Among the most common injuries arising from motor vehicle accidents, such as car accidents and truck accidents, are what are called “soft tissue injuries”. These include neck sprains, back strains, pulled muscles in the knees and arms, and what the insurance companies like to call “whiplash”. When you fill out your Operator’s Report for the police, these injuries are referred to as “non-incapacitating injuries”. By far the most common and effective treatment for muscle sprains and strains is physical therapy, and most people who receive such injuries will also receive physical therapy at some point during the course of their care. In fact, if you report to your family doctor that you have been in a car accident and you now have a sore neck and a sore back, it is likely that the doctor is going to spend very little time with you, but instead send you to the physical therapist. In most cases, there is little that the doctor can do for a sprain or strain other than prescribe pain medicines and/or muscle relaxants. The physical therapist is going to be the one actually administering the treatment. Some doctors will make you wait longer than others, but most will make a physical therapy referral within a couple of weeks of your first doctor visit or of the accident, and that is good and appropriate treatment.
There is a superstition that has emerged, that it is important to get to the physical therapist right away, or else you “ruin” your case. That is not true. In fact, going to the physical therapist too quickly can be a bigger problem. It is important that you see a medical doctor, ideally your family doctor, as soon as possible. However, going to the physical therapist directly, without first seeing an outside doctor, such as your family doctor, is far more damaging to your case than simply delaying until you have seen the doctor. To understand why this is true, it is first important to understand how juries think and how insurance adjusters think. After all, cases are settled against the backdrop of what a jury would do if a jury ever heard a case, and insurance adjusters are people, although sometimes they help us forget, and they approach cases from their own personal perspectives, biases, and points of view.
Throughout almost the whole of Massachusetts, including here in Lowell, a jury is going to be predominantly, if not entirely, white. A jury is going to be largely middle-aged, it will certainly average out to be middle-aged, and even in Lowell District Court, a jury will be mostly from the suburbs. I could have described insurance adjusters with much the same language, although insurance adjusters are likely to be younger than jurors. They would expect a person to treat in the same way they treat when they are sick or injured. As a result, it is good to do a walkthrough of what a white middle-aged suburbanite would do if they were injured in a car accident.
First, they are going to call the police to come to the scene. I appreciate that this is largely a pain in the neck, but it is always good to call the police. When the police tell this person to be examined by the EMT in the ambulance, they will be examined by the EMT. If the EMT thinks that they should be transported to the hospital, then they go to the hospital by ambulance. EMTs and paramedics who come to accident scenes have expertise in the subject, and these folks will respect that expertise. As a result, if you do not get into an ambulance at the scene of an accident, they are going to be wondering why. Either, the EMT examined you and determined that you were not that bad off, or the EMT told you to get in the ambulance and you refused, which they are not going to understand. It begins to plant the seed in their minds that you are in some manner faking or exaggerating your injury. This is especially true because most of them understand, even if you do not, that the car insurance is going to pay for that ambulance ride and hospital visit, so there really is no good reason for an injured person to turn it down.
Second, they are going to call their family doctor. Please note that I said they are going to call their “family” doctor and not the “accident” doctor. I know that there are people who still believe that you see your family doctor when you are sick, and you see the accident doctor when you have an accident. Oddly, I recently spoke to an aide in a family doctor’s office, who indicated that they take the same point of view. That is an incredibly outdated notion. More importantly, the insurance companies seem to believe that they can get some traction off the argument that a person who was injured in a car accident should have called their family doctor. I am aware that some family doctors are hard to get in with. Either they do not want to deal with car insurance companies, and thus try to avoid seeing their patients who have had car accidents, or they are very busy and it takes a long time to get an appointment in general. In those situations, you should still make an appointment to see your family doctor if you can, and in the meantime there are various walk-in clinics and other doctors who will see accident victims on an as needed basis, and then hand off the care to their primary care provider once that doctor’s appointment comes up.
Third, they will go to a physical therapist or a chiropractor after a medical doctor refers them to physical therapy or chiropractic. Chiropractors are doctors, and it is not necessary to have a medical doctor’s referral to go to one. Health insurers do not require a referral to a chiropractor. Still, it is better if a medical doctor makes the referral. In Massachusetts, the law was changed several years ago to allow physical therapists to prescribe physical therapy. However, that is not a best practice. Insurance companies will usually challenge a physical therapist’s treatment when no medical doctor made the referral. In addition, all HMOs and many other insurance plans require a referral from your family doctor before they will pay. In the situation where you are seeing a walk-in clinic or other doctor because you cannot see your family doctor quickly, that is not a problem. Because Personal Injury Protection pays the first two thousand dollars in medical bills, it is often, although not always, possible to make arrangements so that the physical therapy is paid out of the first two thousand and they then get a referral from the primary care physician. However, you can expect a good amount of grief and aggravation if there is no doctor referral at all, or if the doctor referral came from a doctor who works at the physical therapy clinic or works at the chiropractor’s office.
Fourth, they will see any specialists that their family doctor refers them to. I always get a little agitated when a client asks me why they have to see a neurologist or an orthopedist when they are already seeing their family doctor. The short answer is because you see a family doctor for any kind of problem you may have from a cold, to high blood pressure, to a stomach ache, to an injury. They are general practitioners. For routine cases, general practitioners are fine. For more serious cases, it is important to see a doctor who deals with that kind of problem all day, every day. For bone or muscle injuries, that would be an orthopedist. For a nerve injury, that would be a neurologist. I have had clients see eye doctors, dentists, psychologists, oral surgeons, podiatrists, general surgeons, pain specialists, neurosurgeons and every internal medicine doctor you can think of as a result of injuries sustained as a result of car accidents. The main reason I get agitated, though, is because the fact of a specialist referral enhances the value of a case. Specialists are highly skilled and very busy. When they say a person is injured, that person is injured. The mere fact that your doctor has thought it necessary for you to see a specialist is proof of the seriousness of an injury. It is for this reason that the computer programs that insurance companies use to evaluate cases, such as Colossus, affirmatively increase the value of any case simply because a specialist is involved. In fact, the computer algorithms will enhance the value of a case further if a specialist is seen over a period of time, even if there are not very many specialist visits over that period of time. At the end of the day, specialized care is going to be the best kind of care you can receive after an accident.
So the bottom line is if you are involved in a motor vehicle accident and you have soft tissue or “non-incapacitating” injuries, but you are told to get in the ambulance and go to the hospital, then you should get in the ambulance and go to the hospital. If you do not go to the hospital, or as soon as you return from the hospital, the first telephone call you should make is to your family doctor. Frankly, I think it is more important that you call your family doctor than even that you telephone me. Mostly, that is because it takes a while to see the family doctor, whereas I will usually see you right away. So make the phone call and set up the appointment, even if the appointment is a month or so into the future. There are medical doctors, such as walk-in clinics, who will see you in the meantime, and we can help you to find such doctors if that is necessary. Do not go rushing to the physical therapist or the chiropractor. It is important that you see a medical doctor first. I know pretty much all the physical therapists and chiropractors in the area, and I know that I am upsetting many of them by saying this, but you should see the treating doctor first. Insurance companies have a field day with people who go running to the “accident doctor”, to the chiropractor, or directly to the physical therapist without a referral. Finally, if your doctor refers you to a medical specialist, then you should go to the medical specialist. Your doctor is not going to send you to the specialist if your doctor does not believe that you need to see one. I appreciate that all of this can get a little bit complicated, and coordinating insurance benefits makes this even more complicated. Fortunately, if you are involved in a motor vehicle accident, we are available to help you navigate this labyrinth.