Thursday, January 2, 2014
Why should i get an attorney after an Auto/Car accident for my injuries?
An
attorney helps with all aspects of an auto/car accident claim or
injury. They keep an individual from spending countless hours on the
phone with insurance adjusters that really don't care about your well
being. It also helps to keep stress levels down and allow you to
concentrate on recovery and getting well. Our office only works with the
best attorneys/lawyers in Dallas/Fort Worth. We have learned through
trial and error, who best takes care of our patients. They also make
sure that all your medical bills are settled. This allows you to be
additionally stress and medical bill free at the end. We also help those
who are not able to treat in our office, who are in need of an
attorney. We are here to help!!! So don't hesitate in calling and making
an appointment to get examined and also ask about scheduling a free
consultation with a reputable attorney. You only have one body, so you
need to take care of it. Call Today!!!
Migraines and Headaches
MIGRAINES / HEADACHES
Migraines and headaches are NOT the result of an Aspirin shortage. They are NOT normal, and everyone does NOT have them.
A frequent and overlooked cause of Migraines and other headaches is the malfunction of the spinal bones in the neck and upper back.
When the bones of the spine lose their normal position or motion, sensitive nerves and blood vessels to the head can be affected. When spinal nerves and related tissues are stretched or irritated, they can produce Migraines and other types of headaches. Aspirin and other medications may cover up these warning signs, but do not correct the underlying structural CAUSE.
Many people experience correction and long term relief through Chiropractic care, without the short and long term side effects that accompany ALL pain medications.
Call our office to have your type of Migraine or Headache diagnosed and discover the life changing experience many of our Migraine / Headache patients have found.
The Docs at North Dallas Chiropractic
Migraines and headaches are NOT the result of an Aspirin shortage. They are NOT normal, and everyone does NOT have them.
A frequent and overlooked cause of Migraines and other headaches is the malfunction of the spinal bones in the neck and upper back.
When the bones of the spine lose their normal position or motion, sensitive nerves and blood vessels to the head can be affected. When spinal nerves and related tissues are stretched or irritated, they can produce Migraines and other types of headaches. Aspirin and other medications may cover up these warning signs, but do not correct the underlying structural CAUSE.
Many people experience correction and long term relief through Chiropractic care, without the short and long term side effects that accompany ALL pain medications.
Call our office to have your type of Migraine or Headache diagnosed and discover the life changing experience many of our Migraine / Headache patients have found.
The Docs at North Dallas Chiropractic
Neck and Mid Back Pain
Collisions that occur during sporting events, slips, falls or Automobile
crashes can all have a damaging effect on your neck and back. Reduction
of the normal neck (Cervical) curve, repetitive micro-traumas ie. long
hours on the computer, driving in traffic, traveling by car or plane,
lifting heavy or awkward objects or constant stress of work, family and
everyday life can also be directly related to neck and back pain.
Pain can be dull or sharp, boring or burning, constant or intermittent. As the problem progresses, numbness and or tingling can be felt in the upper back, arms and even in to the hands.
NOTE: Many patients who come in for Carpal Tunnel treatment are amazed to find out that the problem is actually a pinching of the nerves in the neck and NOT a wrist or hand problem.
Through careful evaluation of your neck and upper back, we can pinpoint the problem areas and have great success in correcting the CAUSE of our Patients symptoms.
The Docs at North Dallas Chiropractic
Pain can be dull or sharp, boring or burning, constant or intermittent. As the problem progresses, numbness and or tingling can be felt in the upper back, arms and even in to the hands.
NOTE: Many patients who come in for Carpal Tunnel treatment are amazed to find out that the problem is actually a pinching of the nerves in the neck and NOT a wrist or hand problem.
Through careful evaluation of your neck and upper back, we can pinpoint the problem areas and have great success in correcting the CAUSE of our Patients symptoms.
The Docs at North Dallas Chiropractic
What is Peripheral Neuropathy?
NDallasChiropractic.com
Peripheral neuropathy describes damage to the peripheral nervous system, which transmits information from the brain and spinal cord to every other part of the body.
More than 100 types of peripheral neuropathy have been identified, each with its own characteristic set of symptoms, pattern of development, and prognosis. Impaired function and symptoms depend on the type of nerves -- motor, sensory, or autonomic -- that are damaged. Some people may experience temporary numbness, tingling, and pricking sensations, sensitivity to touch, or muscle weakness. Others may suffer more extreme symptoms, including burning pain (especially at night), muscle wasting, paralysis, or organ or gland dysfunction. Peripheral neuropathy may be either inherited or acquired. Causes of acquired peripheral neuropathy include physical injury (trauma) to a nerve, tumors, toxins, autoimmune responses, nutritional deficiencies, alcoholism, and vascular and metabolic disorders. Acquired peripheral neuropathies are caused by systemic disease, trauma from external agents, or infections or autoimmune disorders affecting nerve tissue. Inherited forms of peripheral neuropathy are caused by inborn mistakes in the genetic code or by new genetic mutations.
