Surprise is a major factor in the severity of low speed impact injuries.

To be or, not to be, Whiplash Claims in the 2000’s

The most common “Issue” people face after an auto accident is the condition that was formerly called “Whiplash.” These days there is far more science around this painful and often debilitating injury. Thanks in part due to the work of Arthur C. Croft, Ph.D.(c), D.C., M.S., M.P.H., F.A.C.O. at the Spine Research institute of San Diego. In large part due to their work, we now call whiplash Cervical Acceleration/Deceleration Syndrome or (CAD).

These injuries have been under attack by the insurance industry due to the fact that they don’t like to pay for the necessary rehabilitation needed to restore accident victims to their former health and function. “Soft tissue injuries” can be extremely painful and include contusions, sprains and strains, radicular findings, (Numbness, burning, tingling in the extremities) and can often these types of injuries don’t appear for days or even weeks after the accident.

Sprains are injuries to ligaments and can affect multiple joints including the neck, low back, shoulders, elbows, hands, knees or ankles. Sprains can take up to a year to heal properly and often times cause some level of disability. Strains are injuries to muscles or tendons that can be very painful and can make it uncomfortable to walk or be in any position for an extended period of time without pain.

Many times in accidents with minimal damage to the vehicle these types of injuries occur. In fact research has documented that vehicles colliding at as little as one point five miles per hour can cause severe injuries particularly in people with pre-existing conditions that reduce the shock absorbing properties of their spines such as a straight or reverse curve neck.

In many cases, these injuries do not show up immediately after the accident in fact often taking days or even weeks to fully kick in.  When they finally do however, they can be quite debilitating.

Its almost inevitable these days that when there is minor vehicle damage the insurance claims adjuster will argue that there was insufficient damage to the vehicle to justify a “Soft tissue injury.” This is just patently ridiculous and if you are the one suffering you will surely agree. Insurance adjusters are trained in how to minimize your injuries and claim that treatment was usurious and unnecessary. Oh would that we could transfer the pain of even one patient to these heartless people such that they could truly understand.

The allegation that insurance adjusters are making these days is that Doctors and Patients are in collusion to defraud the insurance companies with these bogus claims and copious treatment. It has been my experience that visits to my office may be considered by some as… somewhat entertaining, but I don’t believe that patients come for my sense of humor.

Let me repeat this concept again this time without sarcasm, patients don’t come to my office for fun or to get rich, they are in pain and the work we do together is designed to get them back to full function in the least amount of time. None of us are getting rich on the backs of the insurance carriers.

Cervical acceleration deceleration injuries can be serious and debilitating, do not allow yourself to become wrapped up in the games that insurance adjusters will undoubtedly play.  Don’t be victimized twice.

If you or a loved one have been in an auto accident, don’t talk to the adjuster yourself, they are not on your side. Get yourself an attorney immediately believe me the carriers have an army of attorneys trying to deny you treatment and payment for your pain and suffering due to your disability.

It is also important that your Doctor be it a Chiropractor or MD has had experience with personal injury cases, can and WILL provide adequate documentation/reports to support your case. Your health care practitioner needs to have the capacity to articulate this to your attorney such that together your attorney and doctor can prevail on your behalf on both liability and damage issues. This is not what you can expect from “Volume” practices as they just don’t allot the time necessary to do the work.

If you are in a car accident, it is best not to discuss your condition with any insurance adjuster from the responsible person’s insurance company. If pressured about your condition say, “Its too soon to tell” if you feel obliged to tell them anything at all.

As the effects of the injury may come days or weeks later, (Which I’ve seen time and time again) you don’t want to put yourself in the position of being unable to get the compensation you deserve for your injury by saying “I’m OK” at the scene of the accident, or a day or two after the accident. If you do and are one of the ones who had a delayed onset of symptoms, they will throw that comment back at you while trying to deny your claim.

The first thing to do after an accident is contact a doctor who works with soft tissue injuries and get yourself evaluated (OK I’m a Chiropractor and yes there are studies that indicate we are the most successful at treating these conditions so call me biased if you will.) Next find a personal injury attorney who can advise you of how to move forward and how best to document your claim for compensation.

Auto Accidents: “Who you gonna call?”

Clearly not Ghost Busters.

I recently came across an article in a Personal Injury Blog that I found so offensive I had to respond to it. No… I’m not going to tell you which personal injury blog as that might give it some sort of credibility. It did however raise a few interesting points I’d like to discuss.

