Blog, Chirosecure Live Event July 30, 2023

Personal Injury 2023 Mid-Term Report

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Hi, I am Dr. Mark Studin, and first, I’d like to thank ChiroSecure for the privilege of letting me share this information with you today. So much is changing in the industry. We’re gonna go to the slides and I’m gonna explain to you specifically what now. Today’s topic is the state of personal injury in chiropractic.

Now you notice I put a date on there, July 1st. Through December 31st, 2023. And I wanna share with you that the data’s important because things change. And the problem I see in the industry, and listen, I’m gonna be a little bit egotistical and I’m gonna acknowledge that right upfront by saying that there is very few people in the country who understand chiropractic and personal injury better than I do.

It is not that I’m smarter than other people, it’s just that this is all I do. I don’t have a practice anymore. I don’t teach, I don’t I do teach, but I’m not in the classroom every day and every single day. I speak to doctors in 49 different states. I speak to medical specialists. I present to insurance companies, defense lawyers.

I write reports for plaintiff. I, I. For plaintiff doctors, I’m reading case reports every day. This is what I’m immersed in and it frustrates me a little bit when I see a lot of other people taking my stuff and a lot of people take my stuff and I really, honestly, it used to bother me a lot, but I don’t because by the time they take my stuff and they put it out there,

It’s already old. And as a matter of fact, I read a newsletter that somebody put out just last week on lawyers wanting to have you put your fee through managed care and bill on managed care rates, and he gave a cookie cutter answer, a one size fits all, which is the wrong answer. Because most states have different rules regarding that, and you’ve gotta be really careful because it’s not about getting paid, it’s about keeping the money.

It’s about not having lawsuits against you or Rico cases or licensure complaints. When we look at what we do and we look at the, in our industry and we look at the state of personal injury for the second half of 2023. It’s very different than the first half of 2023. It’s very different.

So our agenda is gonna focus specifically on what you need to do and what you need to understand and how you prepare. Now with my consulting clients, I tell them, I’m teaching you what to do to get paid six months from now. I’m teaching you how to get a new patient six months from now, if you wait six months and then start to do those things,

You’re not gonna be prepared. And when I have a consulting client, the average doctor stays with me for well over 12 years. Why? Because I’m learning things in 49 different states where I have doctors, I’m learning things in 36 or 37 different states where I have attorneys that I work with. I’m learning things.

When I read case reports, I’m learning things. When I read court rulings and RICO cases against doctors, because documentation is critical. And it goes back to the adage, death by a thousand cuts, which is from Babylonian times when they used to torture people with a thousand cuts till they died, until they bled out.

The same thing is happening to your chiropractic practice and personal injury. It’s death by a thousand cuts, and you have to understand those thousand cuts. So the state of personal injury for the second half of 2023 is far different than it was in the first half of 23. Or in 2022 or 21 or 19, et cetera.

It’s very different. It evolves. It’s the only fluid industry that’s predicated on rulings that come down from the courts almost on a daily basis. It’s unlike legislature where you’ve gotta follow legislature and it’s gotta go through the house, then the Senate, then the governor has to sign, or it’s gotta go through agendas and boards and committees.

This is a court making a rulings, making a ruling on a daily basis. So we are at whim to those precedents. Sometimes it goes to the appellate division where they get to appeal it, and sometimes it goes to the Supreme Court of Appeals. The highest court in the state where it’s affirmed is law, and that’s another thing you would need to understand.

You need to understand your court systems because how could you play in personal injury if you don’t understand the rules? Of the game. So let me do a little bit of reading, and reading is important and I usually don’t like to read, but this is a piece of an article that I wrote actually on Friday.

It says Marketing plus clinical excellence equals personal injury referrals. This is the state of 2023. Marketing works for personal injury if it’s academic marketing. While some dcs have strong long-term relationships with lawyers, most don’t, and even those with strong relationships often find those referrals withering.

Now, I get calls honestly on a daily basis. Mark, Dr. Mark. I don’t understand that I used to have such a big PI practice. Now all of a sudden, I hardly get any at all. This lawyer used to refer to me. I don’t get anything from this lawyer anymore. I just don’t understand. And my favorite one is I.

Every lawyer in my area is on the take. There’s runners. They’re paying people to come in. They’re paying doctors off. Doctors are paying lawyers off for referrals. That’s fraud. In my neighborhood. I heard that. In every state, in every city in the entire country. It’s fraud. It’s fraud. It’s fraud. It’s fraud.

