Why Bad PI Records Sink Cases Before Trial Even Gets Started ft. Dr. Brett Chance | Trial Lawyer View Ep. 96

PI documentation mistakes that sink legitimate injury cases: case managers and paralegals who inherit poorly built files will learn from Dr. Brett Chance, CEO of One Wellness Rx, why carrier AI scores record structure rather than actual injury severity, and how his objective data rescue protocol, using flexion extension views and functional capacity tools, can reintroduce measurable consequence evidence even one to two years post-accident. Dr. Chance's standardized workup identifies a rateable whole-person impairment condition by visit three, giving attorneys the injury language, not just pain language, needed to defend a file against degenerative coding and pre-existing condition arguments.

Dr. Chance draws a hard line between acute traumatic ICD-10 S codes and degenerative M codes, explaining that when a chart opens with degenerative or pain-only language such as cervicalgia or nonspecific low back pain, carrier platforms including Colossus and Injury IQ read the file as a chronic condition and begin building a pre-existing condition defense automatically. He describes "cluster diagnosing" as a red flag algorithm trigger, meaning stacked redundant codes without matching CPT procedures or exam progression. Outcome assessment tools, specifically the Oswestry Low Back Pain Scale and the Headache Disability Index, alongside loss of enjoyment of life (LOE) and duties under duress (DUD) markers, are weighted heavily by carrier evaluation systems because chronic disability exposure is what those platforms are actively trying to quantify and limit.

Attorneys reviewing an inherited file should ask four sequential questions: did the chart preserve acute trauma language in the opening visits; did the provider identify the specific tissue involved, whether ligamentous, disc, or neurological; did diagnosis codes evolve logically across re-examinations rather than repeating identically; and does the mid-case prognosis align with functional findings? Flexion extension views, also called Davy series trauma protocols, are the missing objective layer in most motor vehicle workups because they measure spinal biomechanics and ligamentous instability in ways a standard MRI or CT cannot, making them essential for connecting documented injury consequences back to the original traumatic event.

Connect with Dr. Brett Chance:
LinkedIn
Winter Park Chiro
Facebook (Winter Park Chiro)

Learn more about Synergy’s approach to healthcare lien resolution and firm operations.

Trial Lawyer View features long-form conversations with experienced plaintiff trial lawyers, firm leaders, and industry experts. The show is built for legal professionals who want to lead stronger, more efficient personal injury firms by learning from peers who have built, managed, and evolved successful practices in the real world.

New episodes of Trial Lawyer View are released every 2nd and 4th Monday at 5am EST. 

Learn more here: https://sholink.to/synergycontact

Watch on YouTube

If this episode gave you a useful perspective or sparked an idea for your firm, consider liking the video, leaving a comment, or sharing it with a colleague.

This podcast has been brought to you by APodcastGeek

Transcript

Coming up...

Dr. Brett Chance 0:00

Within visit two or visit three, at least in our clinic, I'd know if this is going to be a permanent impairment for this patient. I'm going to know if I have a rateable condition on this. So think about between a 5 to 25% whole person impairment rating, basically off a third visit. However, my goal is to rehabilitate this patient. That's my number one goal, to rehabilitate and try to stabilize this patient. That's Dr.

Jason Lazarus 0:19

Brett Chance, CEO of OneWellness RX and founder of Winter Park Chiro. He uses an objective data rescue protocol to identify measurable injury consequences that carrier AI often overlooks. By the third visit, his standardized workup can identify a rateable whole person impairment that helps attorneys defend against degenerative coding and pre-existing condition arguments.

Dr. Brett Chance 0:43

The record is no longer really just saying that the patient was hurt. It's just showing that the injury had measurable consequences over time. So that's what it likes to see. It likes to track progress through the coding strategy because it's data. Remember that. It's data, data, data.

Jason Lazarus 0:56

So coding strategy and the data input. In this episode, you'll learn why carrier AI scores record structure, not actual injury severity, how flexion extension views produce objective evidence most files are missing, and how a standardized workup identifies a rateable impairment condition by visit three. I'm Jason Lazarus, and this is Trial Lawyer View. So,

The gap between attorney assumptions and how carrier AI actually reads medical records

Jason Lazarus 1:22

full disclosure for listeners, Dr. Chance treats me for athletic performance optimization. And uh, when I get my my neck or back screwed up from driving my car too fast, uh, he's there to help. And we've always talked about a lot of the issues surrounding personal injury given my background and given what he does and his practice too. So great opportunity to have a real interesting discussion, I think, today, about some of those issues that we've talked about over the years.

Dr. Brett Chance 1:55

Yeah, it's gonna be great. I think hopefully we'll bring some insight to some different, you know, ideas here today, at least, and kind of what I'm seeing that's newer in the market, um, and hopefully bring uh, you know, a little bit more insight to today, specifically, maybe a little bit more coding structure and some different language that is being used out there, especially when it comes to you know evaluating or looking at uh how the new carrier systems are evaluating, let's say, claims analysis or even my own documentation now. Um, you know, we we talked a little bit about this, but what do we actually know about these you know said algorithms that are in there, like the Colossus systems or the DXC technologies, things like that. So hopefully we'll shed a little bit of insight of actually what we do know here today.

