is very important that they are included and well documented in your doctors’ notes and in what is called your attorney’s demand package. The insurer needs to know what you now CANNOT do, that you could do before the accident.
  • The adjuster will also be asked if there are any activities that you can do but only under duress since the injuries occurred. These are called “Duties under Duress factors.” Things that are now uncomfortable to do, but you can still do, they are simply interfered with due to discomfort that is a direct result of your injuries.
  • If you have permanent impairment the software may also ask the adjuster to indicate if there are any documented future care needs that will be required to manage your permanent injury. This is called “Future Care Expenses” that may be projected or anticipated to help manage your situation.These make sense, and all of this information is factored into a claim to adjudicate what benefits you are rightfully entitled to. While logical, they are almost never found to be completely or accurately documented in either your doctors’ notes or in your attorney’s benefits demand package. This can cost you a great deal of benefits and leave you with some very large medical bills that you may end up being personally responsible for.Notoriously, what happens is you received large care bills that the doctor’s documentation does not support the need for, so your insurance company denies them and does not pay for the care. Your attorney takes this poor documentation and passes it onto the insurer because they do not know how to correct it. The unfortunate result of both activities is that access to your rightful injury benefits is unnecessarily denied.Here’s an analogous situation to show the point; lightning strikes a huge oak tree next to your house and it crashes into the side of your house and damages (injures) two floors of your home, but your home repair contractors significantly under-document the damage. Your insurer wants to pay for the damage that was documented, which is a much lower number than that which will cover the actual damage. You may think the insurer is trying to rip you off, so you hire an attorney. The attorney now does not know how to document your house damage properly and they cannot fix the problem – their documentation is simply the original crappy documentation that is causing the problem in the first place. Is the result likely to change? No, of course not – but now you have bad benefits, your house damage is not fully covered and now have your attorney to pay as well.

    This is exactly what is happening every day with injury benefits. Really bad documentation!

When this under-reporting happens, of course the insurer is going to think that some sort of fraud is being perpetrated, and of course your attorney – and even your doctors – will all say it is the insurance company just trying to save money, while in fact it may indeed be the ineptness of both your attorney and your doctors that may be the problem.

In summary, your doctors and attorney must report these basics in their documentation:

  1. Proper codes for all your injuries and care
  2. Any permanent damage must be reported with an AMA impairment rating
  3. Anything you could do before injury and now cannot do as a result of your injuries, called Loss of Enjoyment of Life Factors
  4. Anything that you could do pain-free prior to the accident and now can be done but only under duress, called Duties under Duress Factors.
  5. If you have permanent injuries identified, all the future care your doctor advises that you may need has to be formally documented by your doctor (s) and reported by your attorney

It’s simple, yet 98% of the files that I have ever checked from both the doctor and the attorney are missing this basic information. That is why it is so important to find the right doctor and, if needed, an attorney that understands both your injuries and your documentation needs. Otherwise you could seriously suffer financially with the loss of benefits that were RIGHTFULLY denied, simply due to the documentation blunders that could have been avoided.

 


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28/Mar/2020

The biggest problem in the medical legal system with injuries and compensation was twoi fold in nature:

  1. How to set up a standard system to determine if permanent body damage has occurred with an injury.
  2. The second problem was how to objectively and standardly determine the effect that this identified injury would have on a person’s ability to perform their basic activities of life without pain, discomfort, or suffering.

This monumental task was accomplished in 1970s when the AMA published the first Guides to the Evaluation of Permanent Impairment, which could be easily renamed the “Guides to the Evaluation of Permanent Injury” because that is exactly what impairment is: a condition that injures the person’s ability to function.

This book is the “Kelley Blue Book” of body damage; every doctor treating injuries and every attorney representing injury cases should be very familiar with it. They should readily be able to use it to represent to anyone that you have a permanent injury, and the level of negative effect on a person’s life this injury is agreed to have. The word “objective” means anything that can be verified by others. The chair you may be sitting on can be verified to exist by others, but how you feel in it cannot.

When we look at the AMA Permanent Injury Guides I think the stated purpose of this book says it all: “The primary purpose of the guides is to rate impairment to assist adjudicators and others in determining the financial compensation to be awarded to individuals who, as a result of injury or illness, have suffered measurable physical and/or psychological loss.”12

These books are made so that anyone can look up the identified injuries to any body part, and see what the agreed upon negative consequence are as communicated in the form of a impairment rating. Let’s say you have excessive motion of the spinal segment from a ligament injury that is ratable. If you look up an injury and the book states that the injury can cause a negative consequence to 25% of your activities of daily living, – reported as a 25% whole person impairment – it means 25% of your daily activities may be negatively influenced by this injury. While this is not a perfect system, it does prove that the condition exists, it will negatively impact your life, and it is a worldwide agreement.

The key to this is that it is not the treating doctor stating this – IT IS THE AMERICAN MEDICAL ASSOCIATION!

So, any injury doctor or injury attorney that is not fluent in impairment rating and the AMA’s permanent injury assessment is way out of touch and can seriously reduce your compensation benefits, causing you to possibly be responsible for very large unpaid medical bills.

Once again, Spinal Kinetics put a very good short video on the AMA guides called Spinal Ligament Injuries –Was the AMA Wrong?

(https://www.youtube.com/watch?v=ofmpiE5BP6g)

Mark Blane, a well-known San Diego personal injury attorney, states this about the AMA Guides in his book How to Effectively Document Your Patient’s Personal Injury Case from A to Z: “…your biggest piece of medical evidence in terms of allowing your patient’s lawyer to argue or substantiate appropriate case settlement value is, besides your actual documented injuries, is whether your patient has a medically documented impairment to a function of a body part or parts.” He also states the following about the spinal ligament injuries: “This is probably the worse soft tissue injury diagnosis you could have from an accident. Essentially, it is a ligament instability injury. It affects the neck and lower back (the mid back is protected by the rib cage).” He goes on to say, “This could occur in a rear-end collision that damages ligaments of the spine. Such damage can affect your vertebra’s proper range of motion. Blood can stagnate and cause poor blood supply in the spine, which can lead to degenerative conditions such as bone degeneration and early arthritis. You could also experience continual pain long after the accident. Post-accident, you should make sure to seek medical attention and the advice of a knowledgeable injury attorney. Some doctors and injury lawyers routinely miss these medical diagnoses.”13

This book can be purchased on Amazon.com.

The essential point is this: you should always work with a doctor that knows how to find and diagnose this condition. In fact, I believe that this injury (the spinal ligament injury Mark speaks of here) is so important, so well documented in how you find it, that any doctor that misses this injury should be found guilty of malpractice. Especially if the patient can be shown to have suffered avoidable consequences as a result!

Why work with any doctor or lawyer that does not clearly understand your injuries?

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