Tag Archives: personal injury

Traumatic brain injury (TBI) can be one of the most devastating results of an at-fault accident, in a car, on the job, or even just walking down the sidewalk. The sheer volume of human systems that the brain controls — all of them, essentially — leads to an extraordinarily diverse set of symptoms in cases of TBI. Convincing judges and jurors that these disparate symptoms can all be traced back to a preventable injury is not always easy.

 

The irony here is that a moderate or severe TBI can lead to challenges that most deserve restitution. Some brain injuries are so severe that they deprive the victim of the ability to work. Others might even prevent a patient from participating in the tasks of daily living necessary for independence. If a client in a TBI-related personal-injury case is to be made whole, settlements may have to provide for them for the rest of their lives.

 

This combination of high stakes and soft proofs makes it imperative that attorneys in such cases understand diagnostic imaging. After all, while a defense team may be able to convince the judge that behavior changes are unrelated to an accident, it is hard to argue with an image of a damaged brain.

 

Here are a few things that personal injury lawyers should know about diagnostic imaging as it relates to TBI:

 

1. Different modalities excel at documenting different types of injuries. Radiologists are likely to use standard diagnostic tests like CT and MRI scans to diagnose TBI. They might order X-ray scans, but only in cases of suspected damage to the skull; X-ray images do not differentiate between soft tissues. Doctors might even prescribe advanced imaging techniques, such as perfusion CT, diffusion tensor imaging (DTI), or magnetoencephalography, a form of fMRI.   

 

 

• CT scans without contrast are the primary modality used to identify most primary, acute injuries. A TBI is not a single injury, but a cluster of related events. Doctors divide TBI into primary and secondary injuries. The first occurs at the moment of impact, causing a chain-reaction of events within the brain that often lead to further damage: secondary injuries. This is why doctors typically prescribe ongoing diagnostic imaging for TBI patients.

 

 

While advanced imaging modalities including brain-function tests like PET scans and functional MRI may identify secondary injuries, the first-line test for diagnosing primary TBI is the noncontrast CT scan. This is the fastest way to accurately expose bleeding that requires immediate surgery.   

 

1. Doctors use MRI scans to identify certain types of TBIs that do not always show on a CT scan.  While doctors typically order CT scans first, there are some types of TBI that require MRI for identification. When a primary TBI does not result in intracranial bleeding, MRI scans are often the better choice. Injuries that the MRI identifies better than CT scans include brain bruising and traumatic axonal injury (TAI), shear-strain damage to white matter caused by the brain's rapid acceleration within the skull.       

 

As in any case involving diagnostic images, attorneys should engage expert witnesses such as neurologists or radiologists to explain what's going on in the pictures. This is particularly important in brain-function scans, such as fMRI and PET scans, which are often inscrutable for untrained viewers.  

 

The good news for attorneys new to TBI cases and the diagnostic interventions that document them is that expert help is available. This brings us to our next point.  


Expert Assistance for Personal Injury Cases Representing Victims of TBI

 

Personal injury lawyers and their clients deserve the chance to focus entirely on a TBI case. That can't happen when they're navigating complex scheduling systems at large hospitals or arguing with insurance companies. That's why Precise MRI always strives to provide for attorneys and their clients with what they need, when they need it.

 

Precise MRI offers quick turnarounds on radiology reports, with same-day scans and results within 24 hours. We provide more than 70 imaging centers in California, Arizona, and Nevada for convenient, close-to-home access for patients. Our friendly scheduling staff will find an appointment that works for your client, even on weekends and evenings.

 

Attorneys themselves have their client's crucial information at their fingertips thanks to an online portal designed for legal professionals. It's available 24/7, and so is IT service, ensuring that patients and their lawyers can access medical data at their own convenience.

 

We accept personal injury liens — and even offer a free, downloadable lien form for immediate access — and attorney letters of protection for personal injury. Our teams of fully certified medical professionals have long-term experience working with attorneys on all sorts of personal injury cases, including those involving TBI. Even more important, they're devoted to a patient-based model of care, and work hard to ensure quality, comfort, and convenience for all.

 

To learn more about attorney resources from Precise Imaging, or to schedule a CT or MRI scan for a client, call us today at 800-558-2223.  

 

References:

 

Hill CS, Coleman MP, Menon DK. Traumatic Axonal Injury: Mechanisms and Translational Opportunities. Trends in Neurosciences. 2016;39(5):311-324. doi:10.1016/j.tins.2016.03.002.