Jason Lazarus 2:37

Yeah, we will definitely get to all those things because I think it's incredibly fascinating how things are evolving, especially with the intersection of technology now and how that's impacting claims analysis. So, but as a starting point, your practice is focusing on helping injured people uh in a chiropractic support mechanism role. I I want to ask you a more broad question about just the way personal injury attorneys perhaps make assumptions. And one of the assumptions I think is that if a client was injured and is treating, perhaps you know, the attorney feels like, well, the injury is established. And I'm curious uh from your take, where's the gap between that assumption and how the modern carrier claims platform actually reads the medical records today?

Dr. Brett Chance 3:31

Yeah. So, you know, a big part of what I do is essentially, you know, I'm here to help attorneys and not only attorneys, but providers kind of better understand how these medical records, uh, coding, imaging, um, you know, the impairment concepts that we can kind of get from the AMA guides and then obviously claim evaluations. Essentially, how do all these kind of fit together, right? Because, you know, a lot of these, you know, legitimate uh injury cases are weakened uh essentially by the record. You know, it's not that the patient, you know, wasn't hurt. Um, it's just that the record didn't fully support that, right? So essentially that's why I look at personal injury as you know, more of a sub-specialty in this area. Um, the chart has to work medically, but it also has to hold up into you know the real world uh of the claims environment. So, you know, my work is really about helping medicine and law kind of speak the same language. And I think that's kind of what's missing right now. You know, you guys are the best of the best at doing what you need to do uh legal-wise. And we're really good at documenting and staying on top of, you know, uh progressing what this injury is actually meaning for the patient and the client so that it makes sense, but we have to make sure that it's kind of an X's and O's game, right? You're only as good as your, you know, your physician's notes at the end of the day. And when there's no real logic or clarity behind the injury, the patient suffers, right? Not only in results for the care, because maybe we don't actually know what we're treating because it actually hasn't been truly diagnosed. Um, but then on your end, you know, that's where, hey, now, you know, the claims, uh the claims adjusters and some of the uh AI technology out here is going to essentially once again filter through those claims and say there's no real uh uh injury case here. These are maybe all pre-existing conditions based on the status of maybe documentation and coding. So it's really interesting. We'll get back to the show in just a moment.

Jason Lazarus 5:19

But let me ask you this: what if your firm could scale without adding operational drag? As case volume grows, lean resolution and compliance can quietly slow everything down. Synergy works alongside personal injury firms as an operations partner managing these processes so teams stay focused on clients, strategy, and outcomes, not administrative details. If you want to understand how firms are handling this at scale, click the link in the show notes or scan the QR code on the screen to learn more. Now let's get back to

Injury coding versus degenerative coding: what signals tell the story?

Jason Lazarus 5:51

the episode. Good segue into what I was gonna ask you about next, which is the difference between injury coding and degenerative coding, because we've talked about this. And for an attorney reviewing a treating provider's records, what are the specific signals that tell you a file is being documented as traumatic versus a chronic degenerative issue?

Dr. Brett Chance 6:16

So, you know, remember that always goes into the mechanism of injury, right? And it the MOIs essentially leads to a derangement pattern. So every injury has a clear shot at a derangement pattern. And, you know, we we we know what a dog bite looks like, you know, we know what maybe a burn looks like. Um, in my world and what we see in the market now, because you know, I'm in the non-operative setting, right? I'm in conservative management care. That's kind of what we do, um, at least in our clinical practice. So, you know, I always ask a question to some of my providers and even the attorneys out there is, you know, what does a spinal injury really look like? You know, can we define that? Can we, can we really uh, you know, wrap that up? But you know, the record is essentially, you know, this helps us connect the injury to the care overall and you know, what the patient and their, you know, and and the benefits and which they're entitled to um to receive, right? But the easiest way that kind of I can explain, you know, acute coding is this essentially it's uh current traumatic event, right? What happens. So let's take an auto accident, you know, um, so that's gonna be the the acute traumatic event. But degenerative coding tends to suggest more, you know, I guess, long-standing uh recurrent or pre-existent conditions. And that's typically what's being represented in the market because the acute coding strategy, it isn't fully there. The distinction matters a lot in the MVA cases because once a chart starts reading like a chronic or degenerative file, uh, the whole narrative begins to shift. And you guys know that. Um, but you essentially just handed the defense now uh the room to argue these preexisting conditions or uh, you know, non-specific pain, uh age-related findings, which we hear this all the time. That's just because of the documentation is lacking. Um, but you know, the whole narrative begins to shift at that point. So we need to really figure out and interpret the causation standpoint from uh from a treatment standpoint and the overall uh supportive care. But ultimately, if the provider believes the patient is dealing with a current traumatic injury, the chart needs to preserve uh that clearly and early on because what is coded, you guys know uh that is what the case becomes.

Jason Lazarus 8:22

Yeah. And, you know,

Why "low back pain" and "cervical pain" are killing your cases

Jason Lazarus 8:23

what I've seen over the years in looking at medical records when it's uh an MBA is, you know, terms like low back pain or cervical pain. And it's, you know, almost every personal injury file has language like that. Why is that kind of documentation such a problem and what should be there instead?