The article written by an attorney makes the statement, “Juries don’t like Chiropractors so you’d better get a Medical Doctor on board even if you choose to use a Chiropractor. Having a Medical Doctor referral to a Chiropractor will add some credibility to your case and, you should continue to see this Medical Doctor as the Primary so that he can monitor your progress.” What this action adds from my perspective is cost. Juries in my experience don’t like additional and or inflated costs when they look at these sorts of claims.

Most of this commentary was based on his estimation on the gross disparity in the DC versus MD education. Allow me to point out the flaw in this argument.

Chiropractors go through an immense amount of schooling to receive their DC (Doctor of Chiropractic) degree. We are considered “Portal of entry” or “Primary Care Physicians” in all fifty states in this our great land. The core curriculum of a Chiropractor is essentially the core curriculum in Medical Schools and the comparison is represented on the chart below.

Chiropractic Student Hours    Class Description   Medical Student Hours

520                                Anatomy                      508

420                               Physiology                     326

271                               Pathology                      335

300                               Chemistry                      325

114                             Bacteriology                     130

370                               Diagnosis                       374

217                              Radiography                    148

65                                Psychiatry                      144

65                                 OB/Gyn                        198

225                              Orthopedics                     156

2887                              Total Hours                   2756

1598                         Specialty Courses                1492

4485                        Entire Total Hours                4284

As you can see from the above, there is little disparity in the education of Chiropractors versus Medical Doctors. The split is in the areas of specialty. The Chiropractors chief focus is the ability to diagnose, treat and quantify musculoskeletal conditions. This would be say, the slip and fall, sprain strain, sports injury, overuse injury and…. The Cervical Acceleration Deceleration injury or what used to be known as whiplash.

I am not an attorney and never give legal advice.  However, I am going to use my seventeen years of experience treating the aforementioned conditions and my common sense to make a few points of interest to someone trying to decide which direction to go having suffered an injury of these types.

MD’s, DC’s, PT’s are all people. The range you might find runs from good to excellent in some, others range from mediocre to down right awful. You have to do your own due diligence to decide who in all of these fields, falls where on that continuum.

Chiropractors and Physical Therapists have a certain amount of overlap. PT’s are not at this time considered primary care physicians. Both of these areas of specialty are concerned with soft tissue trauma.

The MD’s come in a variety of flavors again based on specialty. The vast majority have two tools in their arsenal, drugs or surgery. In the absence of breakage or fracture, these are not the most appropriate tools for musculoskeletal complaints.

My Dad often said, “Common sense, so rare it’s often confused with genius” but I’m going to give my readers credit for seeing the point I am making without belaboring it.

As to the statement “Juries don’t like Chiropractors”, I have only appeared once before a Jury and it was I against a battery of insurance MD experts. We prevailed in that case. Juries are people…. they like who they like and if a person makes sense, is presentable and credible, I think the letters after their name are not as important as the work that they did and their capacity to present it clearly and articulately.

Do I think you need an attorney to represent you in these situations? You bet I do, but should that attorney tell you how or with whom to treat your condition, no more so than I should give you legal advise.

Ideally, you want an attorney and health care practitioner who are on the same page and have your best interests at heart. I take umbrage at any practitioner who attempts to undermine the confidence of their patient/client in another practitioner who is serving them well.

Best of luck to you if you have suffered an injury of any sort and please do what makes sense to you regardless of who tells you how to proceed.

Low Speed Impacts – Trauma or no trauma ?

There is a lot of argument in the Med-Legal community as per the effects of “Low Speed Impact” and its potential for producing soft tissue injury. The debate is amongst the people who suffer from the resulting pain and their advocates, and the insurance companies who feel a distinct dislike of paying for the resulting care. I think this exists in part due to the fact you can’t SEE soft tissue trauma though there are ways to measure its effects.

Which side of the argument a person falls upon usually depends on whether you are plaintiff or defendant oriented in your thinking. The medical literature is actually very supportive of the fact that a patients level of injury relates very little to the vehicle speed at the time of impact or the dollar amount of damage to the care and more to a series of other conditions.

True story, I recently had an insurance adjuster state “You can’t believe a comprehensive exam is justified for a soft tissue injury?” Well yes I do as a matter of fact. This is representative of how jaded the insurance adjusters have become. I am more amazed that they would chastise a Doctor for being thorough in the execution of his duty to his patient.

You need to find a practitioner and an advocate who understand these principles and will fight for your rights.

The following is only one article on the subject that I’d like people to be aware of. It appeared in the Journal of Manipulative Physio Therapy 1998 (Nov): 21 (1): 629-639 the following are excerpts from the article:

Background: There is a controversy regarding likelihood of injuries sustained when one car strikes another at a relatively low speed with little or no vehicle damage. Plaintiffs often claim injuries while defendants counterclaim that injuries could not have occurred with such a relatively minor impact.