The mafia’s in the Russian mob is in that’s a big one in New York. I hear that a lot. And that’s all nonsense. I’m not saying it doesn’t exist. But do you think every lawyer wants to go to jail? Heck no. Okay. No. This is not about that. It’s about you. You wanna know why?

Referrals are dwindling in our industry. The answer is that it’s getting harder for lawyers to get their work admitted into the courts based on lack of credentials of you, the chiropractor. This has nothing to do with going to court, nothing, because the lawyers judge you by their end game and it’s grossly unfair, and their end game is court, but that’s how they’re trained.

So the lawyers judge you based on admissibility standards. They must adhere to. They know all about what you got going on. They’ve been listening to chiropractors for decades. They know that we’re real doctors, even though the defense will never acknowledge it, but they’ve gotta bring you to court. Being a DC is incredible.

Earning your doctorate of chiropractic is incredible, however, It’s typically not enough in a personal injury case. And listen, I’ve heard it all. I have Colossus reporting. I have this fancy program that’s designed to bust the insurance company’s algorithm. Be careful because what it’s gonna bust is usually you.

It means nothing to the lawyer. Zippity, Doda lawyers don’t really care. Fancy range of motion testing with all these different things on it. Hey, that’s important. It’s important. It won’t be the reason for them to refer to you first. X-ray, digitizing. Now I own an x-ray digitizing company. I personally own one.

I can tell you factually that will not be the reason that lawyers will work with you. They don’t care. You must have advanced credentials for lawyers to consider working with you. You must. You must. You must. All of those add-ons serve a purpose. Like the reporting or the testing, the digitizing, they serve a purpose, but it’s not gonna be the reason why lawyers are gonna wanna work with you.

It’s not gonna be the reason. Cross my heart, I promise you. I’ve spoken to too many of them. You see all of the above reporting issues are minor reasons to consider you. As I said a moment ago, they’re add-ons to bypass physical therapists because they need somebody to certify rehabilitation care. This, despite the evidence that chiropractors get a 313% better outcome than physical for disability, lawyers really don’t care about that.

They don’t care. All they care about is someone certified long-term care. However, they’ll not want you first for that. You need advanced credentials, and unless they consider you as the first referral option, you’ll always be struggling. Now, what do we mean first? Referral option? That’s called primary spine care.

Primary spine care means you’re the first referral option, not just lawyers, but medical primaries, medical specialists, urgent cares and emergency rooms. Now, I have been championing primary spine care for almost a decade. Really championing it at a very high level. We’ll show you that a little bit later on, but let me explain to you how I figured out how, what we need and why.

And it came from my wife, my now my wife 15 years ago was first diagnosed with cancer. She had cancer three times. And she’s had four surgeries and it was a five-year battle. And and she’s doing great. She had kidney cancer. And when she was first diagnosed, I had to find the right doctor. And I spoke to a lot of idiots out there.

Really subpar people who I would consider the best. I wanted the, she had to live. She had to get to the best of the best, not the one who I liked the best. Now, did I look for someone who had an advertisement on a bus stop bench? Or was standing in a field with a scoliosis unit or whatever they call these things.

No, I wanted someone who was highly credentialed. So living in New York, I went from Boston to New York, to Philadelphia, to Washington. If you can’t find a doctor in that corridor, You’re in trouble. You’re big time in trouble. And I found the right doctor in New York City and Columbia Presbyterian Hospital.

So I called up and I said, okay, my wife has cancer and we need an appointment with the urologist, a kidney surgeon. They said, oh great you, he’s wonderful. You’re gonna love him. I have a opening in six months. I said, six months she’s gonna be dead. Are you insane? This doctor’s busy. He has patients flying in from Egypt, Africa, south America, Europe, Asia.

You know the West Coast, Canada, he is only two hands. And if you don’t like him, I’m sorry, there’s nothing we can do. We don’t have an opening. That’s all I needed to hear and Huang up. So then I got on the phone and I started calling other department chairman, state Senators Assembly, me con anyone I knew it took me two weeks and I got her an appointment.

And the bottom line is he saved her life and I very much appreciate that. Forever and ever and ever. But she had some complications. We went through the same thing. We had to get a special doctor in Boston. It took me a week to get the appointment, then we had to go to other doctors in California.

