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THE CRMA: PROVING SOFT TISSUE INJURY IN ONE REPORT

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Brandon Carter

on 1 September 2016

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Transcript of THE CRMA: PROVING SOFT TISSUE INJURY IN ONE REPORT

THE INSANITY CYCLE OF P.I. CASES
THE LEGAL CHALLENGE
COMPUTERIZED RADIOGRAPHIC MENSURATION ANALYSIS:
PROVING SOFT TISSUE INJURY FOR PI CASES


THE SOLUTION
HOW TO WIN WITH A CRMA
There is a way to win with higher settlements (without the extra work!):
THE CRMA
CRMA finds ALL INJURY BASED ON AMA GUIDES
Are there any other challenges that we haven't discussed yet?
SO WHERE DO YOU GO FROM HERE?
Client is wondering why you can't get the case done faster for more money!
WHAT SLOWS DOWN A CASE?
Collecting medical records
Reviewing all of the medical records
Knowing what to do with all of the records--INTERPRETATION IS A PROCESS!
The doctor doesn't send the records over in a timely manner
Calculating the overall value of the demand
The client skipped town!
Legal Assistants that are struggling with ALL OF THE ABOVE!
Another doctor ruins/damages the case and you don't know what to do about it
What slows down a case?
Collecting medical records
Reviewing all of the medical records
Knowing what to do with all of the records--INTERPRETATION IS A PROCESS!
WHAT IS THE NEXT STEP? IS THE PATIENT FINISHED WITH CARE?
Client has chronic complaints still and no further treatment plans
Calculating the overall value of the demand
The client skipped town!
Legal Assistants that are struggling with ALL OF THE ABOVE!
Patient tells you they have persistent pain when the doctor says the treatment is finished/or no injury
Why does this happen?
No or minimal damage to the vehicle
MULTIPLE PEER-REVIEWED RESEARCH HAS PROVEN INJURY WITH 5 MPH:

1. Panjabi PhD, Spine 1998--
2. Ito, S., et al., Spine 2004--
3. Stemper BD, Yoganandan N, Pintar FA, Rao RD. Med Eng Phys. 2006--
4. Yoganandan, PhD, et al., Spine 2001--
5. Panjabi MM, Eur Spine J 1998--
...and much much more!

A VERY AVERAGE CASE
The Dr. notifies you that the case is done & sends you the file with his final report...
NO OBJECTIVE DATA
I HOPE, I HOPE, I HOPE...
I hope the objective findings match the subjective complaints
I hope the care is medically necessary and correlates to the accepted National Guidelines Clearinghouse & Croft CAD Guidelines
I hope the doctor included Objective Data proving soft tissue injury.
I hope all possible Colossus drivers are included.
I hope the doctor includes DUD/LOE, FCC, WBI based on CRMA and AOMSI.
SEND IN THE DEMAND
So you cross your fingers, face east, do a chant and hope the insurance company gives you a decent offer the whole time feeling you are coming from a very weak negotiating position and at their mercy.

Schedule a consultation with us today
BENEFITS
1.
RESEARCH
driven radiology report adds
VALIDITY
2.
OBJECTIVE DATA
that is compelling in accordance with
AMA Guides
,
SETTING UP THE CASE FOR IMPAIRMENT
3. SETTLE WITH insurance companies with
EVIDENCE
4.
INCREASE VALUE
OF THE CASE by $3,000-$5,000.00 with OBJECTIVE FINDINGS
CRMA shows AOMSI (Cervical Instability) which is a Grade IV 25-28% impairment according to AMA Guides to Permanent Impairment:
NEXT, YOU ANALYZE YOUR PERCEPTION OF THE STRENGTHS AND WEAKNESSES OF THE CASE
THEN YOU DEVELOP A SETTLEMENT AMOUNT THAT YOU FEEL IS NEGOTIABLE FROM PAST CASES YOU HAVE HAD
You go over the report checking for the usual elements of
TX, COST, DX, PROGNOSIS, VEHICLE DAMAGE, POLICY LIMITS, 2ND OPINION, IMAGING MRI, CT, PAIN MANAGEMENT, DR. STATEMENT OF CAUSATION, UM/UIM, ETC.
You determine there are multiple weaknesses in the case with little or no real objective data, and even that seems to be based on a MD/DC opinion.
You may be hoping for business as usual, that the case will at least pay everyone without a reduction, and give your client some money.
You have a very strong opinion that you could do a better job than the doctor, because the doctor gives you no ammunition to do your job so you have to either ask them to revise their reports, or ask if your client can have something more done like an MRI, 2nd opinion, etc. to help you not look so pathetic on your demand to the insurance company.
The doctor in turn says the same thing about you and wonders why you can't settle the case more quickly and for more money so as to not cut his bill. After the doctor's bill gets cut, the doctor trashes on the attorney saying to his billing department that he will never use you again.
SOLUTION
1. Have
X-RAY REPORTS
that
PROVE
soft tissue damage.

2.
X-RAYS
taken by
EXPERTS IN SOFT TISSUE INJURY
using specific criteria--by a Board Cert Radiologist MD.

3.
OBJECTIVE DATA
that is sent into the INSURANCE COMPANY, with
Colossus DRIVERS
included in report.

4. Use of
AMA GUIDES
to prove
AOMSI
and set the case up for a
PERMANENT IMPAIRMENT RATING.
The attorney hopes that the following will be found at the end of the treatment plan...
...WE HAVE PUT TIME, ENERGY, AND RESEARCH INTO THE SOLUTION
CRITERIA FOR ORDERING A CRMA
Traumatic event
"Normal" MRI/CT/Plain films or other medical tests
Timing - 3 to 6 months out post-injury
We recommend 3-5 digital views by trained Rad Tech
Persistent pain/complaints
PI is a difficult niche with many facets!
Pain is the worst pathophysiological indicator of injury
COMPUTERIZED RADIOGRAPHIC MENSURATION ANALYSIS (CRMA) THAT INDICATES CERVICAL INSTABILITY
CERVICAL MRI
AT IRC, WE HELP LAW FIRMS MANAGE PERSONAL INJURY CASES AND SETTLE AT HIGHER AMOUNTS.
20 minute in-house IRC360 registration session
TRY OUR CLOUD-BASED CASE MANAGEMENT
SYSTEM FOR FREE
IT'S AS SIMPLE AS THAT.
Our other services we provide:
Permanent Impairment Rating
Medical Review
Future Care & Cost Analysis
Expert Witness
Case Analysis
Impairment Rating Rebuttal
...and much more
CT SCAN
PLAIN FILM
T
THE IMPAIRMENT: MRI OR FLEXION-EXTENSION RADIOGRAPH?
IN SUMMARY...
"Normal" plain film/MRI DOES NOT equal No Injury (False negatives)
Eur Spine Journal (2013). Hidden discoligamentous instability in cervical spine injuries: can quantitative motion analysis improve detection? M. Mayer, et al.
"Normal" MRI with disc bulge, annular tears likely POSITIVE CRMA
Patient with persistent pain likely POSITIVE CRMA
Herniation OR... AOMSI
Grade III (Repairable with degeneration) vs.
Grade IV (unrepairable, lifetime injury, degeneration, possible fusion)--facet capsule tears, ALL, PLL, LF, interspinous, alars
WHAT IS CERVICAL INSTABILITY?
Over the past 30 years of PI practice, we have noticed the following challenge:
FALSE NEGATIVES EXIST
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