Objective: To review the dynamics of low speed rear-end collisions resulting in little or no visible damage and to see if occupant injury can occur; also, to discuss diagnostic and treatment that may be helpful to the clinical practitioner.

Data Selection: A medline search of low speed rear-end was conducted. Other articles and studies were reviewed that discuss low speed rear-end collisions and factors impacting the neuromusculoskeletal system relevant to clinical practitioners. Articles included were: human low speed rear-end tests, lab tests on cadavers, automotive engineering papers, and peer reviewed journal articles on whiplash. A few live animal and simulation studies were considered for the background of possible injury mechanism and vehicular deformation. Excluded were non rear-end and single case reports as these were not a part of the sturdy group.

Data synthesis: The data was studied to find a relationship between the resultant vehicle dynamics with occupant movement, biologic mechanisms of injury and the neurological mechanisms causing complaints. Data was also studied to investigate objective findings supporting subjective complaints.

Conclusion: In low impact collisions, there are usually no skid marks, minor or no visible damage to the vehicle. There is a lack of relationship between occupant injury vehicle speed and/or damage. There does not appear to be an absolute speed or damage to a vehicle for a person to experience injury. Crash tests indicate a change of vehicle velocity of 4km/h (2.5 mph) may produce occupant symptoms. Vehicle damage may not occur until 14-15km/h (8.7 mph). Occupant soft tissue and joint injuries resulting from low speed vehicle collisions respond positively to afferent stimulation of mechanoreceptors. The diagnosis of the occupant injuries is reliant upon standard orthopedic neurological testing, the autonomic concomitant signs and qualitative sensory testing.

Some of the factors that are apparently involved with the event of injury from these types of cases are head forward posture, military (Straight) neck and whether the victim of the accident was aware or not aware of the impending collision.

And there you have it folks from a peer reviewed article. Suffice it to say if you have suffered from “Whiplash” which we now prefer to call Cervical Acceleration Deceleration injury, Don’t believe your carrier if they tell you there is no compensation available to you based on the speed of your impact. I hear this argument all the time from patients of mine who are being pressed to settle by the carriers. If you are hurt in an auto accident get yourself an attorney to protect your interests and don’t be tempted to deal with the carriers directly. You have to remember their interests are not your own and they have a lot of practice dealing with people who don’t understand the laws, the literature, or in fact the mechanism of your injury and its Potential future complications.

Change in Auto Insurers policies, they are no longer honoring med-pay and playing hardball in minor crash claims.

Insurance companies, their very name is something we want to trust. They are there for us in our times of need and despair. Or, the once were.

In the past auto insurers have always honored Med-pay on their insured drivers. What that means is if you have paid extra for the coverage of your medical expenses they pay them in a timely fashion and then collect from the responsible carrier after your case settles.

Since 2011, four out of the last five patients I have treated who have Med-pay their carrier’s have NOT paid the bill in a timely fashion AND have put the charges that they have paid into “Review” paying only a fraction of the charges which is not the coverage promised to people who pay extra for Med-pay coverage, and leaving their insureds with significant charges they themselves are responsible for.

Historically speaking, insurance companies have had a reasonable response to people who have had soft tissue injuries in low speed collisions. These days if you are injured in what we euphemistically call a “Fender Bender” you will be in the fight of your life to get the insurance companies to pay all the costs you incur even if the accident was the other drivers fault. It has gotten completely out of hand.

I had a case where three family members were in the same car, which was struck on the freeway and totaled by a large SUV. Two of the three had typical injuries and their claims were paid promptly. The third had his elbow strike the armrest so violently it tore the muscles in his shoulder requiring surgical intervention. The insurance company suddenly claimed he wasn’t even in the car, then further stated he had numerous claims so was “Causing accidents” to defraud insurance companies. As it turns out, this fifty year old father shares a name with a seventeen year old who has left a trail of accident claims but… we believe the insurance company knows the truth and still these many months later his bills remain unpaid.

CNN performed and eighteen-month study of low speed impacts crashes around the country. These are the accidents that result in Soft Tissue Trauma and the vehicle has little or no visible damage. Soft Tissue Trauma is not easy to detect with the naked eye or typical tools of the medical trade like X-rays.

Since the two largest carriers, Allstate and State Farm have adopted a “No one is injured in low speed collision” strategy, they have incurred billions in profits for themselves while doing VERY LITTLE for their insured’s if anything.