 

Kim JJ, Gean AD. Imaging for the Diagnosis and Management of Traumatic Brain Injury. Neurotherapeutics. 2011;8(1):39-53. doi:10.1007/s13311-010-0003-3.

It's difficult to overstate the importance of diagnostic images in spinal injury litigation. When properly presented, a diagnostic image offers clear, compelling evidence—but if the image doesn't clearly show the injury, or if there's any question as to the validity of the attorney's interpretation, the entire case can be compromised.

Of course, every personal injury attorney understands these points, but in order to use images effectively, they should understand the basics of different imaging technologies. That includes the tactics that radiology professionals must employ to deliver high-quality, diagnostically relevant images.

 

How Types of Spinal Injuries Affect the Diagnostic Imaging Process

 

The first consideration is the severity and location of the injury. Magnetic resonance imaging (MRI) provides the best diagnostic images for spinal cord and soft-tissue injuries, both for radiology professionals and for laypersons (while diagnostic images need to be evaluated by a trained professional, the images are obviously more useful to attorneys if the injuries are clearly visible and easy to explain).

MRIs can show chronic issues such as spinal misalignment. Spinal fractures are easier to identify via computed tomography (CT), while spinal vascular injuries can be evaluated with either technology. In any case, trained radiology professionals working with the latest tech can discern a surprising amount of information, including the approximate age of the injury, which can help attorneys build winning cases.

 

Choosing Diagnostic Imaging Services for Personal Injury Cases

Personal injury attorneys should keep other practical considerations in mind when directing their clients.

As mentioned earlier, timing is often a crucial factor, particularly in spinal fracture cases. An imaging facility should be able to produce high-quality results quickly and at a fair cost — and, for the benefit of the attorney, those images should be in commonly used digital formats, ready for reproduction. Many attorneys choose to highlight certain parts of MRIs and CT scans with software designed for the purpose; without exceptional images, this can be a difficult process.

 

Finally, as we've mentioned on other blogs, imaging centers should be prepared to handle various types of remuneration and should have experience with workers' compensation and letters of protection.

 

Precise Imaging offers dedicated tools for attorneys through a specialized HIPAA-compliant web portal, which provides 24/7 access to images, case details, and payment information. We're dedicated to keeping patients comfortable, and with more than 70 facilities, we offer unequaled access to qualified imaging experts and state-of-the-art technology.

To learn more about Precise Imaging’s commitment to assisting in personal injury cases, or to refer a client today, call 800.558.2223. You can also make an online referral here.

 

References:

 

Goldberg AL, Kershah SM. Advances in Imaging of Vertebral and Spinal Cord Injury. The Journal of Spinal Cord Medicine. 2010;33(2):105-116. PMID: 20486529

 

Parizel PM, van der Zijden T, Gaudino S, et al. Trauma of the spine and spinal cord: imaging strategies. European Spine Journal. 2010;19(Suppl 1):8-17. doi:10.1007/s00586-009-1123-5.

 

Ellingson BM, Salamon N, Holly LT. Imaging Techniques in Spinal Cord Injury. World neurosurgery. 2014;82(6):1351-1358. doi:10.1016/j.wneu.2012.12.004.

 

https://www.bermansimmons.com/law-articles/medical-imaging-picture-worth-thousand-words

 

Diagnostic Imaging in The AMA's Guides to the Evaluation of Permanent Impairment

 

If you had to pick one book to be the authority on assessing personal damage in U.S. tort-civil law, you might choose The American Medical Association's Guides to the Evaluation of Permanent Impairment (AMA Guides). Personal injury law is more complicated than a single book could encompass, of course, but to this day, many U.S. courts rely on the systems set forth in the AMA Guides to determine a "quantitative estimate of function losses" within a victim's life. Many states use the AMA Guides to settle questions of workers' compensation and disability claims.

 

The AMA Guides assessment can also be a powerful tool in a personal injury case.

 

Note that the types of losses evaluated in the Guides may lead to pecuniary and/or non-pecuniary damages. In the former category, the Guides systems might uncover a loss of earning capacity or, in cases of disability, the necessity of long-term care. The AMA's Guides to the Evaluation of Permanent Impairment may also play into a claim of quality-of-life loss or limited ability due to the injury, both non-pecuniary damages.  