Is there any treatment?
Chiropractic brain based therapy helps in adopting healthy habits -- such as maintaining optimal weight, avoiding exposure to toxins, following a physician-supervised exercise program, eating a balanced diet, correcting vitamin deficiencies, and limiting or avoiding alcohol consumption -- can reduce the physical and emotional effects of peripheral neuropathy. Systemic diseases frequently require more complex treatments.
There are therapies for many forms.
Peripheral neuropathy describes damage to the peripheral nervous system, which transmits information from the brain and spinal cord to every other part of the body.
More than 100 types of peripheral neuropathy have been identified, each with its own characteristic set of symptoms, pattern of development, and prognosis. Impaired function and symptoms depend on the type of nerves -- motor, sensory, or autonomic -- that are damaged. Some people may experience temporary numbness, tingling, and pricking sensations, sensitivity to touch, or muscle weakness. Others may suffer more extreme symptoms, including burning pain (especially at night), muscle wasting, paralysis, or organ or gland dysfunction. Peripheral neuropathy may be either inherited or acquired. Causes of acquired peripheral neuropathy include physical injury (trauma) to a nerve, tumors, toxins, autoimmune responses, nutritional deficiencies, alcoholism, and vascular and metabolic disorders. Acquired peripheral neuropathies are caused by systemic disease, trauma from external agents, or infections or autoimmune disorders affecting nerve tissue. Inherited forms of peripheral neuropathy are caused by inborn mistakes in the genetic code or by new genetic mutations.
Is there any treatment?
Chiropractic brain based therapy helps in adopting healthy habits -- such as maintaining optimal weight, avoiding exposure to toxins, following a physician-supervised exercise program, eating a balanced diet, correcting vitamin deficiencies, and limiting or avoiding alcohol consumption -- can reduce the physical and emotional effects of peripheral neuropathy. Systemic diseases frequently require more complex treatments.
There are therapies for many forms.
Why should i be examined after a auto/car accident?
What are the symptoms of whiplash?
The most common symptoms related to whiplash include:
* neck pain and stiffness,
* headache,
* shoulder pain and stiffness,
* dizziness,
* fatigue,
* jaw pain (temporomandibular joint symptoms),
* arm pain,
* arm weakness,
* visual disturbances,
* ringing in the ears (tinnitus), and
* back pain.
In the more severe and chronic case of "whiplash associated disorder" symptoms can include:
* depression,
* anger,
* frustration,
* anxiety,
* stress,
* drug dependency,
* post-traumatic stress syndrome,
* sleep disturbance (insomnia),
* and
* social isolation.
How is whiplash diagnosed?
After an accident the patient may be taken to the hospital and/or a Chiropractor's office to be examined. The doctor will examine the patient to determine if they have any injuries that require treatment. Based on the symptoms and examination findings the doctor may place a collar on the neck for additional support. The doctor may also obtain x-rays of the neck to check for more serious injury. The most important first step is to make sure there is no major injury to the neck, head or the rest of the body requiring immediate treatment.
If the x-rays are normal but the patient continues to have neck pain, the doctor may keep the cervical collar in place and see the back in the office in about a week for an additional examination. At that time the doctor may obtain new x-rays to see if there have been any changes. If the doctor is still concerned about soft tissue injuries, he or she may obtain either x-rays with the head leaning forward and backwards (dynamic x-rays) or obtain an MRI (magnetic resonance imaging study). These dynamic x-rays or MRI scans are better able to detect injuries to the soft tissues of the neck, especially instability, that may not been seen with normal x-rays of the neck.
The most common symptoms related to whiplash include:
* neck pain and stiffness,
* headache,
* shoulder pain and stiffness,
* dizziness,
* fatigue,
* jaw pain (temporomandibular joint symptoms),
* arm pain,
* arm weakness,
* visual disturbances,
* ringing in the ears (tinnitus), and
* back pain.
In the more severe and chronic case of "whiplash associated disorder" symptoms can include:
* depression,
* anger,
* frustration,
* anxiety,
* stress,
* drug dependency,
* post-traumatic stress syndrome,
* sleep disturbance (insomnia),
* and
* social isolation.
How is whiplash diagnosed?
After an accident the patient may be taken to the hospital and/or a Chiropractor's office to be examined. The doctor will examine the patient to determine if they have any injuries that require treatment. Based on the symptoms and examination findings the doctor may place a collar on the neck for additional support. The doctor may also obtain x-rays of the neck to check for more serious injury. The most important first step is to make sure there is no major injury to the neck, head or the rest of the body requiring immediate treatment.