University of Nevada Law Professor Jeff Stempel stated, “We can see that policyholders individually are getting hurt by being dragged through the court on fender bender claims, and yet we don’t see any collateral benefit in the form of reduced premiums even for the other policyholders. So I think we can say to continue this kind of program is in my view institutionalized BAD FAITH.”

There is a reason you have never heard of this strategy, its because your carrier’s don’t want you to know they are paying out less and less even while their profits soar and your premiums continue to rise. Great business model for them not so good for us the consumers.

This strategy is making it such that you may actually have to go to court to get your medical bills paid. There have been such egregious settlement offers of late that some attorneys are no longer taking these types of claims.

Shannon Kmatz a police officer and former Allstate claims agent said “The company employees were encouraged to get rid of claims as quickly and cheaply as possible and have offered accident victims as little as $50 telling them to take it or leave it.”

And this in America where we stand for fair play…. Oops did I just type that ?

During its investigation CNN found a series of documents with very interesting information.  The short hand version is as follows:

1) Make accident victims look like they are trying to defraud the insurers.

But CNN found documents that indicate profit not fraud is the reason companies are playing such hardball with their policy holders.

2) Focus on soft tissue claims as these are harder to prove.

In other words, get yourself a DAMM GOOD DOCTOR who keeps very good notes and understands this area of treatment.

3) Playing off Allstates signature slogan one document said “Put boxing gloves on our good hands for those who insist on going to court.”

In other words…. Get yourself a DAMM GOOD ATTORNEY who is willing to go the extra mile.

Former Allstate employee Jim Mathis states the strategy is called the three D’s. Deny the claim, delay settlement, and defend against the claim in court. “The profits are good as long as the community and the public allows this to occur, the insurance companies get richer and the people don’t get fair and reasonable settlements.”

Both Allstate and State Farm declined to cooperate with CNN’s study. Allstate claimed it couldn’t expect CNN to do a balanced report. State Farm stated they take customer service very seriously and seek to pay what they owe, promptly, courteously, and efficiently. They further stated we handle each claim on its own merits.

Suffice it to say there are NO studies that prove soft tissue trauma is related to vehicle damage yet this seems to be the current attitude adopted by claims agents.

I recently had a claims agent in a very condescending tone state “You do a comprehensive exam on a fender bender.”  When there are signs of disc injury with findings of sensory loss in the extremities I’d have to say, hell yes. My response to this agent was “I’m sorry to hear most practitioners don’t seem to pay that much attention as if you don’t look, you won’t find anything.” Needless to say we ended our conversation agreeing to disagree.

There are MANY studies that indicate soft tissue trauma can happen at speeds insufficient to do any body damage to the vehicle.

Robert Hartwig, president of the Insurance Information Institute, told CNN that insurers do not have a strategy of blanket denial of claims. He also said that strategies to limit expenditures on minor impact crashes are needed to fight fraud. (Probably on a par with voter fraud which if you are paying attention is about nil.) He further singled out attorneys who work with personal injury victims as “Being upset that the gravy train is over.”

Personally I find that ironic, insurance companies calling attorneys evil.

As someone working in the trenches who treats these people, believe me, they aren’t coming to my office time after time for treatment because I’m so charming and fun to be with. They are truly suffering and want nothing more than to get better and get on with their lives.

I’ve seen the devastation caused by these insurance company policies and suggest, protect yourself, make sure your doctor is paying attention, documenting things adequately and… get yourself a good attorney.

Thanks for reading!

Dr. Camp can be reached at his San Francisco Office at 415 922 2225

Tips on Staying Safe before, during and after an accident.

Many people are prepared for an earthquake but have no idea what to do to prepare for an auto accident. OK we here in California either have or will experience an earthquake but it’s almost as likely we will experience an auto accident and may not have thought about what might minimize the impact on ourselves and the loved ones with us at that time.

Steps to take before an accident:

1. Keep a first aid kit and safety kit in the car - It’s important to keep a safety kit in the car for emergencies. These are available commercially or, you can always make your own.  Your kit should include the items listed later in this article.
2. Have your insurance and emergency contact information in your glove box - After an accident you may be disabled or unconscious.  Emergency responders will often go in the glove box to find information on the driver.  Along with your insurance card keep an emergency contact list with the number of persons you would want notified if you were hurt.
3. Have a spare tire and a jack- Remember, its not enough to just carry a spare tire, you also need a jack and the lug nut tool. It’s also imperative just like you check the fluid levels, to check periodically to see the spare tire is inflated. You also need to know how to physically change the tire in the case of an emergency.

