Choosing your doctor can be very difficult when someone is in an auto accident. It becomes even more complicated depending on your injuries. Certainly, someone in a catastrophic accident and who has suffered a catastrophic injury such as brain damage, broken bones or some other extreme injury are much different than what most people receive from an auto, motorcycle or trucking crash. However, all of these cases do have some similarities in that the majority of doctors do not want to be involved in litigation. Thus, it is best to try to find doctors who will involve themselves in litigation, take the time to take detailed records, spend time with a patient, be available for a deposition and to go to trial if necessary. This; however, is not always the easiest thing to do as over 95% of doctors do not want to get involved in these types of cases. Additionally, it is complicated because most doctors do not want to take PIP insurance which is primary over all other forms of insurance in Florida. PIP must be used first before any health insurance, Medicare or Medicaid can be used. Finally, the last thing that complicates matters is even if your PIP is used up, most people do not want to pay the deductibles and co-pays associated with health insurance which can be thousands of dollars per year and some of these cases can last for 2 to 3 years, somebody could end up spending anywhere from $5,000.00 to $10,000.00 or more with all the co-pays and deductibles as these cases proceed.
Thus, there are a number of doctors who will agree to wait until a case is resolved in order to seek payment. This is generally called “An Assignment of Insurance Benefits” or “Letter of Protection”. If your doctor will take a Letter of Protection it can generally save you a lot of money up front and provide you with top quality medical care. However, again it is necessary to be careful as some doctors who take Letters of Protection or Assignment of Insurance Benefits may be working for their interest and not yours.
WHAT KIND OF DOCTOR SHOULD I HAVE IF I HAVE A NECK OR BACK INJURY?
For neck and back injuries, generally what happens is people will call a facility where a medical doctor is on staff. Again, most primary care doctors are not set up to bill PIP insurance or deal with the detailed work that is necessary in an auto or motorcycle accident case where insurance adjusters or attorneys are looking over every file and record with a fine tooth comb. Thus, many primary care doctors will send patients away if they’ve been in some sort of accident. Therefore, there are medical facilities out there that will treat these type of neck or back injuries.
Generally speaking for neck and back injuries they can generally go from something as a simple sprain/strain that will go away after a period of time to a permanent strain/sprain or all the way to a herniated or ruptured disc. This type of injury would generally call for some sort of what I refer to as “passive modalities” which are basically just massages, hot/cold packs, electrical stimulation, etc…to try and keep the swelling down and keep the muscles from forming scar tissue. Scar tissue can slowly build up around the nerves causing pain. However, if after a doctor has seen you this process is not resolved after a several weeks, the doctors will generally then send you to get an MRI of either the neck or back areas. Please note that doctors can wait must longer to do this, it is in their discretion and doesn’t seem to violate any medical protocols if they choose to wait. But after you have received an MRI the doctors will make a determination whether there is anything there such as a herniated disc, ruptured disc, as some people would refer to it, that would require further attention. If somebody has some sort of disc problem due to a car, truck or motorcycle accident the doctors will then send them to potentially a spinal surgeon or neurosurgeon to see if they are a surgical candidate. As these types of injuries get worse over time and not better, it is important for a surgeon to evaluate this patient. Also, some of the signs or symptoms of a disc injury are:
- localized pain due to torn nerves around the disc and in the outer part of the disc material;
- there can be pain or numbness running down their arms into the hands. This type of pain does not need to run all the way from the neck into all the arms, some of the larger nerves leaving the disc area affect certain areas of the body, so some of the nerves only affect say the triceps, front of the arm, back of the arm, the thumb, the index finger or the 2 bottom fingers on either hand.