We went all over the country. It was a five year battle. But going through that, I kept saying, why don’t patients. And referral sources run after chiropractors like I right after that, cancer surgeon. Is it because we don’t deal with life and death? Folks, guess what? If you have a patient and they’re in agony, their life is on hold.

They can’t function. Drugs aren’t gonna work, surgery won’t work for what we need to treat them for. So they need us to have their life functioning. So the arbiter for me, and this is the secret. You ready? The arbiter for me when I went to find the right doctor ? As I got a referral, it was actually from a family member, and then what I did is I called two other urologists in the region who said, he’s got a great reputation.

Then he went online and he said, oh my goodness. This guy went to Washington University in St. Louis, one of the best urological programs in the world. Then he was in Columbia Presbyterian. He’s been well published. He’s the. Head of the minimally invasive urological department. This guy had all the right credentials.

He was the guy. But when you look at chiropractors, when I started this, hey, I was the president of my state organization. It was called an executive board of director there, so I was the head of my state. Does that mean I’m a good doctor? Heck no. Just means I could BSS better than other people in our industry.

What is there? You become a DAK bar, that’s wonderful. You become a diplomate in in, in orthopedics. What’s a diplomat? No one in the medical industry understands that nomenclature. It seems chiropractic had to have their own, and people don’t understand. Now, I want medical doctors to refer to me.

Why? Because we treat, the literature says 10, 12% of the population. I think it’s really closer to seven. So we’re treating 7% of the population. They treat 99% of the population. Who do I want to tie into the two MDs that I work with, the primary cares in my community that I’m very good friends with.

Their fifth most prevalent diagnosis is back pain. In their office every week. They have 20 to 25 back pain patients a week. They don’t know what to do with them. They’re clueless, clueless, and we’ll talk about how to get them to understand that later on, but I have to tell you, I work with them and now all of a sudden there’s 20 to 25 new patients a week going to chiropractic care, not me.

I don’t treat anymore. So advanced credentials are tho is what you need. And advanced credentials are those you get that are co credentialed through medical and chiropractic academia. Now, I worked for almost a decade with the State University of New York, of Buffalo Jacob School of Medicine and Biomedical Sciences.

It is a highly regarded medical school that every one of our courses are co credentialed. Our course is currently a credential through Cleveland University, Kansas City College of Chiropractic, which I love the school. I think it’s one of the best schools in the nation. But you, if you wanna work in personal injury, you at best have M R I, interpretation credentials.

Tri trauma. Trauma triage, triaging the trauma, spinal biomechanical engineering, accident engineering, all the connective tissue pathology. It’s all of these things you need that are co credentialed through both medical and chiropractic, academia. We have primary spine care courses. We have everything lawyers need to want to work with you now.

I. It’s those credentials you need to market. It’s no different than finding that cancer surgeon. You don’t go to the person with the fanciest equipment. You go to the doctor with the best training, and then you have your CV posted and we have something. And unfortunately I can’t switch I can’t switch screens at the moment, but there’s the US Chiropractic Directory.

It is the only site in the world only. Which has doctors of chiropractics curriculum vitaes posted, and there’s a CV builder on there. Do you know how many hits we’ve gotten on that? Almost 22 million hits on that site. It is possibly the most visited site in our profession now. The Academy of Chiropractic.

What? So here’s the thing. Our organization is called the Academy of Chiropractic. So what we do is we have a playbook. that streamlines everything, so you have to know how to do all this stuff. So for 2023, and this is really important, okay? For 2023, you need a personalized marketing strategy as a primary spine care provider to get not only lawyers, but MD primary care specialists, MD specialists, urgent care centers, and emergency room.

All those things have to run after you lawyers, MD Primaries, MD specialists, urgent cares, er, they’ve all gotta run after you when you need a strategic plan, and that’s what’s important. You also don’t need MDs in your practice, but they need you more, and that’s another issue. Do you know that an MD needs a chiropractor more than a chiropractor?

Needs an md? Doesn’t seem like it when you’re out there trying to build, when you’re trying to build a network. You wanna refer to an md? Why aren’t they referring back to you? A neurosurgeon in New York. Now my, my malpractice, I believe is about $2,000 a year in my, I’m in Long Island. A neurosurgeon is $363,000 a year, and if they have two cases against them, even if they’re innocent, it escalates to $600,000.