If the x-rays are normal but the patient continues to have neck pain, the doctor may keep the cervical collar in place and see the back in the office in about a week for an additional examination. At that time the doctor may obtain new x-rays to see if there have been any changes. If the doctor is still concerned about soft tissue injuries, he or she may obtain either x-rays with the head leaning forward and backwards (dynamic x-rays) or obtain an MRI (magnetic resonance imaging study). These dynamic x-rays or MRI scans are better able to detect injuries to the soft tissues of the neck, especially instability, that may not been seen with normal x-rays of the neck.
What do I do if I was involved in a Car/Auto accident?!
WHAT IF I WAS IN AN AUTO/CAR ACCIDENT ?
Unfortunately, studies show that most of us will be in an auto accident at some point in our lives. The only question remaining, is how bad will it be?
The following are important things to remember if you are involved in an auto accident:
1. Seek treatment as soon as possible.
If there is a chance you may be seriously hurt, you should go to the Emergency room at your local hospital. There they can rule out fractures and life threatening injuries.
2. If you are still experiencing pain and discomfort a few days to a couple weeks later, than you should come to our office to find out if you have any structural damage.
NOTE: The longer you wait after an accident to come to our office, typically the longer it takes to get you better.
3. Most auto insurance companies have what is called Personal injury Protection/Med Pay. This means that your bills will be paid up to 100% up to a certain limit. Our office can check that for you.
4. If the accident was not your fault. The other party's auto insurance should cover your health care expenses in our office. We do all of the paperwork for you.
5. At the accident scene, get as much information on the other driver or drivers as possible. An accident report by Police is always helpful, but not required to have a case.
6. You should never settle with an insurance company before you have had us evaluate your injury for you. If you settle before your injury is fully resolved, you will be completely on your own and will have to pay out of pocket for your care.
7.Dealing with insurance companies can be difficult after an auto accident. We have a number of reputable and highly qualified Attorneys who we can refer you to for a complimentary consultation. Hiring a reputable Attorney essentially takes you out of the direct bargaining process with the insurance company and all the paperwork and phone calls associated with that and lets you concentrate on healing.
8. Injuries sustained after a car-accident if left untreated can lead to spinal degeneration and a host of other problems for years to come.
FINAL NOTE: We find that many people involved in an auto accident that WAS THEIR FAULT never get treatment.
This tends to be due to the fear that their insurance will go up after a claim is filed.
Your PIP (Personal Injury Protection) is why you have auto insurance in the first place.
Many insurance companies will not raise your rates after 1 or even 2 accidents in the same year.
THE INJURIES SUSTAINED IN AN AUTOMOBILE ACCIDENT CAN CAUSE A HOST OF PROBLEMS FOR YEARS TO COME, OR EVEN THE REST OF YOUR LIFE.
YOU OWE IT TO YOURSELF TO COME IN AND GET CHECKED.
Call our office today at (972) 215-7720.
Personal Injury Protection (PIP)
The Texas Department of Insurance requires automobile insurance carriers in our state to issue all automobile policies it writes at least $2500 worth of coverage and you have this coverage unless you reject it in writing. Most people are unaware of this coverage or even know what it is and therefore very few people use it. You end up paying for coverage that they don’t inform you about and you’re entitled to.
Why? Insurance is not understood and most people rely on their agent and claims adjusters to advise them on what to do after an accident. Insurance is a multi-billion dollar industry and are in business to make money. They keep their costs down, less payout, more profits and bonuses at the end of the year. Good for them and not for you.
What is PIP?
PIP is no fault coverage similar to health insurance but on your auto policy for your injuries and your passengers injuries. This coverage is available regardless who is at fault. Yes, you can be the cause of the accident and you will still be covered. There’s no deductible and no co-payment. There is other separate coverage that will cover the other party if you were at fault. If you do not have PIP then you could still be covered if you were in an accident in another state besides Texas. You may also be covered if you were hit in a crosswalk by a car or on a bicycle or borrowing someone else’s car.
What will a claim do to my insurance rates and policy renewal?
Under section 5.7016 of the Texas insurance code, automobile insurance carriers cannot non-renew you for filing one PIP claim in a 12 month period. Also, it is unlikely that they would raise your rates for a sole PIP claim.
Why doesn’t the other guy’s insurance pay for my medical expenses and why should I use my insurance?
Medical treatment is expensive and you are liable for the costs. There is a chance that the other party may never pay for your medical expenses leaving you a financial burden. PIP gives you peace of mind that your medical bills are covered. If you use your health insurance, you may have to pay a deductible and co-pays to your doctor and if the health insurance finds out that you were in an accident they could request to be reimbursed. Some people get referred to a medical provider by their attorney and the medical provider agrees to be paid months or even years later. Since there are a limited number of medical providers who agree to this arrangement, your choice and quality of healthcare may be limited. The answer is to use your PIP coverage so you will not have to pay for medical expenses out of your pocket and get the best possible healthcare treatment available for you and your family’s injuries caused by the accident.
