THE FLORIDA LAW BLOG

DIAGNOSING INJURIES AFTER A CAR ACCIDENT

DIAGNOSING INJURIES

Following a car accident or slip and fall, it is important to diagnose and document your injuries. The most common starting point in diagnosing your injuries may be at the scene of the accident by paramedics, or fire rescue. It is important to allow emergency personnel to examine you, because you may be in shock, and not immediately be aware that you have an injury. In many cases, injured persons refuse medical care by paramedics, refuse to be transported to the hospital emergency room, and tell first responders they are not injured. Later that day or into the night, pain may develop and it is quite common for injured persons to visit the emergency room on their own several hours after an accident.

 

It can take several hours, up to several days, for inflamation and pain to set in following a car accident. Further while fractures may be quite painful, it is possible to have a fracture and not be aware of it. Continuing the normal activities of daily life with a fracture can lead to further injury and in some instances life threatening conditions. One example, a spinal fracture may not be noticeable, however if left undiagnosed and untreated, can lead to paralysis. Other injuries that are not immediately apparent include spinal disc injuries, tears to muscle and ligaments, and brain injuries. Traumatic brain injury may not show up for several hours, and any time you have a blow to the head, there is the possibility that a brain injury may have occurred. Swelling of the brain may take several hours, and the patient should be watched carefully for any signs of brain injury, such as difficulty talking, severe headache, dizziness, nausea, slurred speech, and excessive sleepiness. If any of these signs occur, the patient should go to the emergency room immediately.

EMERGENCY ROOM

The best place to start in diagnosing your injury may be the hospital emergency room. You may be transported by emergency services from the accident scene, or you may drive yourself hours later when pain starts to develop. At the emergency room they will do a complete evaluation of your vital signs, a physical examination and X-rays in many cases. Your emergency room visit should rule out any immediate life threatening condition. However the emergency room is probably not the best place to diagnose or treat soft tissue, and spinal disc injuries.

X-RAYS

The basic X-Ray is a good diagnostic tool to determine if you have a bone fracture. A major disadvantage of X-rays as a diagnostic tool, is that they provide little information about the soft tissues. Since they only show a flat, two-dimensional picture, they cannot distinguish between the various layers of body tissue, muscle, ligaments, and spinal discs.

MRI

Magnetic Resonance Imaging is a test that uses a magnetic field and pulses of radio wave energy to make pictures of structures inside the body. In many cases MRI gives different information about structures of the body that cannot be seen with an X-ray, ultrasound or CT scan. An MRI may show injuries that cannot be seen with other methods. Most soft tissue injuries, as well as spinal disc injuries can only be diagnosed with the aid of an MRI.

MEDICAL DOCTORS

A visit to your family doctor, or MD is one option in diagnosing your injuries following a car accident, however medical doctors normally do not specialize in diagnosing and treating soft tissue and spinal disc injuries. An MD may be a good choice when you have lacerations, need stitches, or have a fracture requiring the services of an orthopedic doctor.

CHIROPRACTIC PHYSICIANS

The Chiropractor is well suited to treat injuries after an automobile accident. The chiropractor is educated in diagnosing and treating soft tissue and spinal disc injuries. The chiropractor may take X-rays of your spine, take a complete history of your health, and conduct a thorough physical examination. Chiropractors are well versed not only in diagnosing auto accident injuries, but in treating those injuries in such a manner as to return the patient as much as possible to their same condition as before the accident. Chiropractors often serve as the center of the wheel (hub) in treating auto accident victims and may send you out for an MRI, or for a consultation with a neurologist or orthopedic doctor. The chiropractor will then coordinate your care, and diagnostic testing with such outside professionals, and create a final report and recommendations regarding your injuries, including the severity of your injuries, any degree of permanent impairment, and the need for ongoing future care.

ORTHOPEDIC DOCTORS

The orthopedic doctor is normally consulted when there is a fracture, ligament tear, and spinal disc injury. The orthopedic doctor will usually see you after your chiropractic doctor has reviewed your MRI report, and determined that you may need a surgical consultation. The orthopedic doctor will evaluate whether your injury is one that can be addressed with surgery. The orthopedic doctor may advise you that you would benefit from surgery for your accident related injury, and will then provide your primary doctor or chiropractor with a written surgical recommendation. It is up to the patient in many cases whether they will undergo surgery, unless the condition is one in which surgery is absolutely necessary such as a life threatening condition, or one with is causing extreme pain.

 

WHAT EVERYONE SHOULD KNOW ABOUT SUBROGATION IN PERSONAL INJURY CASES

WHAT IS SUBROGATION AND WHY DO AUTO ACCIDENT VICTIMS NEED TO KNOW ABOUT SUBROGATION?

