Michael Willens DO mwillenscomcastnet Disclosures Owner Medical Director and CEO of Advanced Pain Management Clinic No other disclosures Purpose of this lecture Ive just been in a car accident Can you help me ID: 630575
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Slide1Slide2
Automobile Accidents:
Important Considerations
Michael Willens, D.O
.mwillens@comcast.netSlide3
Disclosures:
Owner, Medical Director, and CEO of Advanced Pain Management
Clinic
No other disclosuresSlide4
Purpose of this lecture
“I’ve just been in a car accident. Can you help me?”
Often, primary care practices tell patients that they can’t treat auto accidents and don’t know where to refer them.
Protect yourself and your patients.How can you help these patients and get paid?Improve patient outcomes.Slide5
Obstacles to Treating
Who do I bill?
What is covered?
What forms do I use?What do I document?What tests do I order?What specialties should I consult?Slide6
Personal Injury Protection
Florida Section 627.736
PIP is PRIMARY
Fixed amount of funds – Usually $10kNo FaultWho pays?Slide7
Who Pays?
A driver hits another vehicle and injures his own neck.
His commercial insuranceHis PIP insuranceOther driver’s PIP insuranceSlide8
Who Pays?
A
driver gets rear-ended and injures his neck.His commercial insuranceHis PIP insuranceOther driver’s PIP insuranceSlide9
Who Pays?
A passenger
is in a vehicle that gets rear-ended and he injures his neck. His commercial insuranceHis PIP insuranceOther Driver’s PIP insuranceHis Driver’s PIP insurancePassenger owns a car with insurance.Slide10
Who Pays?
A passenger
is in a vehicle that gets rear-ended and he injures his neck. His commercial insuranceHis PIP insuranceOther driver’s PIP insuranceHis driver’s PIP insurancePassenger doesn’t have a car.Slide11
Who Pays?
A passenger
is in a vehicle that gets rear-ended and he injures his neck. His commercial insuranceHis father’s PIP insuranceOther driver’s PIP insuranceHis driver’s PIP insurancePassenger lives with his father who owns a car with insurance.Slide12
Who Pays?
A
pedestrian is struck by vehicle and he injures his neck. His commercial insuranceHis PIP insuranceDriver’s PIP insuranceHe owns a car with insurance.Slide13
Who Pays?
An owner is changing a tire on his car at his friend’s house and injures his back.
His commercial insuranceHis PIP insuranceHis friend’s home owner’s insuranceHis friend’s PIP insuranceSlide14
Who Pays?
A passenger is helping change a tire on a friend’s car and injures his back.
His commercial insuranceOwner’s PIP insuranceHis PIP insuranceSlide15
Who Pays?
A passenger is helping change a tire on a friend’s car and injures his back. He lives with his father who owns a car.
His commercial insuranceOwner’s PIPHis father’s PIP insuranceSlide16
Who Pays?
An owner is changing oil on his car and burns his arm.
His commercial insuranceHis PIP insuranceSlide17
Who Pays?
A boy is playing football, runs into a parked car in a driveway, and breaks his leg. He lives with his parents who own a car with insurance. He has commercial insurance.
His commercial insuranceOwner of the car’s PIP insuranceHis parent’s PIP insuranceSlide18
Who Pays?
A photographer is taking a picture of a car. He slips and falls breaking his leg.
His commercial insuranceOwner of the car’s PIP insuranceHis parent’s PIP insuranceSlide19
Who Pays?
A passenger injures his neck when their car was rear-ended. He gives the doctor his commercial insurance information and the doctor is paid.
The commercial insurance can demand the money back from the doctor.The commercial insurance can’t demand the money back from the doctor.It is soley the patient’s responsibility.Slide20
Who Pays?
A passenger is
rear-ended and injures his neck. He is in pain right away but waits three weeks to see a doctor. His commercial insuranceThe driver’s PIP insuranceThe other driver’s PIP insurance.Slide21
Who Pays?
A passenger is
rear-ended and injures his neck. He is in pain right away but waits three weeks to see a doctor. He has no other insurance. He is S.O.L.The driver’s PIP insuranceThe other driver’s PIP insurance.He may be able to recover damages with litigation.Slide22
Who Pays?
A passenger is
rear-ended and injures his neck. He is treated at the seen by EMS. He is in pain right away but waits three weeks to see a doctor. He has no other insurance. He is S.O.L.The driver’s PIP insuranceThe other driver’s PIP insurance.Slide23
Who Pays?
A driver is
rear-ended and is treated the next day by a chiropractor. He has no other insurance. His bills are $15k and his limits of coverage are $10k.His PIP insurance pays $10k and he pays $5k out-of-pocketHis PIP insurance pays $0 and he pays $15k out-of-pocketHis PIP insurance pays $2500 and he pays $12.5kSlide24
Who Pays?
A driver who hits a tree is treated by his D.O. the same day and for the next 2 months by a chiropractor. He has no other insurance. His bills are $15k and his limits of coverage are $10k. His doctor states it is an EMC.
His PIP insurance pays $10k and he pays $5k out-of-pocketHis PIP insurance pays $0 and he pays $15k out-of-pocketHis PIP insurance pays $2500 and he pays $12.5kSlide25
Who Pays?