 

As we've mentioned in previous posts, diagnostic imaging can also occupy a major role in personal injury cases. So the question is: How do The AMA's Guides to the Evaluation of Permanent Impairment implement diagnostic imaging as a factor in their determination systems? And which modalities most clearly demonstrate injury, according to the Guides?

 

Here are a few key facts about the intersection of diagnostic imaging and The AMA's Guides to the Evaluation of Permanent Impairment that every personal injury attorney should know:

 

 

• Diagnostic Imaging Studies are an Important Part of Injury Assessment in the AMA Guides to the Evaluation of Permanent Impairment

 

 

In assessing impairment or disability, as in health care itself, diagnostic imaging plays an outsized role. The AMA Guides present each body system in its own chapter, introducing principles of assessment for each system. In nearly every chapter, some form of diagnostic imaging appears in the Guides' assessment criteria.

 

The results of all diagnostic studies — including imaging — must also be part of the physician's report, according to the Guides.  

 

 

• Imaging Modalities May Differ from One Edition to the Next

 

 

Editions matter. Depending which state you're in, the worker's compensation code may defer to the 6th and latest edition of the AMA Guides — or it might not. Some states use the 5th or even earlier editions, while others prefer state-specific criteria for evaluating injury, unrelated to the Guides. And while these codes relate specifically to worker's compensation rather than personal injury cases, the court's familiarity with a particular edition could add up to more compelling evidence of preventable injury and lasting impairment.  

 

Differences between editions complicate the evaluating physician's choice of imaging modality. For instance, according to analysis from health care news site Medscape, methodology changes between the 5th and 6th editions of the Guides upend the rules for assessing impairment in a knee joint injury.

 

"No provision was made for ratings based on magnetic resonance imaging (MRI) or arthroscopic findings of cartilage pathology in the 5th edition of the Guides," reports Medscape. "However, in the 6th edition of the Guides, there is provision for full-thickness articular cartilage defects, with a range of 5 to 9 percent impairment...MRI and arthroscopy are objective measures with accepted grading systems for cartilage lesions."

 

So should an attorney ask the evaluating physician for an X-ray or an MRI scan in a knee-injury case? It may depend on which court tries the case.

 

 

• Imaging Findings Alone are Not Enough

 

 

The 5th Edition of the AMA Guides makes the important point that the results of an imaging study alone aren't enough to classify an injury as impairment or disability.

 

The purpose of an assessment using AMA Guides systems is to establish a diagnosis-related estimate, or DRE. DRE categories are a measure of the "impairment of the whole person," expressed as a percentage range, with 0 percent impairment equating to no injury and 100 percent representing imminent mortality.

 

"To be of diagnostic value, clinical symptoms and signs must agree with the imaging findings," the 5th edition AMA Guides claim. "In other words, an imaging test is useful to confirm a diagnosis, but an imaging result alone is insufficient to qualify for a DRE category."

 

So where does all of this leave personal injury attorneys considering the inclusion of diagnostic imaging into a particular case? The key is to work as closely as possible with the client's attending physician or, in some cases, a court-approved health care provider. In the medical setting, imaging is a crucial part of diagnosis, which is necessary for healing. In a court of law, radiographs and MRI scans are just as valuable — but for the very different purpose of assessing injury for a fair damage claim.

 

Interested attorneys can purchase a copy of The American Medical Association's Guides to the Evaluation of Permanent Impairment at the AMA webstore, here. For more information on how Precise Imaging can help personal injury firms better serve their clients, see our Attorney Resources page, or contact us at 800-558-2223 today.      

 

Personal injury attorneys have relied on MRI scans to bolster their clients' claims for years, but the role of this crucial technology may soon grow dramatically. As a diagnostic imaging modality, MRI is ideal for recording soft tissue injuries, including disc protrusions and herniations and muscle tears. But even perfect documentation of these injuries doesn't necessarily prove a devastating type of affliction that's all too common, and often difficult to demonstrate: chronic pain.

 

Pain is a subjective sensation. One person's agony might be another's slight discomfort, and defense attorneys have a history of leaning on this subjectivity to reduce damages. Meanwhile, though, patients' lives can be destroyed; ravaged by pain, they might not be able to work, or even perform daily tasks of living. A fair settlement might be the only thing that stands between them and utter destitution.

 

But how can an MRI scan document pain? Neuroscientists say they're right on the verge of an answer.