Unfortunately, studies show that most of us will be in an auto accident at some point in our lives. The only question remaining, is how bad will it be?
The following are important things to remember if you are involved in an auto accident:
1. Seek treatment as soon as possible.
If there is a chance you may be seriously hurt, you should go to the Emergency room at your local hospital. There they can rule out fractures and life threatening injuries.
2. If you are still experiencing pain and discomfort a few days to a couple weeks later, than you should come to our office to find out if you have any structural damage.
NOTE: The longer you wait after an accident to come to our office, typically the longer it takes to get you better.
3. Most auto insurance companies have what is called Personal injury Protection/Med Pay. This means that your bills will be paid up to 100% up to a certain limit. Our office can check that for you.
4. If the accident was not your fault. The other party's auto insurance should cover your health care expenses in our office. We do all of the paperwork for you.
5. At the accident scene, get as much information on the other driver or drivers as possible. An accident report by Police is always helpful, but not required to have a case.
6. You should never settle with an insurance company before you have had us evaluate your injury for you. If you settle before your injury is fully resolved, you will be completely on your own and will have to pay out of pocket for your care.
7.Dealing with insurance companies can be difficult after an auto accident. We have a number of reputable and highly qualified Attorneys who we can refer you to for a complimentary consultation. Hiring a reputable Attorney essentially takes you out of the direct bargaining process with the insurance company and all the paperwork and phone calls associated with that and lets you concentrate on healing.
8. Injuries sustained after a car-accident if left untreated can lead to spinal degeneration and a host of other problems for years to come.
FINAL NOTE: We find that many people involved in an auto accident that WAS THEIR FAULT never get treatment.
This tends to be due to the fear that their insurance will go up after a claim is filed.
Your PIP (Personal Injury Protection) is why you have auto insurance in the first place.
Many insurance companies will not raise your rates after 1 or even 2 accidents in the same year.
THE INJURIES SUSTAINED IN AN AUTOMOBILE ACCIDENT CAN CAUSE A HOST OF PROBLEMS FOR YEARS TO COME, OR EVEN THE REST OF YOUR LIFE.
YOU OWE IT TO YOURSELF TO COME IN AND GET CHECKED.
Call our office today at (972) 215-7720.
Personal Injury Protection (PIP)
The Texas Department of Insurance requires automobile insurance carriers in our state to issue all automobile policies it writes at least $2500 worth of coverage and you have this coverage unless you reject it in writing. Most people are unaware of this coverage or even know what it is and therefore very few people use it. You end up paying for coverage that they don’t inform you about and you’re entitled to.
Why? Insurance is not understood and most people rely on their agent and claims adjusters to advise them on what to do after an accident. Insurance is a multi-billion dollar industry and are in business to make money. They keep their costs down, less payout, more profits and bonuses at the end of the year. Good for them and not for you.
What is PIP?
PIP is no fault coverage similar to health insurance but on your auto policy for your injuries and your passengers injuries. This coverage is available regardless who is at fault. Yes, you can be the cause of the accident and you will still be covered. There’s no deductible and no co-payment. There is other separate coverage that will cover the other party if you were at fault. If you do not have PIP then you could still be covered if you were in an accident in another state besides Texas. You may also be covered if you were hit in a crosswalk by a car or on a bicycle or borrowing someone else’s car.
What will a claim do to my insurance rates and policy renewal?
Under section 5.7016 of the Texas insurance code, automobile insurance carriers cannot non-renew you for filing one PIP claim in a 12 month period. Also, it is unlikely that they would raise your rates for a sole PIP claim.
Why doesn’t the other guy’s insurance pay for my medical expenses and why should I use my insurance?
Medical treatment is expensive and you are liable for the costs. There is a chance that the other party may never pay for your medical expenses leaving you a financial burden. PIP gives you peace of mind that your medical bills are covered. If you use your health insurance, you may have to pay a deductible and co-pays to your doctor and if the health insurance finds out that you were in an accident they could request to be reimbursed. Some people get referred to a medical provider by their attorney and the medical provider agrees to be paid months or even years later. Since there are a limited number of medical providers who agree to this arrangement, your choice and quality of healthcare may be limited. The answer is to use your PIP coverage so you will not have to pay for medical expenses out of your pocket and get the best possible healthcare treatment available for you and your family’s injuries caused by the accident.
