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BILL GALLAGHER, DC, CMVI | Chiropractor Radiology in Your PI Case
Since about 1990 with the in- troduction of TEACH at State Farm and Colossus at Allstate automobile insurance companies have worked o two basic formulas. e one that personal injury attor- neys are all too familiar with is deny, delay, defendant. e other is the one most attorneys would do well to fully understand.
When James Mathis created TEACH at State Farm and managed Colossus for Allstate it was based on some very simple premises. His rst question was what are we paying? is forced healthcare providers to become more pro cient at diagnosing injuries, a skill that most doctors have not mastered.
is lack of diagnoses usually leads to a low-ball settlement o er. I use the plural because medical doctors tend to diagnose a cervical strain while chiropractors go with cervical sprain when dealing with whiplash type in- juries. ese two oversimpli cations reduce the value of a claim. More im- portantly, they omit the more serious underlying injuries.
Mathis’ second question asked us to prove the diagnosis. By simply posing this question we now needed to have testing, reproducible objective testing to validate that diagnosis. What test do you have to verify your diagnosis, your clinical impression, your opin- ion?
For attorneys, opinions are what is all about. Two attorneys will present their opinions based on facts in and the court will render an opinion. Doc- tors may have plenty of opinions but clinically we need a diagnosis. From
the Greek root of gnosis, to know, a diagnosis is something that a doctor knows about the patient’s condition.
is knowledge can be based in ex- perience of having seen X number of cases with a similar set of symptoms and ndings that an experienced doc- tor will know what to look for. Even with this experience, if the case gets to litigation you need proof of what you think you know.
For all the orthopedic/neurologi- cal testing that can be done the one test that is the most objective and most veri able is radiology. Radiol- ogy o ers an image of where injured structures are at a given time. Like the old adage of a picture being worth a thousand words, in a personal-injury case these pictures can be worth thou- sands of dollars.
As with any testing there is vari- ability and especially variability of interpretation but for the trained eye especially one with a digital ruler with which to measure, these images become irrefutable. Usually, when an attorney asks me to review a le I will receive copies of the radiology re- ports. Sometimes that alone is all the information I need. When the written information is insu cient, viewing and measuring the lms myself may reveal more serious injuries that may be the cause of permanent impair- ment.
So what can be found on radiology. With plain lm X-rays misalignment may lead to additional testing. Frac- tures, o en very small and compres- sion fractures can add considerable value to a case.
When the plain lm study does not
provide enough information to ex- plain the patient’s complaints an MRI may be in order. ese studies of the spine not only show a more detailed picture of the bony structures but also involvement of injured discs that are more serious cause of pain.
When on the subject of MRIs, it is also important to consider brain scans. In attempting to detect lesions in the cerebral cortex a stronger mag- net, 3T will usually reveal far more ndings than the weaker 1T MRI. A multitude of other studies performed with this MRI can reveal brain inju- ries that might otherwise go unprov- en.
In addition, a stand-up MRI o ers two advantages. First, the additional weight on the discs in this position will cause weakened discs to bulge farther then they would on a recum- bent MRI. is simple procedure will demonstrate far more disc injuries than a recumbent MRI. e weaker magnet on an upright or weight bear- ing MRI makes it less desirable when studying brain injuries with one ex- ception. is goes to the cerebellar tonsils which a er a hyperextension/ hyper exion trauma can cause them to fall into the foramen magnum causing myriad symptoms.
With a recumbent MRI the brain will slip back into the cranium and this problem can o en go undetected. With the patient up-
right the structures
will fall toward the
foramen magnum
and detection of
this injury increases
three-fold.
Scottsdale chiropractor, Bill Gallagher has taught personal injury seminars across the United States and Europe through the American Academy of Motor Vehicle Injuries. He also offers support to attorneys with Phoenix Medi- cal Legal Services and the Concussion Recovery Center. He can be reached at [email protected] or (480) 664-6644.
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