Whose time is more valuable? Mine are theirs. Theirs is. But who needs the referral more? They do. Without your referral. They’re going bankrupt without their referral. I’ll be just fine. I could afford $2,000 a year. They need you more than you need them. So I call the surgeon and say, I have the case to refer to you.

And I’m gonna send the case over and I do that, send the case over. I didn’t say orthopedic surgeon. You notice that I will never ever send a spine case to a general orthopedist. Now, if that orthopedic surgeon has a fellowship in spine, then you know what? Then I’ll consider sending them. But for my 2 cents, it’s always neurosurgeon.

But I tell them I’m gonna be sending you a lot of cases, a lot because I order MRIs. If there’s Alopathic or Myelopathic component, I’ll talk about that in a moment. I’m gonna be sending an immediate, I’m gonna order an immediate M r i. I’m not gonna treat them. What are you treating for? If a patient’s radiating down the arms or legs and it’s myopathic, what’s causing it?

Don’t tell me subluxation, biomechanical lesion. Don’t tell me you’re gonna put a genie rub on it. What’s causing the pressure on the nerve root? Or is it a spinal cord issue? Is it a my myopathic finding? Is it alopathic finding? You gotta know all of those things. And it’s funny, I just read a research article that came outta Denmark, which says, That 95% of every chiropractic patient in Denmark is thrilled with the initial evaluation, but only 50% with the treatment.

Now, it’s not the chiropractic that’s for radiculopathy and that’s not for chiropractic adjustment. They were upset that imaging wasn’t referred to quicker. They were upset that it wasn’t explained to them why or why not. They weren’t getting imaging immediately. That was the crux of the upset and that research article just came out.

Patients aren’t stupid if you don’t see, you don’t know, and that’s critically important. And here we are. If you don’t know, don’t touch. You need a diagnosis, prognosis, and treatment plan before you treat. You need all those things because you have to know, and here’s where you start. Here’s your e and m encounter, and I’ve done this before.

Here’s your e and m encounter. Am I gonna do an x-ray? Am I gonna do collaborative care with a specialist? Am I gonna order adjunctive therapies? Am I gonna do a chiropractic spinal adjustment or an M R I? What am I gonna do first? That’s what M stands for in e and m, evaluation and management. It’s not evaluate and treat, it’s evaluate and manage.

You need to know what’s going on with your patient, and if you don’t know, don’t touch period. If you don’t know, don’t touch. Here’s your 10 most common pain generators that must be demonstrable. Folks, show and tell. You’ve got spinal cord, you’ve got fecal sac, you’ve got the recurrent meningeal nerve, which sits in the outer third of the disc.

You could have cord edema when there’s pressure on that cord or myelomalacia, the cord starts to die. You could have compression on the nerve root. You can have connective tissue pathology, strain sprain. You could have chemical radiculitis when a piece of that nucleus opsis goes from the inside out, you could have a fracture in the endplate or in the bone.

There could be microfractures or you could have bone on nerve, which happens at the facet level, not at the root level. And we’ve talked briefly about that before. Maybe next month or the next time we do this, we’ll talk about bone on nerve at length. But you need to know all these things. And when you get there, you need there’s, these are your causally related pain gen, pain generators, cord, nerve root, thecal sac, disc, or current meningeal, nerve cord edema, myelomalacia fracture, chemical radiculitis, connective tissue orders, bone on nerve connective tissue.

These last two. , they’re responsible for 98% of back pain, 98%. MDSs are trained typically in the other 2%. They don’t know anything about connective tissue or bone on nerve. I know that factually, I teach them. I know what’s going on in their offices, folks. So if you think there’s anatomical pathology, fracture, tumor, infection, herniation, all these things, you need an immediate M R I.

You need an immediate M r I. Your chemical radiculitis will be your incidental finding. Don’t have time to get there. If you have radi, osteopathic, or myelopathic signs or symptoms or positive x-ray, digitizing for translation and angular deviation because you need to do an M R I with a stir you short tower inversion recovery or a fat saturated T two and you gotta know all these things to be able to suppress the fat and see if there’s edema in those ligaments.