Why an MVA can't always be Measured as to the extent of injury, But the Insurance company will try for their own Gain
Dynamic Chiropractic – January 15, 2010, Vol. 28, Issue 02
Study Confirms Flaws in Standard MVC Defense Strategy
By Arthur Croft, DC, MS, MPH, FACO
The seemingly complex, or perhaps even inscrutable, calculus of what practitioners term personal injury is, in truth, deceptively simple. However, while it keeps getting simpler, many practitioners and lawyers feel hopelessly wrapped around the axle of this puzzling system. The net result is abandonment of needful patients and clients, with a corresponding loss of revenue stream. Consider just a few facts. Motor vehicle collisions are a leading cause of injury in the U.S. and constitute one of our most burdensome public health dilemmas. With 3 million such injuries each year, a total recovery proportion of only about 50 percent, a permanent disability proportion of 10-12 percent, coupled with the fact that many of the injured are young and have many quality life years to lose, the $43 billion annual price tag is hardly surprising.1
Auto insurers make every reasonable effort to insulate themselves from their liability. Some would argue that they engage in efforts most of us would consider unreasonable, if not downright unsavory or unethical. Regardless of your personal judgment, most would agree that over the past two decades, the insurers’ concerted and very expensive campaign to limit claims has been fairly successful.
With Allstate taking the vanguard position with their now-famous three Ds – delay, deny, and defend – most major auto insurers have since instituted similar policies, and the plaintiff persona-injury bar has more often withered than weathered. With a loss of potential legal representation, plaintiffs have had fewer alternatives for compensation. This often has meant that needed health care resources are simply not available to them, which contributes further to the doleful outcome statistics mentioned above. Since inaugurating its get-tough policy in the mid-1990s, which was described by its consulting firm as a transition “from good hands to boxing gloves,” Allstate has reportedly posted surprising high profits.2 Other insurers have not failed to notice.
The Standard Defense and the Importance of Delta V
How could any of this possibly be simple? One need look no further than the essential game plan of most defense lawyers: deception, dissimilation and obfuscation. It requires a team of experts from the fields of medicine (including chiropractic), accident reconstruction and biomechanics who have collectively developed what I consider to be the standard defense strategy. It continues to be the most successful and widely used strategy today, having become the world standard.
This has fostered a small research industry dedicated to the production of pro-defense literature to aid in the cause. Most is junk science. Make no mistake, insurers have the best researchers money can buy and they know how to get published. As a result, even many clinicians remain split on critical issues depending on which brand of literature they rely upon. I note, with all due respect to the Insurance Institute for Highways Safety (IIHS) and members of the International Insurance Whiplash Protection Group (IIWPG), that their research activities are quite laudatory and most welcome. However, there is just a bit of schizophrenia in this industry when it comes to research. While the valid research of the IIHS and the IIWPG is squarely aimed at reducing the industry payout problem by reducing the number of actual injuries, the “other” research seems to be aimed at providing verisimilitude for company experts to wield in courtrooms to sway jurors toward defense theories.
The standard defense has three parts and is based on the ultimate playing field: a court of law, and, in particular, the biases and naivete (i.e., the normal lack of specific factual information in the field of crash traumatology) of jurors. Polls suggest that Americans are also divided on the question of whiplash injuries. As many as 60-70 percent consider it either definitively or very likely a non-injury, but merely an opportunity to bilk insurers at the expense of the rest of us policy-holders who subsidize the system through the increasing premiums we must pay. Thus, jurors are easily misled by the standard defense strategy because it merely reinforces that which they already believe.
The first and most fundamental part of this strategy is to demonstrate that the forces of the collision would not have been of a sufficient magnitude to cause injury. The common currency for this discussion is the plaintiff vehicle’s delta V or change in velocity. For this, an accident reconstructionist is usually employed. Because reconstructionists are rarely allowed to provide opinions as to injury risk, they are often followed by a biomechanist, who is granted more latitude to venture into the discussion of injury risk. In some cases, they are allowed to consider medical records, MRIs, etc., in forming their opinions. Finally, the defense physician (DC, DO or MD) adds the icing to the cake, testifying that either there was no injury or that there was a minor straining-type injury that has long since resolved.
When pre-existing conditions are present, the plaintiff’s complaints are often attributed to them rather than the injury. Company doctors will typically also be of the opinion that a large portion of the medical expenses claimed by the plaintiff are unnecessary, unreasonable,and represent unwarranted treatment and diagnostics. Note that low back injuries are virtually never admitted to be causally related to low-velocity collisions. I have written a paper on this subject which is available upon e-mail request at drcroft@san.rr.com .3
As I have so many times implored readers – and this fact is never contested even by my small army of industry-affiliated detractors – the entire defense mechanism just described is nothing more than a series of interlocking nonsequiturs. The accident reconstructions and biomechanists provide a very polished and seemingly airtight argument based on what appear to be sound mathematical principles and classical Newtonian physics. This is all very interesting, and would be even more so if it had the additional virtue of being true.
