If you have been hurt in a car accident, motorcycle wreck, trucking accident, workers’ compensation accident, or in a trip and fall or slip and fall at an apartment, hotel, store, restaurant, or other business, you should have two goals in mind—making sure you have the best physical recovery possible and making sure you and your family are fully compensated by insurance.
Finding the right car accident doctor to treat your injuries can make all the difference to both your physical recovery AND in ensuring you recover everything you are due from insurance. This guide will help you to find the best doctors who can help you with both goals.
Car wrecks, trucking accidents, and trip, slip and falls cause different injuries than what most family doctors usually see and treat. You want a doctor experienced with “accident” injuries like concussions, traumatic brain injuries (TBI), whiplash injury, herniated or bulging discs, knee and hip injuries, multiple fractures (broken bones), internal injuries and soft tissue injuries. These injuries often require treatment with multiple medical specialists: orthopedic surgeon, neurologist, chiropractor, physiatrist, neurosurgeon, pain management specialist, a physical therapist to list a few.
A good accident doctor may be one of these specialists, but if not, he or she is an M.D. (Medical Doctor), D.O. (Doctor of Osteopathic Medicine), or a D.C. (Doctor of Chiropractic) who:
(1) knows accident injuries inside out and
(2) has a network of other specialists who are also experienced in treating accident injuries (a multi-specialty network).
It should be obvious how going to the right doctor can help your physical healing, but going to the right doctor is just as important for your legal claim as it is for your physical healing.
Whether you were hurt in a semi or trucking accident, car or motorcycle collision, bicycle accident, or slip and fall, an experienced New York accident doctor can be the difference between you having a successful legal claim or having no claim at all.
Most primary care doctors don’t like treating car accident or other personal injury victims. They don’t want or don’t have the know-how, to take third-party, PIP or no-fault payments, and they don’t have the experience or want to get involved in the New York legal system.
A doctor experienced with the legal system and no-fault insurance claims will know how to document your injuries properly and how to preserve evidence for use in your no-fault claim.
The right no-fault doctor will also know how to submit, and no-fault bill claims as well as what to say, and more importantly, what not to say, at trial or in a deposition to make sure your legal rights are handled with the same care as your physical health.
You can see from the above, finding the right doctor can be crucial not only to your physical health but also to your financial well-being after a car wreck or other accident—so you want to find a doctor that is:
(1) competent with the art of medicine but also
(2) skilled in documenting, presenting, billing and filing New York no-fault insurance claims—and, finally
(3) willing to face the legal system.
The first thing you should do after an injury accident, wreck, or workers’ compensation accident is to seek evaluation and critical care from your local emergency room. The ER staff will assess your injuries and provide “emergent” care ranging from stitches and pain medication to emergency surgery. As part of the ER evaluation, they may do diagnostic testing such as X-rays or CT scans to see if any bones are broken.
Not only will the ER make sure your injuries are treated as soon as possible—which gives you the best hope for a full recovery—but if you don’t go to the ER after an accident, the insurance company can try to use that against you to say that you weren’t really hurt.
Many accident victims do not realize they are injured until several days later after the shock wears off when they realize they are hurting even more than on the day of the wreck. Going to the ER immediately will better your chances of discovering your injuries soon enough to ensure the best recovery possible. As said above, it will also eliminate the insurance company claims you are not really hurt.
The ER, though, is not equipped to provide the most follow up care. For that, you will need to see the appropriate specialist.
It seems reasonable to ask the emergency room staff for a doctor recommendation, but unfortunately, many emergency rooms simply refer all accident patients to “accident mills,” (sometimes called “insurance mills”) which are not usually your best option for medical treatment. They are in every city—clinics with names like “Accident Center” or something similar. They provide treatment and “bill” the insurance company.
Why these accident mills not usually the best option:
• They are thought to provide unnecessary or ineffective treatment;
• They are often thought to be staffed by less experienced doctors and support staff
• Many believe they inflate treatment charges as much as five or ten times the usual rate which makes it difficult to get your case settled or to leave any money for your wage loss or pain and suffering;
• They “bill” the insurance company, often by filing a lien against your insurance settlement (while these “liens” may sometimes be a good option, they may not be if you have health insurance or Medicare);
• Insurance companies know who these Accident Mills are and resist paying their inflated bills;
• An “Accident Mill” does not typically care about you getting better or you being compensated for your injury— They are known for providing duplicative treatment until ALL of the insurance money is gone and then abruptly stopping treatment whether you have recovered or not, leaving you with little or nothing out of the insurance recovery.
