Real injury or carte blanche for diagnostics?
Recent studies have shown that whiplash injuries occur in about 1.3 million auto accidents a year. The estimated cost? About $30 billion per year to manage and treat whiplash-related injuries…not to mention the waste and inefficiency that adds even more time and dollar costs.
Despite the abundance of data and the economic incentives, there’s a lot of potentially wasteful gray in this intersection of the law and medicine. Professional disagreements abound regarding the specific mechanism of injury, the diagnosis and the treatment options. Not surprisingly, it’s an area of complex litigation and claims management that often involves difficult interpretation and analysis of medical records and insurance fraud.
First, a few facts
It’s important to know some of the medical basics. For starters, whiplash is a sudden hyperextension of the cervical spine, followed by hyperflexion on the neck. The Mayo Clinic defines whiplash as “a neck injury due to forceful, rapid back-and-forth movement of the neck, like the cracking of a whip.” More than 90 percent of all whiplash injuries affect the cervical column. The rest of the cases involve the thoracic and lumbar areas of the spine.
Whiplash is a common diagnosis following rear-end collisions, which are an ongoing problem in the United States with high-dollar costs and exposure. The National Transportation Safety Board says there were about 1.7 million rear-end collisions in 2012 that resulted in 1,700 fatalities and 500,000 injured people.
Difficult and complex records analyses
Remember: Not all rear-end motor vehicle collisions result in whiplash. The mechanism of the injury, the speed and the impact must be considered when reviewing a vehicular accident that resulted in a whiplash diagnosis.
Depending on the accident, shear force, tension and head rotation all can affect the extent of an injury. Headrests can provide some protection as they will prevent the head from hyperextending. Without a headrest, significant injuries can occur to facet joints, ligaments and other soft tissues. The soft tissue, for instance, stretches ligament and muscles, which, in some cases, leads to acute and chronic symptoms.
Lumbar and thoracic injuries are much less common because of the seat and restraints. These usually cause strains much like those injuries found in cervical whiplash.
The claims managers’ and adjusters’ perspectives
These days, the mere diagnosis of whiplash injury can strike fear into the heart of the insurance industry – and for good reason. The costs of diagnostic tests — along with the added time a file is open — can be staggering to the insurance company. All medical tests should be done judiciously and only if there are clinical concerns that would warrant them. In fact, in 2014, the United Kingdom took a radical stand on the issue. At the time, most insurers in the United Kingdom were starting to deny ANY whiplash claim as bogus. Some insurance companies say whiplash isn’t even a legitimate injury.
In 2015, the government of the UK set up panels of “accredited” doctors to vet all whiplash claims to reduce the number of fraudulent claims and save customers on their premium. In 2017, leaders approved a series of reforms, including a compensation cap for whiplash.
Even more influences
The experienced reviewer and analyst has learned to take additional relevant factors into account when looking at a whiplash case or claim. For example…
- Gender of the claimant
- Any pre-existing conditions and
- Social and psychological factors
In addition, the litigative process also can strongly influence complaints, diagnostics, treatment plans and final outcomes for whiplash.
What’s more, providers and hospitals are increasingly fearful of medical malpractice and may order questionable tests. All parties involved with these kinds of cases should proceed with care and thoughtfulness. Whiplash injuries can develop into long, drawn out and costly cases.
Is there a middle ground?
There may be valuable lessons from the approaches in both the United Kingdom and the United States. There’s little doubt that whiplash injuries can cause major medical issues that can, in some cases, make for a legitimate claim.
Is it really necessary, however, to spend thousands of dollars in diagnostic testing to determine a cervical, thoracic or lumbar strain? In the case of whiplash, it seems the medical community could reduce its dependance on testing for this diagnosis. If that doesn’t happen, the health care system in the US might just go the way of the United Kingdom, making it almost impossible for anyone to get treatment for whiplash at all.