Delta V Not a Valid Gauge of Injury Risk?
But figures don’t always add up, which brings me back to the headline of this article. A new study that provides further compelling evidence that delta V, the keystone in the standard defense strategy, is not a valid gauge of injury risk.4 The authors recruited a total of 57 people within 48 hours of their MVCs. The subjects were recruited either from an engineer’s office for vehicle damage assessment or an ER. The whiplash grades ranged from 0-4 (0 indicating no claimed injury and 4 indicating fracture). The collision types included 13 frontal, 21 rear, 19 side, three multiple crashes and one rollover. There were 25 males and 32 females with a median age of 33.
In all cases a trained engineer determined the delta V by examining both crash vehicles. The VAS and Neck Disability Indexes (NDI) scores were tabulated. The authors found no significant correlation between NDI and delta V, no correlation between whiplash grade and delta V, and only a moderate correlation between VAS reported pain and delta V. However, the R2 value (coefficient of determination) for that correlation was only 0.30, which means that 70 percent of the proportion of the variability of pain severity was not explained by differences in delta V.
There was no lower threshold below which a large proportion would predictably not be injured, nor was there an upper threshold above which most would predictably be injured. This was because some people were injured in very low velocity crashes while others were not injured despite fairly high velocity crashes. The authors commented, “It can be concluded that delta V is an irrelevant predictive value for cervical spine injury after MVA [motor vehicle accident].”
Some specific findings include the following: Cervical spine fractures in frontal crashes occurred in delta Vs of 9.3, 19.9 and 31.1 mph. Fractures in side impacts occurred in delta Vs of 6.2 (z-joint fracture of C4), 9.9 (C7 with dislocation of C6-7), 19.9 (z-joint fracture of C2), 31.1 (C5 fracture with C5-6 dislocation and paraplegia), 32.3 (rupture of alar ligaments), 36.0 (atlantoaxial dislocation) and 36.6 mph (rupture of alar ligaments). There was a dens fracture in the one rollover with the delta V reported as 9.3 mph. This article is available for free download at www.ncbi.nlm.nih.gov/pmc/articles/PMC2657117.
A related component of the standard defense strategy is the property damage issue. Specifically, the argument goes, when the property damage is minor, an injury is very unlikely. We addressed this issue earlier in a meta-analysis of medical and engineering literature dating back as far as 1970 that failed to provide a clear link between property damage and any of three outcomes: risk for acute injury, degree of injury severity and risk for long-term symptoms.5 As I always caution readers, this lack of correlation considers the genre of collisions producing property damage that would be described as minor or non-severe. Clearly, when crash severity increases beyond this, there is an increased risk for injury or death.
A related interesting paper by Viano and Parenteau demonstrated that more than 60 percent of the National Automotive Sampling System case database for rear impacts are for crashes with delta Vs of under 15 mph. They noted, “In very low speed crashes, advanced age, stenosis and degeneration of the cervical spinal canal can lead to spinal cord injury and paralysis in crashes otherwise not causing injury in normal adults.”6 I would also note that it has been demonstrated rather conclusively that human variables (i.e., risk factors) are more determinative vis-a-vis injury risk than crash metrics in the lower crash-severity range.
In the end, when essential parts of the foundation of the defense strategy are tested, they repeatedly fail to hold up to the scrutiny of hard science. In a court of law, however, if the plaintiff and their experts cannot effectively present the real facts and rebut the junk science, 12 impressionable jurors will decide the outcome of the case based on their perception of the soundness of the arguments they heard. The simple fact is that more often than not, the plaintiff and their witnesses are simply not adequately prepared. Knowledge is power and information is the currency of success.
References
Zaloshnja E, Miller T, Council F, Persaud B. Comprehensive and human capital crash costs by maximum police-reported injury severity within selected crash types. Annu Proc Assoc Adv Automot Med, 2004;48:251-63.
Berardinelli DJ. From Good Hands to Boxing Gloves: The Dark Side of Insurance. Portland: Trial Guides, LLC, 2008.
Croft AC. Low back injuries in low velocity rear impact collisions. Forum, 2009;39(4):33-7.
Elbel M, Kramer M, Huber-Lang M, et al. Deceleration during “real life” motor vehicle collisions: a sensitive predictor for the risk of sustaining a cervical spine injury? Patient Saf Surg, 2009;3(1):5.
Croft AC, Freeman MD. Correlating crash severity with injury risk, injury severity, and long-term symptoms in low velocity motor vehicle collisions. Medical Science Monitor, 2005;11(10):RA316-21.
Viano DC, Parenteau CS. Serious injury in very low and very high speed rear impacts. SAE, 2008;2008-01-1485.