Dr. Brett Chance 8:43

I think overall pain tells us how the patient feels, you know, that is important, right? Uh, but it doesn't fully tell us what is actually injured. So then we have to really get down to the nitty-gritty of, you know, true, proper injury diagnoses. So, like you said, terms like low back pain, uh, you know, the cervicalgia, the neck pain that we hear, or even just general-based headaches, um, they're appropriate and they should be a part of the chart, but they need to be a little bit more specific. Um, but by themselves, they do not build a strong injury narrative, especially on our end. Um, that's something that we do not teach. And I don't teach that to my attorneys or my providers uh out in the market, that's for sure. But, you know, they they need to tell us whether the problem is ligamentous, is it a disc injury, neurological muscle instability, all those different factors, right? That actually have more significance on, you know, maybe this is going to lay into where we're gonna be doing a treatment-wise and justification for medical necessity on, you know, imaging strategy and things like that to get a clearer picture of actually what's going on with the patient. But this is where essentially, you know, the ICD 10 uh guidelines on my end come in, which these are the diagnosing codes that we use. And um, and we're always referencing these as well because things are always changing. But we use the ICD 10 expert physician coding guidelines, and these are out in the market uh and they're readily available for physicians and our attorneys. Um, but I don't need you guys to be expert coders or expert uh diagnosis strategies because I think uh there's a lot of doctors out there too that are, you know, still working on it, um, including myself. We always can get better, right? But once the provider has enough information to, you know, be able to actually identify the injury, um, then the chart should move uh more, you know, I guess beyond the symptom language, right? And start actually describing the injury itself. So a stronger record really isn't built by adding more of those symptom codes on it. We have to be even more specific when it comes to the diagnosing. So um, it is built by using the right codes at the right time with the right clinical support. So, you know, remember pain language may describe the complaint, but injury language is what explains the case over and over again. We we preach that all day long.

Walking through a defensible, acutely coded record from day one

Jason Lazarus 10:47

Well, since you brought it up, either a hypothetical case or an actual case that you've been involved with, obviously not giving away any confidential information. Can you walk us through what an ICD 10 diagnosis timeline looks like as a story? What does a defensible, acutely coded record look like from the day of the crash through MMI? What what does that look like?

Dr. Brett Chance 11:13

Obviously, that's a that's you know long one here, but let's you know try to simplify it. You know, we need to find, first of all, the mechanism of injury, MOI, right? What actually generated that? In the ICD, there's very specific language as you know, acute traumatic language, and these are essentially what we call like S-codes, right? Um and M codes are more in our land of musculoskeletal care because once again, you know, we're we're in that non-operative space. Um, but you know, there there should be charting as far as what's going on with the acute language and then those symptoms to match what's actually going on there. So if we have, you know, what we see mostly in the uh uh auto injury space is you know whiplash, right? Or maybe a sprain strain code uh that is typically tied to that. And then we have assumed symptoms of muscle spasms or mild spasms in there, maybe cervical thrown in. But now with you know what we're what we're getting into is that might be okay as placeholders in the beginning of the record because they're showing acute injury, but now we actually have to start forming the kind of uh causatory language here as far as what's actually going on with the patient. So, you know, some of those generalized uh, you know, pain codes are going to be okay in the beginning until you get down to the nitty-gritty of actually a definitive diagnosis. So now what we're typically seeing on our end is, you know, there's there's more and more layers of you know AI uh technology in this medical legal space when it comes to actually looking at radiology reports for clear objective data, right? So even when we're going out and sending the patients for early MRIs, do we have that justifiable early on in the record with numbers tingling complaints, focal neurological deficits, very specific to dermatomal changes that we recognize in the body from more of a neurology sense? And is that going to dictate an MRI on my end? Most likely. But when I get that MRI back, how are we going to diagnose this? Are we going to diagnose this based on the trauma? Is it going to be a traumatic disc injury, an acute traumatic disc injury or acute traumatic nerve injury? Or are we going to stay with a little bit more of a pain language or degenerative coding and kind of maybe aim for what we're seeing on the MRI? So that's essentially what a lot that I see that is, you know, at least on my case reviews, is physicians are in in my space using the MRI to then capture their diagnoses, but not really capturing the diagnoses in in their medical record. They're simply just reverting back to the MRI only because we're they're kind of stuck, right? And that's what the market has uh you know wanted over these years is solely MRI, MRI. But now the degenerative language and pre-existing condition uh ideology out there, it's really high, especially in the carrier realm. So if we can identify early on with symptoms diagnosing uh in the clinic with orthopedic assessments and that actually follow real medical necessity, now the language is changing because we're actually suspecting this in our diagnosis strategy when we're uh when we're actually seeing the patient one-on-one, um, it's all, you know, it's all being recorded, of course. Um, so that's higher medical necessity for what we want to do with the patient.

Jason Lazarus 14:31

Well, so

How to align imaging, neurological findings, and diagnosis codes into one coherent injury narrative

Jason Lazarus 14:32

when you have imaging and neurologic finding and diagnosis codes and and they're living in in separate silos, how should attorneys think about aligning them so that the record reads is one coherent injury rather than separate, you know, distinct findings that perhaps doesn't tell the story?