Generally speaking, after that evaluation the person will then need to determine whether the amount of pain they are in and the symptoms would warrant a surgery. Many chose to wait and some chose to do it at that time and everyone is different. All sorts of neck and back surgeries are generally minimally evasive and don’t have any kind of extended recovery periods. In fact, many people go to work not long after having a neck or back surgery. Thus, many of our clients will start back to work on light duty within a week of the surgery even though that is not recommended by their doctors. However, if someone chooses not to do the surgery, there are other treatment options, such as they may continue to simply go to get their massages, electric stimulation and other types of passive modalities that they have been doing until they reach maximum medical improvement, which means they are as good as they are going to get or after that, just to try to get some sort of temporary relief from their pain.
Another way of dealing with pain without having surgery would be to have some sort of injections into the area where there is pain. Some of these injections are just to the muscle itself and they are generally known as “trigger point injections.” These types of numbing injections can help isolate the areas in which the pain is coming from. This is also what happens with any type of injection you might receive for pain. With the trigger point injections, if they seem completely effective what will end up happening is the doctor will be able to diagnosis that some or all of your pain is coming from the soft tissue damage around the cervical spine and top of the shoulders.
Another type of injection is “epidural steroid injection.”. This injection is much more evasive since it is usually done in some sort of operating room or special room where specific procedures are done. This type of injection will be guided through a motion x-ray, known as a fluoroscope where the doctor is able to guide a needle close to the spine and also close to the spinal cord where they will inject numbing solutions to see if that will reduce or eliminate a person’s pain.
The last type of injection that is generally given for neck or back issues are “facet injections.” The facets are part of the boney portions of the vertebral bodies that make up the spine. These facet bones come together and have nerves running through them. They can be significantly damaged in a crash by the extreme stretching that is done with forces that generally take place in about an 8th of a second. Even a mild amount of force can cause these injuries. These nerves can be damaged by the stretching and cause pain. A doctor can also, with a fluoroscope in a special room, inject numbing solutions into the area where the facets are all up and down the portion of the spine that is painful and if it is able to eliminate the pain or lessen the pain, the doctor knows that all or part of the pain is being generated from or through the facet joints. Please be advised that pain coming from a neck or back issue in a car crash can generally take place from multiple sources so there may be a soft tissue component to the pain, a disc component to the pain or the facet joint nerve damage can also be all or part of the cause of the pain. If any of these injections work, doctors are able to isolate where they believe all or part of the pain is coming from.
WHAT IS MAXIMUM MEDICAL IMPROVEMENT AND DO I NEED TO TREAT AFTER A DOCTOR HAS TOLD ME THAT I AM AT THAT STAGE?
Yes. People who reach maximum medical improvement or better known as “MMI” should treat on an as needed basis. Most doctors will tell you that. One of the biggest misconceptions of when somebody is at maximum medical improvement (MMI) many people think they are not allowed to treat anymore which is not, in fact, the case. Many people who have reached maximum medical improvement, which means “as good as they are going to get medically”, without some sort of other procedure whether it be injections or surgery, still need care. People with surgery still need to follow up care because surgery may not eliminate all the pain problems. Also, people who don’t get surgery are going to need care. The more someone uses the area of the body that is injured, such as the neck or back, the more likely they are to have pain in those areas. It is not uncommon also for people to go through times of less pain and then engage in some activity and have worse pain for a period of time. These are called “exacerbations” and they can be quite painful and generally will require some sort of follow-up care. The amount of an exacerbation in a year can depend greatly on a person’s activity level and their own body and how they are dealing with the injury.
Thus, if somebody has reached maximum medical improvement (MMI) it is not uncommon and in fact, they are encouraged by their doctors to come and treat, either to try to get some relief and maintain their situation or to try to get help when they have exacerbated their injuries.
IN CONCLUSION – injuries to the neck or back generally will require treatment that generally lasts a number of months, depending on the type of injury which can vary greatly. You are encouraged that if you are hurt in those areas to actually seek medical attention and see doctors in your area that are willing to treat accident victims.
If you have any questions about particular doctors or want to know what doctors in your area you should call that would treat your injuries, please feel free to call the office of Christopher Ligori & Associates at 813-223-2929. We are available 24/7 to help you answer your accident needs and medical treatment concerns.