Study Confirms Flaws in Standard MVC Defense Strategy
By Arthur Croft, DC, MS, MPH, FACO
The seemingly complex, or perhaps even inscrutable, calculus of what practitioners term personal injury is, in truth, deceptively simple. However, while it keeps getting simpler, many practitioners and lawyers feel hopelessly wrapped around the axle of this puzzling system. The net result is abandonment of needful patients and clients, with a corresponding loss of revenue stream. Consider just a few facts. Motor vehicle collisions are a leading cause of injury in the U.S. and constitute one of our most burdensome public health dilemmas. With 3 million such injuries each year, a total recovery proportion of only about 50 percent, a permanent disability proportion of 10-12 percent, coupled with the fact that many of the injured are young and have many quality life years to lose, the $43 billion annual price tag is hardly surprising.1
Auto insurers make every reasonable effort to insulate themselves from their liability. Some would argue that they engage in efforts most of us would consider unreasonable, if not downright unsavory or unethical. Regardless of your personal judgment, most would agree that over the past two decades, the insurers’ concerted and very expensive campaign to limit claims has been fairly successful.
With Allstate taking the vanguard position with their now-famous three Ds – delay, deny, and defend – most major auto insurers have since instituted similar policies, and the plaintiff persona-injury bar has more often withered than weathered. With a loss of potential legal representation, plaintiffs have had fewer alternatives for compensation. This often has meant that needed health care resources are simply not available to them, which contributes further to the doleful outcome statistics mentioned above. Since inaugurating its get-tough policy in the mid-1990s, which was described by its consulting firm as a transition “from good hands to boxing gloves,” Allstate has reportedly posted surprising high profits.2 Other insurers have not failed to notice.
The Standard Defense and the Importance of Delta V
How could any of this possibly be simple? One need look no further than the essential game plan of most defense lawyers: deception, dissimilation and obfuscation. It requires a team of experts from the fields of medicine (including chiropractic), accident reconstruction and biomechanics who have collectively developed what I consider to be the standard defense strategy. It continues to be the most successful and widely used strategy today, having become the world standard.
This has fostered a small research industry dedicated to the production of pro-defense literature to aid in the cause. Most is junk science. Make no mistake, insurers have the best researchers money can buy and they know how to get published. As a result, even many clinicians remain split on critical issues depending on which brand of literature they rely upon. I note, with all due respect to the Insurance Institute for Highways Safety (IIHS) and members of the International Insurance Whiplash Protection Group (IIWPG), that their research activities are quite laudatory and most welcome. However, there is just a bit of schizophrenia in this industry when it comes to research. While the valid research of the IIHS and the IIWPG is squarely aimed at reducing the industry payout problem by reducing the number of actual injuries, the “other” research seems to be aimed at providing verisimilitude for company experts to wield in courtrooms to sway jurors toward defense theories.
The standard defense has three parts and is based on the ultimate playing field: a court of law, and, in particular, the biases and naivete (i.e., the normal lack of specific factual information in the field of crash traumatology) of jurors. Polls suggest that Americans are also divided on the question of whiplash injuries. As many as 60-70 percent consider it either definitively or very likely a non-injury, but merely an opportunity to bilk insurers at the expense of the rest of us policy-holders who subsidize the system through the increasing premiums we must pay. Thus, jurors are easily misled by the standard defense strategy because it merely reinforces that which they already believe.
The first and most fundamental part of this strategy is to demonstrate that the forces of the collision would not have been of a sufficient magnitude to cause injury. The common currency for this discussion is the plaintiff vehicle’s delta V or change in velocity. For this, an accident reconstructionist is usually employed. Because reconstructionists are rarely allowed to provide opinions as to injury risk, they are often followed by a biomechanist, who is granted more latitude to venture into the discussion of injury risk. In some cases, they are allowed to consider medical records, MRIs, etc., in forming their opinions. Finally, the defense physician (DC, DO or MD) adds the icing to the cake, testifying that either there was no injury or that there was a minor straining-type injury that has long since resolved.
When pre-existing conditions are present, the plaintiff’s complaints are often attributed to them rather than the injury. Company doctors will typically also be of the opinion that a large portion of the medical expenses claimed by the plaintiff are unnecessary, unreasonable,and represent unwarranted treatment and diagnostics. Note that low back injuries are virtually never admitted to be causally related to low-velocity collisions. I have written a paper on this subject which is available upon e-mail request at drcroft@san.rr.com .3
As I have so many times implored readers – and this fact is never contested even by my small army of industry-affiliated detractors – the entire defense mechanism just described is nothing more than a series of interlocking nonsequiturs. The accident reconstructions and biomechanists provide a very polished and seemingly airtight argument based on what appear to be sound mathematical principles and classical Newtonian physics. This is all very interesting, and would be even more so if it had the additional virtue of being true.