 

Using MRI Technology to Track Pain's Pathways in the Brain

 

A specialized type of MRI scan, functional magnetic resonance imaging, or fMRI, measures blood flow within the brain. When a certain region of the brain activates, cerebral blood flow in that area increases. The fMRI tracks these changes.

 

Brain mapping allows neuroscientists to associated certain areas of the human brain with general functional experiences within the thinker — including, perhaps, the thinker's experience of pain. If an attorney could demonstrate that a client's brain activity is consistent with chronic pain, that could be enough to sway the judge. However, we're not quite ready to break out the fMRI scans in tomorrow's personal injury case.

 

Hurdles in the Use of fMRI Scans for Personal Injury Cases

 

Neuroscientists are still debating the reliability of fMRI to demonstrate chronic pain. Most of the studies involving pain and brain mapping have been conducted on acute pain, not the chronic variety. Some scientists argue that patients could "cheat" the scan, imagining a greater-than-baseline intensity of pain.  

 

The science behind demonstrating pain with fMRI scans isn't quite up to courtroom standards yet, but it's close, and it's getting closer. With every new study on the subject, fMRI technology inches toward a future in which pain is as visible as a broken arm in an X-ray.

 

Meanwhile, standard MRI scans continue to be an important element in many personal injury cases. This technology has changed the way personal injury law functions, and it appears it will continue to do so in a broader range of cases soon.  

 

References:

 

Cherniak, Todd. "Litigation MRI: Why lawyers are asking for it and why your patients need it." BCMJ. British Columbia Medical Journal, Sept. 2005. Web. 20 Dec. 2017.

 

Davis, Kevin. "Personal injury lawyers turn to neuroscience to back claims of chronic pain." ABAJournal. American Bar Association, Mar. 2016. Web. 20 Dec. 2017.

 

Geddess, Linda. "Human brain mapped in unprecedented detail." Nature. Macmillan Publishers Limited, 20 July 2016. Web. 20 Dec. 2017.   

 

Medical liens offer a simple and convenient way for patients to receive medical services well before paying. That's the good news. The bad news is that, if another organization pays for your health care following an injury — and then you win a lawsuit — you'll probably have to pay your benefactor back out of the settlement.

States set laws on eligibility for liens, so you'll definitely want to talk to a local attorney to see if there could be liens on a personal injury settlement. Generally, though, liens can be categorized by the institution that actually pays for health care following an injury. Here are the possible holders of medical liens to ask about when you win a personal injury case:

1. Health Care ProvidersSome hospitals, doctors, and independent clinics accept payment on a lien basis. If you have the luxury of forethought, talk to your attorney; they probably have some great providers they already work with.
   
   Some hospitals might ask you to sign a Letter of Protection, which guarantees their right to payment out of the eventual settlement. Still, paying out of your settlement is a much better alternative to paying out-of-pocket.


2. Health Insurance CompaniesInsurers usually expect to get paid back for any medical expenses you've incurred if you win a handsome settlement in court. There's probably a clause in your policy that gives the insurer a right to place a lien on that settlement.
   
   One option to sidestep a payout to your insurance company is to find a facility that offers cash pricing before you receive treatment. Providers and patients alone negotiate a cash price, which is typically much, much lower than what your insurance company has to pay. For low cash prices on all diagnostic imaging procedures, with or without a lien, call BestPriceMRI.com at 888-322-7785.


3. Government Agencies and ProgramsLiens from Medicaid, Medicare, and the Veteran's Administration must be paid back before liens from other parties. That's why they're called "super liens." If you any of these institutions paid for your medical care, talk to an attorney about how these liens will affect your settlement.
   
   Again, if you're in a position to choose, you can always choose a diagnostic imaging facility that accepts cash payments to avoid incurring a super lien.


4. Workers' Compensation BenefitsIf worker's compensation pays for your health care, and your lawsuit is with your employer, it's unlikely that they'll place a lien on the settlement. However, if you sue a third party involved in an injury, and workers' compensation pays for your care, they probably will issue a lien on any final payout.
   
   Luckily, many states limit workers' compensation liens to just two-thirds the value of the actual medical expense. Still, it's always a good idea to ask health care providers about the possibility of cash pricing when possible.

As in all health care spending, choosing affordable providers will keep more money in your pocket. When you've been wrongfully injured, you're not always in a position to choose your place of treatment, but if you are, inquire about cash pricing to avoid more expensive liens from third-party payers.

Give us a call if we can assist you with your medical lien MRIat 800-558-2223