Dr. Brett Chance 14:55

That's always a tough one, right? And it really depends on you know the type of attorneys um and their, you know, the practice and and how they actually work these cases up. Um but you know, the coding timeline is really the life cycle of the injury. So, you know, I tell attorneys first, you know, let's start by asking the simple question, you know, go through the chart. Did this actually preserve the injury as an acute uh trauma early on in the case? Um from there, you know, I want to know whether the provider um identified the actual tissue involved, whether there was objective findings and whether the diagnosis kind of evolved, you know, uh logically over time. Um I also want to see whether the diagnosis and some of the treatment, you know, we talk about some CPT codes as well, um, imaging, and you know, if the prognosis also tells the same story. So you have to capture it at different lenses and angles here. But you know, the big red flags are, you know, pain-only charting, you know, those vague diagnoses, no clear, you know, MOI, no progression for the patient. The biggest thing now is function, you know, um, insurance couriers are really looking at function and ADLs and capacity for these patients because you know, chronic pain is running rampant in our society. And it starts with neck, low back, and chronic headaches. Um, and especially in whiplash cases, you know, uh and severe ones, the uh uh the data in the research shows us that, hey, there's there's about a 50 to 60 percent chance that hey, this patient is gonna have chronic pain long term. So, you know, we just want to make sure that you know the chart isn't drifting too early into degenerative language. Um, uh once again. So, but it has to contain, you know, a long list of codes, but you know, several of them are basically repeating the same complaint without separate exam findings. So there's different strategy that I I kind of teach in there in our uh injury decoded program and some of my local CLEs that we do in this Orlando market at least on kind of how we identify um, you know, some of those red flags for uh for the providers and the attorneys.

Jason Lazarus 17:37

So is that ADL impact something that's really important in terms of charting? Is that something that you guys focus on in terms of your patient interviews? Because I'm assuming that that's all self-reporting of the patient in terms of what limitations they have and what what they're experiencing.

Dr. Brett Chance 17:55

Yeah, exactly. You know, we we call these outcome assessment tools or oats essentially. And we also have two other big ones too. We call these uh loss of enjoyment of life factors and duties under duress, right? LOE and DUDs. Um, these need to be documented early on, then maybe midway through the case, depending on how the patient is responding. Um, and then also at the end, of course, when you know when we're kind of uh deciding on MMI strategy or you know, supportive versus maintenance care uh for the patient long term. So, you know, those those are huge value drivers according to you know the AMA and kind of what their placement is on a permanency impairment and and restrictions. But obviously for us as clinicians, I want progress, right? I mean, I want my patients getting better. And even though these are still pretty subjective, right, they've been used for a long time with data collection and there's a lot of published research on a lot of these, like uh the oswestri low back uh pain scale, headache disability index, and things like that are two that we can just reference. Um, but those give us a good idea of where we're at with treatment for the patient. Are they actually responding to care? Um, or do we need to go ahead and now get multidisciplinary uh or interdisciplinary providers involved? Do I need to get ortho involved, neuro involved, uh, or pain management or neurologists, right? Um, so that's what how we use some of the outcome assessment tools. But yeah, you know, they look at that and they, you know, uh what we know at least is they weigh that pretty heavily uh because long term they don't want to have to pay for chronic disability for a lot of these injured patients.

Jason Lazarus 19:25

In terms of causation, what specific finding, sequencing, or phrasing tends to hold up

How AMA impairment documentation changes case value and resolution

Jason Lazarus 19:32

under carrier review and what tends to collapse? Meaning, like how do you ultimately make sure you're pinpoint pointing causation back to the uh accident?

Dr. Brett Chance 19:44

Yeah. So, you know, once again, that's all starts with the diagnoses and how the provider is actually documenting these injuries. You know, yes, you do you want to be able to show structured progression all the way through, but early on in the beginning, we need to have, you know, acute injuries. We go through different phases of healing as well for soft tissue injuries. You know, I think um, you know, hey, the patient was involved in a car accident, uh, insurance carrier says, hey, you have six to eight weeks to repair the soft tissue, or we're gonna cut you off. Um, and you know, that is maybe due to pre-existing conditions, due to lack of documentation uh strategy that's on there. Um, but you know, there is something, you know, that we call cluster diagnosing as well. That's kind of a little bit of another uh flagging system, is you want to be very specific with the diagnoses. You don't want to have a lot of, you know, kind of random diagnoses codes in there that are representing the same injury. If you have a definitive idea, at least of what's going on right now, you need to make sure that we're diagnosing that um early on, and then also changing up your coding uh in a reaval or getting into your final, uh, your final kind of case here as your as your patient is more in a subsequent or a sequelae of healing uh uh for their body. So, you know, that's another that's another test that they use is hey, does any of these diagnoses codes actually change? How do the CPT or our procedures do they line up with those diagnoses codes? Do they track the right way? But midway through, hmm, did my prognosis actually make sense? So they're calculating all this data now. Once again, you know, we're we're learning more and more of once again what's in this market and what's actually public to us because you know, uh, everyone is a little bit different as far as the algorithm and and the chain that they use, but your ICD diagnose strategy should change along the way of the case. It shouldn't stay the same all the way through. I shouldn't have an acute injury all the way through if I've been treating this patient for two years. It's not acute anymore. You know, so that's when it comes into repetitive coding, repetitive billing, and we probably know what's going on in this case.