’cause you can see ligament damage. I and all. But what if you don’t have, you just have localized pain that’s not radiating you can do an M R I after about six weeks of conservative care, but you need an immediate x-ray. And we’ve talked about this also needing an immediate x-ray, because what occurs with x-ray is it will give you biomechanical pathology and show you exactly where the primary lesions are, if you know how to look.

Oh, I don’t want to take x-rays. It’s gonna hurt people. That’s nonsense. You need 4,500 cervical x-rays, 56 lumbar x-rays, and a hundred thoracic x-rays to have less than one in 100,000 negative incident for radiation from radiation. It’s according to the evidence and literature folks, you need over a hundred milli serves in any one sitting.

And radiation’s not cumulative. The sky isn’t falling. Don’t let people tell you like, like nonsense. So all of these things are really important. Hey, if you wanna work with lawyers and MDs, and here’s the key for 2023, you need to make these 10 issues demonstrative. Specific MDs are still calling back pain nonspecific, and they don’t know what to do with it.

Go to a pt, go to a nurse practitioner, take muscle relaxers, do a Medrol dose pack, do nothing. Lay in bed. The Mayo Clinic lists about 23, 20 things including surgery before they say chiropractic care. But you know what? There are tools out there which can show you exactly where those lesions are coming from and make them very specific.

And when you make it specific, it’s game over because now you have a level of demonstrable. In 2023, it’s about making all of these pain generators demonstrable. Once you could do that, it’s game over. If you work with another consultant and they tell you, oh, I want you to do social media marketing. Send this newsletter, get this colossus busting program work with this x-ray digitizing burger.

That’s all you need. You know what? Hold your wallet and run like hell. It’s not the truth, folks. Remember, I own an X-ray digitizing company. It’s not all you need. Remember death by a thousand cuts. Here’s a cut. You take an M r I, I’m sorry, an x-ray and you report lateral cervical reports encroachment at the C five C six, or actually oblique cervical reports encroachment at C five C six.

Lawyer won’t work with you. Why? Because you didn’t say, I personally reviewed the images and they showed. That’s a cut, one of those thousand cuts because that’s the tell to the lawyer that you don’t get it because they think you might’ve read off the x-ray report of the radiologist and that becomes hearsay and inadmissible.

That’s one of a thousand cuts. I’ll give you another one. Mrs. Jones had an accident. They’re not working with you. Mrs. Jones had a crash. I gotta take that word accident out of there. These are the things that we teach you that’s different. These are the things you need to know. For 2023, it’s getting harder.

The lawyer’s admissibility standards are getting much more stringent. There’s something called Motion in Limine, just Latin to English. A motion to limit the chiropractic to testify. We’ve seen it in New York, New Jersey. Georgia, Texas, Colorado, Connecticut. We’ve just started to see those. And in every case, if the motion was granted to limit the chiropractor to talk about a chiropractic exam, chiropractic x-rays, and a chiropractic adjustment.

That’s it. Nothing on causality, nothing on MRIs, nothing on functional losses. Zero. That’s the new game for the carriers. This is something called the Fellowship in Primary Spine Care. This is the only one like it on the planet Earth. This is it. It’s certified by an Enjoin Providership with the State University of New York at Buffalo Jacob School of Medicine and Biomedical Sciences, office of Continuing Medical Education and Cleveland University in Kansas City Chiropractic and Health Sciences.

These two schools have joined up and it’s taken me over a decade to do that, to certify a chiropractor as a fellow. And you get F P S C after your DC. It’s upwards of a two year program. You don’t have to travel anywhere, but every one of those doctors that’s got an motion in limine that has these credentials, not a problem.

Not a problem. There’s other credentials short of the fellowship that can almost make you as bulletproof, but in 2023, you’re gonna need advanced credentials is every one of our courses, every one are co credentialed through chiropractic and medical academia. So the question is, where does your journey start?

You can take your phone out if you want to learn how to do this, and you want that playbook on how to get PI cases. Just take a picture of that’s on the consulting side. If in fact you want just academics, take a picture of that. That’s on the academic side. Either way, no matter what side you pick, you can always call me.

It’ll be my pleasure. Here’s my cell phone number. So that’s the consulting, that’s our academics. You’re more than welcome to call me, but I do want to share with you, I do want to share with you in 2023. It’s different. It’s just different. So folks, again, ChiroSecure, thank you so much for your time. I appreciate or the platform for doing this, and it’s my pleasure to share and I look forward to sharing with you next time.

Have a great day.