While you don’t want to treat at an “Accident Mill,” YOU DO WANT TO TREAT WITH A COMPETENT “ACCIDENT DOCTOR,” WHICH IS DIFFERENT FROM AN ACCIDENT MILL.
An “Accident Doctor” is a doctor who specializes in treating accident victims, but, unlike the “Accident Mills” does not offer a one-size-fits-all treatment plan, but tailors a specialized treatment plan for each patient. A good medical specialist should be able to steer you clear of the accident mills. So will your reputable personal injury lawyer.
It makes sense you would call your primary care physician (PCP) or a family doctor when you are injured. However, most general practitioners, though, just aren’t equipped to navigate the legal system. You need a doctor who not only provides excellent medical care but for one who also knows how the legal system works in New York. That is most often not your PCP, but an experienced New York car accident doctor.
Some PCPs refuse to treat accident victims because:
• They think—although it’s not true—that major medical health insurance or Medicare will not pay medical bills from an “accident”;
• They do not want to be involved in the legal system, for instance, by being called to testify on your behalf at trial.
Even if your PCP treats a car accident victim, they may not be the best choice because:
• They don’t accept third-party billing (No-Fault, PIP, Workers’ Compensation, MedPay, liability coverage);
• They generally treat more chronic diseases (like diabetes, arthritis) or acute sickness, disease, and other medical conditions (like flu) rather than the most common car accident injuries such as spine injury, concussion, whiplash, and other soft-tissue injuries;
• They just don’t understand the legal system or the no-fault insurance claims process.
If you already have a lawyer, listen to him or her. An experienced personal injury lawyer knows who the good doctors are in their area. Your good personal injury lawyer knows who the insurance companies respect, and who will or will not overcharge and over-treat (taking the insurance money and leaving little or nothing for YOU—the injured).
Not only do you want and need a doctor who knows how to treat car wreck injuries and slip and fall injuries, but you want a doctor who is familiar with the insurance claims process.
For instance, you need a doctor familiar with the coding process used by insurance companies in evaluating and paying claims. You want medical providers who understand and accept third-party billing such as No-Fault Insurance, PIP (Personal Insurance Payment), Workers’ Compensation Insurance, Medical Liens, and other liability insurance payment.
New York is a “no-fault” state, meaning a person injured in an auto wreck need not prove “negligence” or “liability” to be entitled to compensation from the insurance company. This no-fault coverage is called PIP for “Personal Injury Protection.” If you have a straight PIP claim, you cannot make a separate claim against the at-fault driver (but see next section, “Exceptions to PIP”).
You want a doctor who understands: (1) what is (and isn’t) covered by New York PIP;
(2) how to submit a claim under PIP coverage; (3) what each claim “form” (NF-2 Form, Assignment of Benefits Form, NF-3 Form) is for and when to file them; and,
(3) how to work with your New York personal injury attorney since insurance companies fight tooth and nail, even over “no-fault” coverage.
Most importantly, you’ll want a doctor who is familiar with the time-limitations for submitting claims under your PIP insurance.
There are times when New York PIP does not prohibit you from filing a claim against the negligent, or “at fault” party. The exceptions apply to “Serious Injury” which includes:
• Death or dismemberment
• Broken bones
• Permanent impairment
• Disability lasting at least 90 days
• Other exceptions
If your injury claim falls within an exception, you are not limited to your PIP coverage, but may also file a liability claim against the at-fault driver’s liability coverage. If you fall within an exception, you’ll want a doctor familiar with PIP and familiar with the exceptions to PIP, as well as with the differences in how each is resolved.
Unlike car wreck or trucking accident claims covered by PIP, Serious Injury Auto Claims, slip and fall and other non-automobile claims are not covered by PIP, but are “liability” claims. For a “liability” claim, the injured person has the “burden of proof.”
What you will have to prove in a typical liability case is:
• The accident was caused by the negligence of another person or entity;
• You have injuries that were caused by accident;
• the accident “aggravated” (made worse) a preexisting injury.
That means whether your claim is settled or tried, you are entitled to money if you have enough of the right kind of evidence to show that the accident was someone else’s fault and you were injured in the accident. Your doctor is crucial to providing that kind of evidence.
Many doctors don’t know this, but the American Medical Association’s ethical guidelines (Code of Medical Ethics Opinion 9.7.1) require that doctors assist their patients with a legal claim. Many Primary Care Physicians either do not know about the ethics rule or they just ignore it—many doctors just don’t want to get involved in an insurance claim and certainly not with a lawsuit. A good injury doctor knows about the rule and is willing and able to comply.