Jason Lazarus 21:46

Yeah, I know for me and probably many listeners, whether they're trial lawyers or personal injury paralegals or you know, those uh in the case management role with law firms, the AMA um impairment concepts feel very abstract in kind of layman's terms. How does AMA aligned residual and impairment documentation change what a case is worth at resolution?

Dr. Brett Chance 22:13

The AMA, you know, it's uh there's a lot in there, you know, and and I specifically reference the fifth edition and also the sixth edition, but um, I like to reference the fifth edition uh a little bit more because we use a lot of objective studies that are uh well represented in the fifth. Um I know some practitioners who actually still reference a third edition, um, which don't ask me why, but it's it's still represented. There's some good language in there and it's all playable, right? But I explain, you know, this essentially, you know, the ICD helps build the injury timeline. We talked about that. That, right? While the AMA concepts help kind of explain what the long-term consequences are of that injury and what they actually mean for the patient and also for you guys representing this. So this is where ideas of like impairment, function, right, permanency kind of comes in, the different categories that are that are rateable. But for us, we want to look at okay, is this patient is there incomplete healing here? Is there going to be chronic-based care that this patient is going to need long-term, more supportive care? But this is where it starts moving from, once again, that short-term complaint to a longer-term consequence for the patient. So we talked a little bit about those value drivers. And they're once again, they're all referenced in the AMA. So, you know, some of the major value drivers I look for are clear acute diagnoses, once again, the imaging to support it, asymmetrical ranges of motion, neurological findings, things that we can actually, you know, test for and be a little bit more prevalent. Objective data now is huge. You know, we need it because it kind of beats the bias of the pre-existing conditions. If, once again, it's documented correctly and the patient is actually having those type of symptoms. But one thing I like to also point out on that is, you know, that a stronger record is not built by throwing out more codes into the chart. You know, I just said you can't stack, don't stack the codes there. That's a, you know, that's a good, you're gonna get flagged, you're gonna get profiled into that system. Um, is built by building a clean, you know, a cleaner, more supportive clinical story. But um, the AMA helps explain the story of the patient's lost. What is the functional capacity loss of this patient? That's where those ADL markers come in. That's where the diagnosis strategy comes in for this patient long term. Because remember, if I cannot properly diagnose this patient, how can I properly guide them into treatment protocols and to actually send them out to maybe a referral status as well? So I need to know really, you know, what I'm doing here because ultimately, you know, I want my patients to uh get good results and give them the you know the uh benefits in which they're entitled to um and what you guys are representing.

Jason Lazarus 24:45

To back up, if if a lawyer inherits a case or simply is listening to this and is already

Can a poorly documented case be repaired, and when does the damage become permanent?

Jason Lazarus 24:52

down the the path and the case has been documented poorly, how much of that can be repaired downstream? And at what point does damage to the file become permanent based on what has been already done in the records?

Dr. Brett Chance 25:09

Let's say if we're if we're kind of down the hole here, you know, patient isn't getting better, they're still dealing with a lot of their chronic pain and same symptoms from day one of where they've been getting treated. You know, now we can maybe introduce some new evidence uh in there, such as maybe different objective testing based on the patient's complaints that probably were not done before. Um so that's what I would look at is you know, I would look at some of the objective data here and see if things are matching up and making sense, which if we're in that type of case, it's probably not. Um, and there's a reason why, you know, maybe this patient jumped shipped or they want a different counsel. Um, so you know, for me, looking over case reviews and and trying to guide strategy here on, and even when we get, you know, hand-me-downs, um, you know, it's like, man, I really wish I was able to work up this patient in the beginning, you know, because I could have really helped them early on. The the early on we have a diagnosis, you know, the the faster we're able to help kind of clean up, you know, some of those soft tissue injuries uh in the beginning, which really helps for you know more optimal healing, of course. But um, you know, if we're kind of living now, you know, let's say one or two years post, we're dealing with chronic residuals and chronic pain that maybe isn't represented other than symptoms, right? The patient just keeps complaining of that, but nothing is really matching up. So we need to be able to uh kind of harness in some objective data here and look at maybe a different strategy as far as you know imaging goes. Um, so you know, a big takeaway, you know, in this market, um, and you know, something that I've learned along the way is when it comes to spinal trauma and injury workups, um, especially in PI in Florida, there is really no standardized process for an injury workup when it comes to you know treating and triaging these patients in uh motor vehicle accidents. So what we have done is we've standardized this process and we understand what medical necessity brings on us, what uh the understanding of early MRI utilization for patient satisfaction and rates later on with chronic pain, um, and how we can desensitize this record a little bit. But I want objective data to reign supreme here, you know, when it comes to what I'm looking at. So let me just back up. So if we can capture this patient now chronic-wise, and I'm getting an old record in, is I'm really going to see, first of all, what imaging did this patient have done? That's going to be my number one thing. Because most likely they probably just had an MRI or standard X-ray views. I want very specific X-ray views. I want flexion extension views on every single one of my patients. These are what we call Davy series or trauma protocols. Everybody learns this. Your MDs know this, DOs, chiropractors are trained on this as well. However, it's not being utilized in the market. So that's one thing I always tell my providers that we teach in our program and also my attorneys is did they get flexion extension views? That's how you assess for whiplash, uh, real mechanism there. That's how you assess for ligamentous injuries, right? Um, we we have what we call Nexus guidelines. There are national X-ray utilization study that we use for trauma protocols, essentially more of an ER or critical care status. And majority of the time patients are going in there and obviously they are in pain. So they jump right to a CT scan of either brain, cervical, low back, and then they get discharged out of the emergency room. However, it's probably more soft tissue work that needs to be worked up. There's no blood or guts in the ER for this type of patient, so they send them on home. We just missed early on a great opportunity to assess the actual spinal function and biomechanics here to see, hey, how did this actually whiplash actually deform the tissue? But instead, what we see in the market, Jason, is early jump to MRI with no real medical necessity for an early jump to MRI. So if I see that right away early on in the record, I know that this probably was not a good workup. All right. But takeaway here is I want flexion extension views on every single one of my MVA patients all day long. Slip and fall, same thing. Okay. We need to assess the mechanics of the spine. We need to look at a true alignment factor, and then we're actually able to produce a more objective data on actually how the spine actually moves into flexion extension, because majority of the patient's symptoms are not going to be from the disc, or majority of those symptoms are going to be from ligamentous injury and damage to that soft tissue area, which is once again one of our main spinal stabilizers. So, however, if we do have a disc in that region that needs to be identified, if I have, let's say, excessive range of motion on a flexion extension view that we capture either from the radiologist or for a third-party examiner, um, we're gonna know, hey, most likely there's gonna be a disc injury in that area. Now, once again, medical necessity is going to reign supreme on that. So we just want to be able to really track and follow the record there and understand documentation timelines, understand the objective data that's coming in. Does it match up and correlate uh with the diagnosis codes that are in there? And then also does it match with the CPT standards too.

