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Shaw Chiropractic
A Medical-Legal Newsletter for Personal Injury Attorneys
by Dr. Steven W. Shaw

Who is your Client’s Health Care Provider?

During our last physician staff meeting Dr. Ron Maringola, the primary attending physician of our Meriden office, expressed his thoughts on the treating doctor’s responsibilities. He focused on the doctor’s role as the team leader in the coordination of all care, communications and documentation. He was proud to share that until now he has never worked with an organization which has coordinated these responsibilities so well. He also emphasized that the Shaw Chiropractic organization, in order to stay at the pinnace, would need to find even better ways to maintain quality control. His thoughts were right on the mark so I suggested that he write a newsletter addressing these points from the perspective of the attorneys who utilize our services with their clients.

It is my understanding that, in addition to liability and insurance concerns, one of the most important factors of any personal injury matter are the health care providers. These providers may include doctors of medicine, chiropractic and osteopathy. Non-physician professionals may include physical therapists, occupational therapists, psychologists or anyone else who may supply health care services to the client. It is important that the attorney is not only on good terms with these professionals, but that they understand the type of care the client may receive. Free-flowing communication between attorney and healthcare provider can help avoid common errors that can have a negative impact on a client’s case.

The client must choose a healthcare provider that practices in an ethical and professional manner. One who presents a pleasant environment within their office. Far too often, clients feel that they are not getting quality time spent with their physician. They often feel rushed during treatment sessions or express a concern that their physician is not truly caring for their particular complaints. A client needs to feel welcomed into a healthcare facility. If a client does not feel the doctor’s compassion, they begin to question the care being provided. This often leads to missed appointments and gaps in treatment. Clients who do not follow their provider’s advice suffer from a clinical perspective in the form of poor outcomes. They also give the appearance that they are not injured as badly as they actually may be. These gaps in care have secondary effect of providing ammunition for adjusters and defense attorneys who will certainly spin these compliance issues towards their favor during settlement negotiations or at trial. An argument can be made that there was little effort to mitigate the physical injuries and that the residuals are in part due to the patient’s non-compliance.

It is essential that an attorney’s client utilize a healthcare provider that is thorough in documenting injuries. The client’s medical chart is discoverable and subject to examination at trials. Anything that is written in the clients chart will be treated as the fact. Therefore, it is extremely important that the attorney be confident that the primary provider will document every aspect of the client’s management. This includes meaningful and timely reports, comprehensive treatment notes, specialty opinions and imaging when appropriate. The doctor should also be concerned with establishing causation and identifying co-morbid conditions which may be complicating but not primary. Examples such as pre-existing degenerative changes and diabetes may make a relatively minor injury much more severe.
The healthcare provider should be familiar with the nature of personal injury matters. The provider should be aware that when injuries are permanent, stationary and unresolved the responsibility of performing an accurate and comprehensive final evaluation may make the difference between a favorable outcome and one that is disastrous. The entire patient chart should reflect a logical treatment and outcome leading towards the conclusions expressed in the final report. In this manner, the attorney can review periodic exams and prepare opposing council and adjustor for a fair result.

While the health care provider is only one cog in the wheel he may play the role as the weakest link or the glue which ties it all together. By having a team leader who is clinically competent and aware of the medical legal responsibilities the attorney can optimize the clients case and assure fair and appropriate compensation to the client. This level of physician care and documentation, when shared with opposing council, should enable the attorney to transition towards settlement discussions which can begin swiftly and without the long waiting period that are experienced when there are numerous holes in the physicians records. Of course, physician bills which are usual, customary and reasonable also help.
An attorney should feel that they can contact the healthcare provider and speak candidly about the clients condition and status. Remember, this type of communication benefits the attorney, the physician and most importantly the client. In conclusion, using the right heath care provider can have a significant favorable effect on client satisfaction, case outcome, and level of work load.