When it comes to proving and resolving an injury claim, medical records are king! There is a saying in the law with respect to injury and medical records—“if it isn’t in the records, it didn’t happen.” Don’t fall victim to inexperienced, or worse—lazy—recordkeeping by your doctor.
An experienced injury doctor will know how to document your injuries properly and how to prepare reports and other records to explain exactly how the accident caused the injury (or aggravation of injury) and how it will affect you in the future. They will compile a complete and accurate record of all testing and results as well as keep complete and accurate records of all diagnoses and treatment recommendations. They also know how to present this information in a format that provides the insurance company with all necessary information to prove the seriousness of the injuries. All of this helps you to get the maximum settlement or recovery from the insurance company.
Your regular doctor, by contrast, may not know how to document a claim to maximize insurance payment. His or her charts are likely incomplete from an insurance perspective. He or she may not understand the “burden of proof,” which can mean all the difference in your insurance claim.
For instance, as a result of not understanding the burden of proof, it is common for a primary care doctor to say only that a certain injury was “possible” from the accident or injury. That will destroy that part of your personal injury claim. They do not understand that this does not satisfy the legal burden to even be able to talk about that injury to the jury.
By contrast to the above, a doctor experienced with treating accident injuries and experienced with the legal system will understand the crucial difference between saying the injury (or at least the symptom) was “possibly” caused by the accident, versus saying it was “probably” caused by the accident. That small difference means everything since “possible” does not meet the legal burden in an accident case but “probably” does.
A short answer is “Yes! Since most auto-related accidents involve back and neck injuries (whiplash), chiropractic physicians can be one of the most important “accident doctors” when it comes to your post-accident rehabilitation.
Often, a chiropractor will act as your “primary” doctor or a “quarterback” for your recovery program – providing chiropractic therapy and if necessary referring you out for diagnostic testing and to other medical specialists like orthopedic surgeon, neurologist, pain management specialists. Together with the chiropractic physician, these accident doctors work as a multi-specialty team to get you back on your feet as soon as possible.
Every injury attorney has stories of the cases where the client had no physical complaint before the fall or wreck and then experienced immediate pain upon the fall or wreck. But the treating primary care doctor will only say the fall or a car accident was the “possible” cause of the injury, rather than state the rather obvious fact the fall or wreck was the “probable” cause of injury. Under the law, the jury cannot be told about the injury. Don’t let that be your story.
Accident law, or the law of negligence, is part of the “civil justice system” and has a different standard of proof than the criminal system. That means instead of having to prove your case “beyond reasonable doubt” (which is the criminal standard), in a “civil case” you only have to prove that the necessary facts are “more likely true than not” (or a preponderance of the evidence). Also, to prove medical injury requires “expert” medical opinion in most cases. Medical experts (like all experts) must testify that the opinion they offer is “more likely true than not.”
Many doctors do not understand this important difference and assume they must satisfy the higher, criminal, burden. Because of that, they don’t want to testify for their patients because they (understandably) aren’t comfortable saying anything is “beyond doubt.” These doctors will often only say the accident is a “possible” cause which does not satisfy the burden of proof to even talk about the particular injury to the jury.
A doctor experienced with the legal system understands the standard of proof and knows he or she need only be able to testify the accident is the “most likely” cause of the injury or aggravation.
Many doctors who do not have experience with the legal system do not understand that you are entitled to monetary compensation if the accident didn’t “cause” your injuries, but instead “aggravated” an existing injury. Your experienced injury doctor understands that both injury AND aggravation of injury must be compensated.
Most injury victims do not understand that liability insurance (other than health, no-fault or workers’ compensation) does not pay for medical treatment as it rendered, but will pay a full and final settlement at the end of the claim or case that includes reimbursement for medical care. In a contested case even PIP is handled the same way. This means you may have to be able to get your own medical care to be able to substantiate your insurance claim for medical damages.
They know they can give you the treatment you need both to “get well” and to support your insurance claim and then they can recover directly from PIP or file a lien, treat under a “letter of protection” (or under a “promise to pay” out of settlement, which is similar to a letter of protection).
If you have health insurance or Medicare, it may, but not always, be best to use that to pay for your treatment (even though you may have to repay them some or all of what they have paid). But what if you don’t have health insurance or other means to pay for your medical treatment? In this case, a “medical lien” may be a good option (NY Medical Lein Law,§ 189)
A medical lien is a lien that is filed against an injured person’s insurance claim. When insurance later pays the claim, the injured person will have to pay the medical liens out of the recovery, but that is a better option than not getting treatment which will not only be bad for your health—but will dramatically reduce or even eliminate your entire insurance claim.