Jason Lazarus 30:18

So, for everything you've just talked about, what are the best resources or tools for

How can PI attorneys and paralegals collaborate best with medical professionals?

Jason Lazarus 30:25

personal injury attorneys and paralegals to have access to or tap into to make sure that they're working with the medical professionals in a collaborative way around these issues?

Dr. Brett Chance 30:41

This is what we're putting together here. You know, this has been a long time coming. Um, you know, we've we've been really uh hitting the PI space hard for you know about seven and a half years now and is continuously you know evolving. What my mission is, you know, with our injury decoded program, and you know, if there's any, you know, if there's an opportunity, if there's any local attorneys who are listening to this in this Orlando area, you know, I'm always more than happy to chat about this too. Um you know, I do offer CLE as well through the Florida Bar. Um I have multiple courses that we teach on, but um, we're gonna be introducing here very soon. I'm I'm hoping uh, you know, sometime in July or early August, um, our injury decoded system. Essentially, you know, the the mission behind, you know, my injury decoded is that it's not really about codes alone, right? It's it's about clarity, it's about alignment, you know, defensibility, better patient access to care, um, and ultimately better outcomes for attorneys and for us as doctors in here. My number one thing is results for my patients, and and that's all I care about. You know, this is our community. We have a great reputation here, and we want to keep that by bringing bringing in good results. But um, the attorneys, you know, you guys don't need to be doctors, uh, but you do need to understand when the chart is helping and when it's hurting you. Um, and some of the providers need to understand that personal injury is not general documentation. It requires much more intentional record because the stakes are higher, and that's that's simple. But at the end of the day, you know, the the stronger documentation can help both patients and the case. And that is really heart of the message that we're trying to send out. But, you know, it's it's not about you know fighting the insurance carriers. It's just about eliminating confusion in this already very confused market. You know, confusion is contagious, um, but creating alignment and improving results is we want to make this uh situation as cohesive as possible and ultimately make sure that the patient is guided in the proper directions and path.

Jason Lazarus 32:36

You've alluded to it several times, and I want to double-click on it now. Uh I've got several articles

What carrier AI systems actually score inside the medical record

Jason Lazarus 32:43

I've written in my peak practice newsletter talking about how AI is being overlaid with some of the carrier systems that analyze injuries, systems like Colossus, and with carriers now seemingly relying more and more on these types of systems as part of their claims platform to triage and value demands. In practical terms, what are those systems scoring inside the medical record? And what do they ignore typically?