Delta V Not a Valid Gauge of Injury Risk?
But figures don’t always add up, which brings me back to the headline of this article. A new study that provides further compelling evidence that delta V, the keystone in the standard defense strategy, is not a valid gauge of injury risk.4 The authors recruited a total of 57 people within 48 hours of their MVCs. The subjects were recruited either from an engineer’s office for vehicle damage assessment or an ER. The whiplash grades ranged from 0-4 (0 indicating no claimed injury and 4 indicating fracture). The collision types included 13 frontal, 21 rear, 19 side, three multiple crashes and one rollover. There were 25 males and 32 females with a median age of 33.
In all cases a trained engineer determined the delta V by examining both crash vehicles. The VAS and Neck Disability Indexes (NDI) scores were tabulated. The authors found no significant correlation between NDI and delta V, no correlation between whiplash grade and delta V, and only a moderate correlation between VAS reported pain and delta V. However, the R2 value (coefficient of determination) for that correlation was only 0.30, which means that 70 percent of the proportion of the variability of pain severity was not explained by differences in delta V.
There was no lower threshold below which a large proportion would predictably not be injured, nor was there an upper threshold above which most would predictably be injured. This was because some people were injured in very low velocity crashes while others were not injured despite fairly high velocity crashes. The authors commented, “It can be concluded that delta V is an irrelevant predictive value for cervical spine injury after MVA [motor vehicle accident].”
Some specific findings include the following: Cervical spine fractures in frontal crashes occurred in delta Vs of 9.3, 19.9 and 31.1 mph. Fractures in side impacts occurred in delta Vs of 6.2 (z-joint fracture of C4), 9.9 (C7 with dislocation of C6-7), 19.9 (z-joint fracture of C2), 31.1 (C5 fracture with C5-6 dislocation and paraplegia), 32.3 (rupture of alar ligaments), 36.0 (atlantoaxial dislocation) and 36.6 mph (rupture of alar ligaments). There was a dens fracture in the one rollover with the delta V reported as 9.3 mph. This article is available for free download at www.ncbi.nlm.nih.gov/pmc/articles/PMC2657117.
A related component of the standard defense strategy is the property damage issue. Specifically, the argument goes, when the property damage is minor, an injury is very unlikely. We addressed this issue earlier in a meta-analysis of medical and engineering literature dating back as far as 1970 that failed to provide a clear link between property damage and any of three outcomes: risk for acute injury, degree of injury severity and risk for long-term symptoms.5 As I always caution readers, this lack of correlation considers the genre of collisions producing property damage that would be described as minor or non-severe. Clearly, when crash severity increases beyond this, there is an increased risk for injury or death.
A related interesting paper by Viano and Parenteau demonstrated that more than 60 percent of the National Automotive Sampling System case database for rear impacts are for crashes with delta Vs of under 15 mph. They noted, “In very low speed crashes, advanced age, stenosis and degeneration of the cervical spinal canal can lead to spinal cord injury and paralysis in crashes otherwise not causing injury in normal adults.”6 I would also note that it has been demonstrated rather conclusively that human variables (i.e., risk factors) are more determinative vis-a-vis injury risk than crash metrics in the lower crash-severity range.
In the end, when essential parts of the foundation of the defense strategy are tested, they repeatedly fail to hold up to the scrutiny of hard science. In a court of law, however, if the plaintiff and their experts cannot effectively present the real facts and rebut the junk science, 12 impressionable jurors will decide the outcome of the case based on their perception of the soundness of the arguments they heard. The simple fact is that more often than not, the plaintiff and their witnesses are simply not adequately prepared. Knowledge is power and information is the currency of success.
References
Zaloshnja E, Miller T, Council F, Persaud B. Comprehensive and human capital crash costs by maximum police-reported injury severity within selected crash types. Annu Proc Assoc Adv Automot Med, 2004;48:251-63.
Berardinelli DJ. From Good Hands to Boxing Gloves: The Dark Side of Insurance. Portland: Trial Guides, LLC, 2008.
Croft AC. Low back injuries in low velocity rear impact collisions. Forum, 2009;39(4):33-7.
Elbel M, Kramer M, Huber-Lang M, et al. Deceleration during “real life” motor vehicle collisions: a sensitive predictor for the risk of sustaining a cervical spine injury? Patient Saf Surg, 2009;3(1):5.
Croft AC, Freeman MD. Correlating crash severity with injury risk, injury severity, and long-term symptoms in low velocity motor vehicle collisions. Medical Science Monitor, 2005;11(10):RA316-21.
Viano DC, Parenteau CS. Serious injury in very low and very high speed rear impacts. SAE, 2008;2008-01-1485.
Subscribe to:
Posts (Atom)