Safety Car Kit Should Include:

• Jumper Cables
• Tire Pressure Gauge
• Flashlight (with fresh batteries)
• Flares/Cones/ Hazard Triangle
• Emergency Poncho
• Small Set of tools
• Utility or pocket knife
• First Aid Kit

Steps to take during an accident:

1. Relax – You need to try to remain calm in these situations, panic never helps. Try not to make any sudden movements as you may be injured. Carefully check that you and your passengers are all physically OK.
2. Find a Safe Place to Move the Car- If the accident is minor, and you are not hurt, it is often better to move the car to a safe place than leave it in the middle of the road. In a more serious accident, or if the car can’t be moved, proceed with caution, especially if you choose to exit the vehicle.
3. Call 911- Do NOT assume the other party has called them.
4. Get Information from the Other Party – It is VERY important at this point to get the information from the driver of the other vehicle. This would include make model, license plate number of the other parties vehicle and their insurance carrier. Do NOT state who was at fault even if you think it was yourself. Let the police and insurance companies work out the liability issues. If you have a camera phone, you may want to take pictures particularly if you intend to move the cars from the point of impact. It’s always a good idea to have pictures taken before you alter the scene. If the other party is belligerent, do not engage them, get back in your car and wait for emergency responder assistance.

Steps to take after an accident:

1. Get a copy of the police report- Again, don’t admit fault to the officer or to the other party.  Allow the officer and insurance company to handle that. If you took pictures with your camera phone don’t forget to submit them to your carrier.
2. Damages- Often times a few days after an accident, you may start to feel pain.   It is common for people to have a delayed reaction after an accident often five to ten days after the incident. The common symptoms that can occur: Headaches, neck pain, dizziness, disorientation, memory loss, low back pain, shoulder pain and the list goes on and on. Do not delay treatment. The quicker you get on it, the quicker you will recover.
3. Attorney- I am sorry to have to print this but insurance companies do not have your best interests at heart. If they play games with you, get yourself an attorney. Never sign anything without reading and understanding it first, and never sign blank documents. Sadly, many carriers try to “Negotiate” with accident victims when they are at their weakest, hurt and fearful. Again even your own carrier is most interested in their own bottom line not your physical or emotional state.

I hope the above information will help you if you are involved in an auto collision. Please take the steps I’ve mentioned, its better to be prepared in advance then sorry later.

Yours in Health,

Dr. H. Edward Camp

Damage to your car in an auto accident does not equal damage to your body.

I had a patient recently tell me that his attorney stated “Insurance companies don’t think your medical bills should exceed the cost of the damage to your car.” Hence this attorney’s advice was to discontinue care regardless of health status due to an arbitrary dollar amount consistent to the damage to the car. I would disagree with that underlying premise.

I’m going illustrate this with a little story I like to tell my patients who have the idea that little or no damage to the car relates somehow to their own level of symptoms.

Four guys in a car get hit; a minor fender bender lets say backing out of a parking space at the super market. Three say “Wow…. lets go hit the beach.” The fourth says “Gosh, my neck feels a little funny.” The others say you faker none of us are hurt.” Sadly the one who felt a little funny…. probably gets progressively worse for the next week or more until he can’t stand it any longer and ends up in my office.

Why does one person in this story complain and the others feel fine? The reason is that this poor unfortunate person had a pre-existing condition, most likely a poker straight neck (Often called military neck) or a reversed cervical curve.

There have been MANY studies done that point out “Delta V” the force required to cause soft tissue injury in an auto accident is 1.5 Miles per hour. This may sound crazy but it’s actually physics. When a car crumples, the car itself is absorbing much of the force of impact. When it doesn’t, ALL of the force of the impact is imparted to the passenger compartment. If we revisit our physics, force = Mass X Velocity. That means if a 2000 pound car is moving 1.5 miles an hour…. Do the math. Then sit down and say YIKES that is a BIG number!

The myth I am trying to dispel is this, MANY people in minor fender benders have major injuries. If your attorney, doctor, or insurance company is telling you different, you need to think about their understanding of what they are dealing with. OK when it’s an insurance company they actually know these facts, what they are worried about is this thing called profits, not your health.

The kinds of symptoms patients are commonly left with after these minor collisions are diverse. These can include; neck pain, headaches, dizziness, ringing in the ears, disorientation, memory loss, low back pain, nausea and the list goes on and on.

So if you have been in an accident, don’t be shocked or surprised if you have issues that seem persistent. If it was a low speed impact with little damage to the car, don’t be down on yourself if it takes you longer to recover than “others” may think is necessary. Please listen to your own body not some arbitrary time frame or dollar amount given to you by someone else. Take care of your body it’s the only one you’ll ever have.