Whiplash and Car Accident Injuries

Getting Medical Care For Automobile Injuries ©

Disclaimer: The purpose of the following information is to educate you about personal injuries and medical treatment following car accidents in South Carolina. It is not intended to give you legal advice or medical recommendations for your specific situation, nor does it establish any type of doctor-patient relationship. – Dr. Ken Curtis

According to the most recent Traffic Collision Fact Book published by the SC Department of Public Safety, Charleston County has the most injury collisions and persons injured compared to all 46 counties in South Carolina.  This high number of collisions is likely a result of large population and high amount of travel within the county. 

Despite the title of this essay, most car accidents are not actually accidents.  I have testified in court as an expert witness many times in personal injury cases in both North and South Carolina and the opposing attorneys always want to emphasize the term accident. “This was just an unintentional little accident, sometimes things just happen without cause” or “The ______ (fill in the blank) unexpectedly contributed to the accident so my client shouldn’t be held at fault”.  The truth is 96% of collisions were the driver’s fault because they violated a traffic safety rule which led to the crash.  Negligence is not an accident, therefore collision, crash or wreck are more accurate terms. 

Some unscrupulous insurance company adjustors will call you just hours after a collision to try to get you to sign off and settle your claim – DON’T!!!  There is no way for you to properly assess car damage that quickly let alone bodily injury.  In fact, most people feel worse the following day or even days or weeks after the wreck.  Delayed onset of symptoms is characteristic of whiplash injuries and well documented in the scientific literature.1,2,3,4,5  Most patients feel little or no pain after injury, then pain gradually intensifies over the next few days.6  Delayed symptoms is likely due to traumatic edema and hemorrhage that occur in injured soft tissues.7,8  Don’t speak about any details with the adjuster until you have educated yourself about the process or hired an attorney.

I have treated patients with neck pain every day for the past 30 years.  38% of those with chronic neck pain state it came from an old car wreck that wasn’t addressed at the time – I am one of those patients.  I was rear-ended when I was 16 years old, hurt for a few weeks yet never had treatment until later in life.  When you’re young, you feel bulletproof, but those things accumulate and catch up to you later in life.  The five most dangerous words you can say are “maybe it will go away”, yet this is the advice emergency room and family doctors give their patients all the time.  If they do refer you elsewhere, they recommend an orthopedic surgeon and chances are you don’t need surgery.  You need expert care from someone trained to evaluate and treat traumatic whiplash injuries – a chiropractic physician.

If you are in pain, something is wrong and you need to get care quickly for several reasons: 1) early care improves prognosis and outcome; 2) if they told you at the ER to follow up, you should follow the doctor’s orders; 3) document injuries since you don’t know if they will go away quickly or not; 4) avoid delay or gap in treatment that insurance companies will exploit and argue that you were not really hurt.

If there is a delay in treatment, you should tell your medical provider why – describe the onset of symptoms, did pain gradually worsen, was pain manageable until you finished prescribed medications, did you do home care in lieu of formal treatment, did you have transportation problems due to wrecked vehicle, were you trying to mitigate or avoid medical bills, was your job at risk if you missed work?  Documenting seemingly mundane circumstances could prove to be important for claim credibility down the road.  But it’s also important to see a healthcare provider who will listen to you and record the information appropriately in your medical record.  

Tell your doctor everything that hurts. Providers are so used to treating one disorder at a time they often wear blinders to accompanying symptoms.  They allot only so much time for neck sprain therefore concomitant shoulder pain, arm pain and finger numbness may be overlooked.  Each individual symptom and injury needs to be documented, both for proper treatment and medicolegal tracking.  Again, this is reliant on provider experience dealing with personal injury claims.

During a collision, muscles, ligaments, facet capsules and other soft tissues are stretched and torn.  The body’s immediate response is to restrict movement and repair with scar tissue and adhesions.  If not properly treated the tissue remains less flexible, leads to permanently restricted range of motion9,10, chronic pain11 and premature degeneration12.  Mobilization and chiropractic care can help minimize adhesions, normalize function and improve prognosis13,14,15,16.  

The MOST important thing to do is get proper treatment, and no one is more trained to treat car wreck injuries than a chiropractor.  But just as medical doctors have become more specialized, so have chiropractors.  I have a board certification specialty in Chiropractic Neurology, however for three decades I have maintained a high interest in vehicular injury treatment.  There are chiropractic specialists in pediatrics, nutrition and radiology who may have zero interest in treating motor vehicle accident victims.  Pick the right doctor, evaluate their credentials, experience, and ask friends and family with similar conditions for recommendations.