Subrogation is an essential part of handling a personal injury claim by an attorney. Every attorney has an obligation to explain subrogation to their clients, and to address subrogation issues in their client’s case. This article is intended as an overview of subrogation and further discussion with your attorney is suggested.

WHAT IS SUBROGATION

Subrogation is an equitable doctrine holding that when a third party pays a creditor or obligee the third party succeeds to the creditor's rights against the debtor or obligor. In terms of an automobile accident claim, subrogation is a doctrine holding that when an insurance company pays an insured's claim of loss due to another's negligence, the insurer succeeds to the insured's rights (as the right to sue for damages) against the tortfeasor. Subrogation can take place either by operation of law or by contractual agreement. The purpose of subrogation is to compel the ultimate payment of a debt by the party who, in equity and good conscience, should pay it.

WHY DO INJURED PERSONS NEED TO KNOW ABOUT SUBROGATION

When you are injured as a result of someone else’s negligence, and you will likely obtain medical treatment for injuries sustained, such as in an automobile accident. In Florida there is currently a requirement that all drivers carry personal injury protection insurance coverage or PIP, also known as no-fault. In theory your no-fault insurance is supposed to pay for your medical care following an automobile accident. However PIP is normally limited to $10,000.00 and will pay only 80% of your medical bills. To make matters worse your own insurance company may cut off your PIP benefits and simply stop paying your medical bills after you are examined by one of their doctors in what they call an independent medical exam or IME. No fault benefits are not subject to subrogation, and as such payments made to medical providers through PIP do not have to be reimbursed.

The problem arises when other sources of payment must be utilized to cover your medical bills following a car accident. These sources may include health insurance, medicare, medicaid, and medpay. These are known as collateral sources, and any payments made by them are subject to subrogation, which means that they may have a lien against any settlement you may receive from the at fault party, and must be reimbursed for payments made to your medical providers.

In many cases, the collateral sources are willing to accept a reduced amount and your lawyer may be able to negotiate these reductions on your behalf.

It is the lawyers obligation to determine if there were payments to any medical providers by collateral sources, to obtain written lien amounts from those collateral sources, and to pay back those collateral sources through the subrogation process.

WHAT YOU SHOULD KNOW ABOUT MSPRC

The subrogation process becomes even more complex when medicare or medicaid have made payments, which triggers federal laws and complicated rules, particularly with regard to medicare. Subrogation for medicare falls under the MSPRC or Medicare Seconday Payer Recovery process. In order to understand the complexity of MSPRC and the time frame that should be expected, please review the following; Medicare’s has a Right of Recovery from  Liability Insurance, No-Fault Insurance, Workers’ Compensation. The applicable statute is 42 U.S.C. 1395y(b). See particularly, 42 U.S.C. 1395y(b)(2)(A)&(B). See also 42 CFR Part 411 for the applicable regulations. Medicare is secondary to all types of liability insurance, no-fault insurance, or workers’ compensation. Note: For liability insurance, this includes self-insurance which is defined by statute as follows: "An entity that engages in a business, trade, or profession shall be deemed to have a self-insured plan if it carries its own risk (whether by a failure to obtain insurance, or otherwise) in whole or in part." Medicare may make conditional payments while a claim is pending but is entitled to repayment. "A primary plan, and an entity that receives payment from a primary plan, shall reimburse the appropriate Trust Fund for any payment made by the Secretary under this title with respect to an item or service if it is demonstrated that such primary plan has or had a responsibility to make payment with respect to such item or service. A primary plan's responsibility for such payment may be demonstrated by a judgment, a payment conditioned upon the recipient's compromise, waiver, or release (whether or not there is a determination or admission of liability) of payment for items or services included in a claim against the primary plan or the primary plan's insured, or by other means." The MSPRC begins retrieving all claims paid by Medicare with dates of service on or after the Date of Incident. Once the MSPRC receives this information, the claims are reviewed to determine which items and/or services are related to the Liability Insurance, No-Fault insurance, or Workers’ Compensation case. MSPRC is not able to provide the Conditional Payment information until the medical claims information is available and has been reviewed. This process takes approximately 8 weeks. During this time either Proof of Representation or Consent to Release documentation, as appropriate, needs to be sent to the MSPRC as soon as possible. If no valid Proof of Representation or Consent to Release document has been received by the MSPRC, the Conditional Payment Letter (CPL) will ONLY be sent to the beneficiary and any no-fault insurer or workers’ compensation carrier reflected in the MSPRC’s records.