Dr. Brett Chance 33:14

Depends on their, you know, I guess their proprietary data that they have. You know, you referenced Colossus as one of the bigger players out there, right? There's there's injury IQ, there's Medeco, you know, there's different uh IBM. Uh IBM has a big one out there too. Um, you know, and their internal work workflow and how they evaluate claims is is all different. Um, so you know, and I'm not pretending to know the exact scoring logic once again on every single one of these platforms, but um, you know, we're just speaking on once again what is publicly known. Um and I always throw that you know disclaimer out there because it's it's changing. It changes every single day, every single minute on what they're seeing. So what I'm speaking about is once again publicly known, but at a high level insurance evaluation systems, including Colossus, um, these type of models and uh are essentially the technology-assisted platforms that you know that you preach about. Now, I know you're big into AI, you're you're working on some uh some really nice systems yourself, but uh generally assesses what is documented in the medical record, not what is assumed. So we need to make sure that everything is first documented on there. Remember, we talked about you know uh AMA and what some of these main value drivers are. They pump a lot of this data through, you know, from the AMA and ICD coding language, and they have to make sure that everything is representing. But the number one thing that it's gonna be evaluating uh is the injuries, okay? But they're not reading the file the same way a treating doctor or trial attorney uh essentially is gonna be reading it. They're looking for structured inputs and uh supportable documentation on every single thing that I am doing. Um, but they're looking at, you know, the uh the coding diagnoses, treatment duration, frequency of care. Um, this is too where maybe IMEs start coming in as well. Those independent medical examiners are saying, all right, you're coding all this stuff. Things aren't really making sense. I'm gonna get sanctioned out to see if this patient actually has pain. Or they're actually, you know, does this record actually prove that this patient is injured? So we want to make sure that, you know, early on, that some of those main value drivers on there that are referenced, and this is what we do with with every single one of our patients. Obviously, it's number one is uh his injuries. Two, we're looking at functional capacity and those different index. We talk about loss of enjoyment in life, duties under duress. Is there any main impairments that just happened from more of this acute injury as well? Um But you know, they're they're looking at, you know, quite a few things. But in practical terms, I mean, you know, the quality of documentation becomes, you know, a huge driver of how the claim is going to be interpreted, first of all. Um, but you know, if the file looks like a short-term sprain with, you know, like minimal follow-up, then it may be viewed, you know, very differently from majority of what my files look like. Um so you know, we want progression into maybe ligament dysfunction, a dyspathology, ridiculous pathy codes. Um, is there any so you know, kind of sequelae conditions? Is there any uh anything that's maybe impeding uh the patient from you know actually getting better? Is there pre-existing conditions? Is there comorbidities listed? All these things matter and they all tie in kind of a different value that once again the the AI or the machine on that side is then going to find a little bit of a rating. Okay, so the record is no longer really just saying that the patient was hurt, it's just showing that the injury had measurable consequences over time. So that's what it likes to see. It likes to track progress through the coding strategy because it's data. Remember that it's data, data, data. So coding strategy and the data input, and when you're looking at S codes and traumatic injury codes versus more degenerative language, once again, if degenerative is early on in the file, then we have already lost. The patient lost, the you know, the benefits in which they're entitled to, you know, maybe shutting down. Um, but you know, these these systems essentially they reward structure, they reward consistency, and they reward supportability, which is medical necessity. So that's what they reward. But if the record is vague, inconsistent, uh, you know, fails to connect uh to the conditions to the original trauma, these are gonna be undervalued regardless of what the patient is actually experiencing. So once again, it puts the patient in a bind, um, not necessarily the doctor, because then the doctor is gonna just move on and treat another patient, right? But once again, technology evaluates the record that was built, not the severity. So we need to basically create a nice reward structure by documenting properly, once again, to get the clients and our patients the benefits in which they're entitled to.

Jason Lazarus 37:48

So, with what is going on with technology and claims practices, if you look two to three years

What personal injury firms should build now to stay ahead of how carriers will value claims tomorrow

Jason Lazarus 37:55

out, what should personal injury firms be building into their intake, their treating provider relationships, and their case workups to stay ahead of how carriers are going to value claims tomorrow?

Dr. Brett Chance 38:08

It's understanding simply, you know, the patient that's in front of them clinically, right? And that's where communication, I think, with the physicians and communication with other providers out in the market really help this. So I know, you know, we do attorney check-ins and I let them know, hey, this is what's going on with our patient, but we want to make it clear and simple and let them know what's going on. Um, you know, we are big on medical necessity once again and following the kind of path of command there and big on guidelines and uh guidelines and consensus of actually what these injuries are. So within visit two or visit three, at least in our clinic, I'd know if this is gonna be a permanent impairment for this patient. I'm gonna know if I have a rateable condition on this. So think about between a five to 25% uh whole person impairment rating, basically off a third visit. However, my goal is to rehabilitate this patient. Okay, that's my number one goal to rehabilitate and try to stabilize this patient. So although we may have some significant findings here, we're gonna be able to still reference, you know, our guidelines and uh the AMA and what is gonna be trackable for us when we reach maybe MMI, and once again getting the patients the benefits they're entitled to. So, you know, strategy for attorneys, paralegals, case managers is going through the record, identifying acute injuries, looking at CPT codes and the billing there. Does it really match up? Or are you seeing the consistent language over and over again? I know the notes that I review, the the language is consistent, and those are flagged. Those are going to be flagged in the system all day. Um, and they should be flagged in an attorney office and they should be flagged on the patient as well. Um, now there, you know, there does have to be some consistency with treatment, right? Because you want to know it's just like working out. You know, you you need to see if something is adapting or not. How is the patient responding or not? So some some things do have to be consistent, but really where the differentiator is how are they in the uh, you know, that re-exam? Do those re-exam codes change or is the same language, you know, is it still acute during this re-exam process? So um, it's just a little bit of a better understanding and communicating, you know, the overall logic of what actually am I communicating to the attorney? How can the attorney communicate this to the patient as far as settlements and all that stuff goes on your end?

Jason Lazarus 40:24

So you've got a lot of experience with injuries and you've been an athlete all your life. I I'm curious

How a background as an athlete shapes the approach to treating injured patients

Jason Lazarus 40:32

how all of that plays into how you go about your uh treatment of people that have been involved in these kinds of unfortunate events. Of course, I know and and you know that I know this very intimately because I was struck by a car back in 2016. And so, and I know, you know, the way you've worked with me, I feel like you're very in tune with all of that, whereas some practitioners aren't. I'm just curious about your just overall philosophy based on your experience and how you incorporate that into your treatment of this specific population.