An experienced accident doctor not only knows how to use a lien to provide necessary treatment, but will also know that sometimes he or she will have to reduce the lien in order to make sure the injured person receives some of the settlement for permanent disability, pain and suffering, lost wages, and emotional distress.
Sometimes rather than filing a lien, a provider will agree to provide treatment if the patient and his or her attorney signs a “letter of protection.” This is like a lien in that it gives the medical provider a level of assurance they will be paid so that they can agree to provide medical treatment even to those without health insurance or other means to pay.
Don’t worry, a medical lien (or letter or protection) is not a lien against your home or other assets, but only “attaches” to the insurance recovery.
Just like a good lawyer will be able to refer you to an experienced doctor, a good doctor will know when it is in your best interests to consult with an insurance or personal injury lawyer. He or she will also know who the good experienced attorneys are, and will be able to give you a referral to an attorney capable of maximizing your claim.
Auto wreck injuries are often complicated, requiring referral to various specialists, or an experienced New York multi-specialty medical team.
An experienced New York Accident Doctor will be able to refer you for diagnostic testing (such as MRIs and CTs), physical therapy, and pain management, or to other specialists such as orthopedic, neurological, or surgical specialists, experienced in treating auto accident injury.
A good personal injury doctor will understand the need to document such things as how long you need to be off work and future limitations from the automobile or other accident that will affect your ability to earn a living in the future. They will be able to refer you to the proper vocational rehabilitation or refer you to a lawyer if they think you may need additional documentation of work disability.
While you don’t have to prove your employer was at fault for a workers’ compensation claim, you do still have to prove you were injured, and the nature and extent of those injuries. Because of this, it is just as important in a workers’ compensation claim as in a personal injury claim for you to seek treatment with a doctor experienced with the workers’ compensation system.
An experienced injury doctor will know how to prove and document your injuries so that you get all that you are supposed to out of your claim. That will give you the ammunition you need to fight the insurance company lawyers whose job it is to make sure you get paid as little as possible from the insurance company.
NOTE: If you were injured on the job, see our guide: New York Workers’ Compensation Made Simple.
An experienced injury doctor will know how to protect you from insurance company claims you have “gaps” in treatment that show you weren’t really hurt in the accident. A treatment “gap” is any unexplained gap or delay in your medical treatment. Unexplained treatment gaps kill the value of your claim.
Your PCP may not even know to protect you from this “treatment gap” defense, and may instead take a “wait and see” approach that can destroy your insurance claim.
Your medical records, more than anything else, make or break your insurance or legal claim. That is why finding the right car wreck doctor is so important.
Because your medical records establish the value of your claim, it is important that you make sure your doctors, starting with the emergency room forward, know and record that your injuries were caused in an accident, including enough detail about the accident to show how the injuries occurred from the accident.
It is also crucial that you tell your doctor how the injuries have affected you; what are you no longer able to do, or able to do, but now with pain or other difficulties?
Do not lie to your doctors—as important as telling your doctor about your accident and about your injuries, it is also important that you not lie or withhold information from your doctors about prior injuries or medical conditions.
Prior injuries do not prevent recovery. If you have a prior medical condition that is made worse (“aggravated”) by accident, you are entitled to compensation for the aggravation. Be sure to be honest about prior conditions—again, remember, if you lie about the condition and it comes out later, you will do major damage to your claim. You must be honest with your doctors—and your lawyers—for that matter!
If you are not honest about prior medical conditions, you will damage your claim because the insurance company knows if the case goes to trial it will be able to tell the jury that you were not truthful to your own doctor—the last thing you want the jury to think is that you are not a truthful person.
And don’t think the defense will not find out about your prior medical condition. Insurance companies and defense lawyers are very good at sniffing out such things. Don’t hide from a prior condition—embrace it.
You have a duty to lessen (“mitigate”) your losses or damages. The last thing you need is for your medical records to show that you missed appointments or were “noncompliant” with medical recommendations. This would tell a jury that you were not really hurt. The insurance companies know that and so use these things to devalue your claim.
Do what your doctors tell you to do.
This means attending all appointments, do your physical therapy, and take your medications as prescribed.
As stated throughout this guide, you need your doctor’s testimony. For that reason, you want your doctors to smile when they hear your name.
Don’t get into pointless arguments with your doctors which serve only to make them, even subconsciously, not disposed to help you out. Get along with your doctors and they will get along with you—and they will be more likely to help you with your insurance claim.
While not as bad as a long treatment gap, continuing treatment after a full recovery, called “malingering,” will also hurt your claim. Be truthful with your doctors about when you have recovered from your injuries.
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