All insurance companies now use evaluation software such as Colossus, Injury IQ or Decision Point to assess damages for bodily injury claims.  Each adjusters has their own personal authority level, but they are required by specific guidelines not to deviate from the values arrived at through the use of these softwares. The settlement results of each adjuster, unit and region are tracked and deviations from the softwares’ evaluations result in monetary and promotional opportunities lost for the individual adjuster.  The process depends on the input of the claim handler alone.  Who would you trust more to generate proper input, your general practitioner who dabbles in the occasional car wreck or a seasoned provider who deals with these conditions day in and day out?  

The process starts with your doctor and your medical records.  In this day and age, everything is software and code driven.  The International Classification of Disease (ICD-10) codes are used to diagnose your condition.  A novice practitioner may diagnose “neck pain”, while a more skilled practitioner diagnoses “cervical sprain/ strain with ligament instability and radiculopathy”… there is a big difference when it comes time to settle your case.  Another set of codes that was developed by the AMA is the Current Procedure Terminology (CPT) which describe the services provided to a patient each visit.  These codes should link and make sense to the human adjuster as well as the software.  This information is transmitted electronically to the insurance company or attorney for reimbursement.

Many injured people can handle their own case without involving a lawyer – if there is minimal car damage, minimal injury/ medical bills, clear fault of the other driver, and a reasonable insurance adjuster for a good insurance company.  But remember the opposing party has an entire legal team working on their behalf which is usually at odds to your interests.  Therefore it’s never a bad idea to have a legal analysis by someone looking out for your benefit.

One of the challenges after an injury from someone else’s negligence is that the insurance company won’t pay anything until the end of the case.  Most healthcare providers, including hospitals, are not set up to wait to be paid for months or years later.  You may be able to negotiate a payment plan or ask the provider to put your account on hold instead of sending to a debt collector.  To alleviate any financial stress that may impede healing, Mount Pleasant Health Center will wait until settlement to be paid.  We can help, call (843) 885-0898.

REFERENCES

1. Deans GT, McGailliard JN, Kerr M, Rutherford WH: Neck pain – a major cause of disability following car accidents. Injury 18:10-12, 1987. 

2. Dunsker S: Hyperextension and hyperflexion injuries of the cervical spine. In Youmans JR (ed): Neurological Surgery, 2nd ed. Philadelphia, WB Saunders, 1982, pp 2332-2343. 

3. Evans RW: Some observations on whiplash injuries. Neurologic Clin 10:975-995, 1992.

4. Jonsson H, Cesarini K, Sahlstedt B, Rauschning W: Findings and outcomes in whiplash-type neck distortions. Spine 19:2733-2743, 1994.

5. Spitzer W, Skovron M, Salmi L, et al: Scientific monograph of the Quebec Task Force on Whiplash-associated Disorders. Spine 20 (Suppl 8): 1S-73S, 1995.

6. Teasell RW, Shapiro AP: Clinical Picture of Whiplash Injuries. In Melanga GA (ed): Cervical Flexion-Extension/ Whiplash injuries, Philadelphia, Hanley & Belfus, 1998, pp 257-270.

7. Jeffreys E: Disorders of the Cervical Spine. London, Butterworths, 1980.

8. Lieberman JS: Cervical soft tissue injuries and cervical disc disease. In Leek JC, Gershwin ME, Fowler WM Jr (eds): Principles of Physical Medicine and Rehabilitation in Musculoskeletal Diseases. New York, Grune & Stratton, 1986, pp 263-286.

9. Jonsson H, Cesarini K, Sahlstedt B, Rauschning W: Findings and outcomes in whiplash- type neck distortions. Spine 19:2733-2743, 1994.

10. Watkinson A, Gargan M: Prognostic factors in soft tissue injuries of the cervical spine. Injury 22:307, 1991.

11. Norris S, Watt I: The prognosis of neck injuries resulting from rear-end collisions. J Bone Joint Surgery 65B:608-611, 1983.

12. Pettersson K, Karrholm J, Toolanen G, Hilingsson C: Decreased width of the spinal canal in patients with chronic symptoms after whiplash injury. Spine 20:1664-1667, 1995.

13. Cassidy JD, Lopes AA, Yong-Hing K: The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: A randomized controlled trial. J Manipulative Physiol Thera 15:570-575, 1992 & JMPT 16:279-280, 1993.

14. Brodin H: Cervical pain and mobilization. Int J Rehab Res 7, 1984 & J Manual Med 2, 1985.

15. McKinney LA: Early mobilisation and outcome in acute sprains of the neck. BMJ 299:1006-1008, 1989.

16. Mealy K, Brennan H, Fenelon GC: Early mobilization of acute whiplash injuries: BMJ 292:656-657, 1986.