Dr. Brett Chance 41:10

I think uh, you know, injuries in general, they're they're always tough to deal with, you know. And you know, I've been uh I've been an athlete my my entire life. Um I've played Division I college basketball. I've had five hip surgeries, blown out both my knees. Um, and you know, it's it's been a little bit of rough for me. But what got me into this was all my injuries in the first place, you know, and my own healing capacity and what I was able to do with the practitioners and providers that I was able to work with and how I was able to, you know, succeed in my own health. So I wanted to bring, you know, something a little bit different to the table. And that's why, you know, I kind of got into chiropractic and you know, what I do is, you know, it's not just as simple as chiropractic. I hold multiple board certifications and what we do, chiropractic, physiotherapy. I do a lot in the functional medicine space and human performance. Um, that's really what it's about, you know. And even when, you know, there's a time of injury, you know, I'm here to support and be, you know, be that teammate for uh, you know, for that said person, you know, if there is an injury, you know, and and always like to say too is you know, the physical component of healing is usually uh, you know, a lot easier than the mental aspect. I'm not only here to help, you know, my patients guide um you know physically, but also here to support them mentally as well, because you know, I've been through, I've been through the trenches myself. I understand these things. It's not easy to rehab and have to come back from an injury or you know, have your entire life disrupted. It's it creates you know a lot of stress and different scenarios and in all people. And you know, we all have our own journeys in life. And, you know, unfortunately, you know, an auto accident or you know, traumatic injury, you know, it's gonna be a part of that process. But we want to make sure that um, you know, I'm always doing the best by my patients, and I and and we fully believe that all of our practitioners in here.

Jason Lazarus 42:51

Great point you just made about you know the emotional and um psychological injuries that I suffered were definitely much more challenging to recover from than the physical side. You know, after a few months, I mean, well, most of the injuries, my dental injuries took a lot longer to fix. But uh, you know, the the emotional side of it took longer for me to figure out, hey, I needed to seek some professional help because of just anger issues, because for me, you know, the it produced a lot of anger directed at the driver. And how did you not see me in a bike lane? Um I've got lights on my bike and all those things. And and you start to to blame yourself a little bit for it because, you know, it's just human nature. Like, why didn't I see him or why didn't I stop? Or yeah, anyway, a million things go through your head in dealing with all of that. And for me, having flashbacks once I got back on my bike and having to ride by the same spot that I got hit because it was you know on my regular route, like all those things are probably the toughest part of getting over this kind of event when it happens to you. And it's a really good reminder that, you know, these these injuries, they they're called personal injuries because it is intensely personal when you've gone through something like this.

Dr. Brett Chance 44:11

I know myself too, you know, going through it mentally, you know, things can manifest differently, right? You know, the manifestation of pain and different symptoms and you know, you just not being yourself, you know, it it really changes, you know, the people around you. It changes everything, the dynamic. And one thing we always want to get right is what's going on up here, because once again, it's gonna allow that person the capacity to heal a hell of a lot better, hell of a lot faster. And we know that we're doing our job there as a good teammate. So there's a lot that goes on into that mental component of it. But, you know, we we like to have, you know, we have a lot of different resources and educational materials. We actually have a mental health counselor in the office who's a very high performer uh herself. So, you know, if we ever need any referrals, we have a great referral sources all around the local uh local Orlando community too. But we want to have that outlet for people, you know. I think it's uh definitely misunderstood and once again not really talked about too much in this PI space.

Jason Lazarus 45:06

Well, you've been very generous with your time today. One final question. It's pretty open-ended. I ask it of all my guests. Uh, as a medical practitioner who is involved in the personal injury space and treating people who've been injured, what's your view?

Dr. Brett Chance 45:22

What's my view on this? Is I think everybody, we can all be better. Let's all continue to grow, continue to evolve, continue to treat our patients, our clients better, and uh continue to get results.

Jason Lazarus 45:35

Well, Dr. Shants, if anyone has questions about anything you've talked about today, what's the best way to get in touch with you?

Dr. Brett Chance 45:42

I can also send you the hyperlink or just my personal email. That's always fine. Um, you know, I'd like to engage with once again my community and you know, some of the other attorneys that we get to work with uh all around the U.S., but it's gonna be my personal email. We can do uh drchance at winterparkkyro.com. It's just drchance at winterparkchairo.com.

Jason Lazarus 46:01

And we'll include that in the show notes. And thank you again, Dr. Chance, for joining me today on the podcast. And we'll see everybody on the next episode of Trialore Review. If today's episode gave you a new perspective on how your firm operates or sparked a useful idea, consider sharing it with a colleague and be sure to follow the show so you don't miss future conversations with leaders across the personal injury space. Trial Review is brought to you by Synergy, a strategic operations partner helping personal injury law firms resolve healthcare liens more efficiently. If you're looking to accelerate case flow and allow your team to focus on high-level legal work that moves cases faster, consider partnering with Synergy. I'm Jason Lazarus, and I'll see you in the next episode.