A driver who hits a tree is treated by his D.O. the same day and for the next 2 months by a chiropractor. He has no other insurance. His bills are $15k and his limits of coverage are $10k. His doctor states forgets to document that it was an EMC.
His PIP insurance pays $10k and he pays $5k out-of-pocketHis PIP insurance pays $0 and he pays $15k out-of-pocketHis PIP insurance pays $2500 and he pays $12.5kSlide26
Florida § 627.736
“…must provide personal injury protection to the
named insured
, relatives residing in the same household, persons operating the insured motor vehicle, passengers in the motor vehicle, and other persons struck by the motor vehicle and suffering bodily injury while not an occupant of a self-propelled vehicle….”Slide27
Florida § 627.736
“$10,000
in medical and disability benefits and
$5,000 in death benefits resulting from bodily injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle”Slide28
Florida § 627.736
Medical benefits.
—Eighty percent of all reasonable expenses for medically necessary medical, surgical, X-ray, dental, and rehabilitative services, including prosthetic devices and medically necessary ambulance, hospital, and nursing services if the individual receives initial services and care pursuant within 14 days after the motor vehicle accident.Slide29
Florida § 627.736
Initial services and care that are lawfully provided, supervised, ordered, or prescribed by a
physician
licensed under chapter 458 or chapter 459, a dentist licensed under chapter 466, or a chiropractic physician licensed under chapter 460 or that are provided in a hospital or in a facility that owns, or is wholly owned by, a hospital. Initial services and care may also be provided by a person or entity licensed under part III of chapter 401 which provides emergency transportation and treatment.Slide30
Florida § 627.736
Followup
services and care consistent with the underlying medical diagnosis rendered which may be provided, supervised, ordered, or prescribed only by a
physician licensed under chapter 458 or chapter 459, a chiropractic physician licensed under chapter 460, a dentist licensed under chapter 466, or, to the extent permitted by applicable law and under the supervision of such physician, osteopathic physician, chiropractic physician, or dentist, by a physician assistant licensed under chapter 458 or chapter 459 or an advanced registered nurse practitioner licensed under chapter 464. Slide31
Florida § 627.736
Followup
services and care may also be provided by the following persons or entities
:A hospital or ambulatory surgical center licensed under chapter 395.An entity wholly owned by one or more physicians licensed under chapter 458 or chapter 459, chiropractic physicians licensed under chapter 460, or dentists licensed under chapter 466 or by such practitioners and the spouse, parent, child, or sibling of such practitioners.An entity that owns or is wholly owned, directly or indirectly, by a hospital or hospitals.A physical therapist licensed under chapter 486, based upon a referral by a provider described in this subparagraph.A health care clinic licensed under part X of chapter 400 which is accredited by an accrediting organization whose standards incorporate comparable regulations required by this state,Slide32
Florida § 627.736
Reimbursement for services and care provided up to
$10,000
if a physician licensed under chapter 458 or chapter 459, a dentist licensed under chapter 466, a physician assistant licensed under chapter 458 or chapter 459, or an advanced registered nurse practitioner licensed under chapter 464 has determined that the injured person had an emergency medical condition.4. Reimbursement for services and care provided is limited to $2,500 if a provider determines that the injured person did not have an emergency medical condition.Slide33
Florida § 627.736
Medical benefits do not include
massage
or acupuncture regardless of the person, entity, or licensee providing massage or acupuncture, and a licensed massage therapist or licensed acupuncturist may not be reimbursed for medical benefits under this section.Slide34
Florida § 627.736
Benefits due from an insurer under ss.
627.730
-627.7405 are primary, except that benefits received under any workers’ compensation law must be credited against the benefitsPersonal injury protection insurance benefits are overdue if not paid within 30 days after the insurer is furnished written notice of the fact of a covered loss and of the amount of sameSlide35
Florida § 627.736
Upon receiving notice of an accident that is potentially covered by personal injury protection benefits, the insurer
must reserve $5,000
of personal injury protection benefits for payment to physicians licensed under chapter 458 or chapter 459 or dentists licensed under chapter 466 who provide emergency services and care, as defined in s. 395.002, or who provide hospital inpatient care. The amount required to be held in reserve may be used only to pay claims from such physicians or dentists until 30 days after the date the insurer receives notice of the accident. After the 30-day period, any amount of the reserve for which the insurer has not received notice of such claims may be used by the insurer to pay other claims. Slide36
Florida § 627.736
Accidental bodily injury sustained by the owner while occupying a motor vehicle, or while not an occupant of a self-propelled vehicle if the injury is caused by physical contact with a motor vehicle.
Accidental bodily injury sustained by a relative of the owner if not an owner of a motor vehicle
Accidental bodily injury sustained by any other person while occupying the owner’s motor vehicle or, if a resident of this state, while not an occupant of a self-propelled vehicle if the injury is caused by physical contact with such motor vehicleSlide37Slide38
Whiplash
Most common injury in MVA – up to 83%
Economic impact with medical care, disability, and sick leave, is estimated at $3.9 billion annually in the US
Including litigation, over $29 billionIncidence in US is estimated at 4 per 1,000 personsSlide39
Whiplash
The most recent literature suggests that whiplash injury may occur as a result of hyperextension of the lower cervical vertebrae in relation to a relative flexion of the upper cervical vertebrae, which produces an S-shape of the cervical spine at the time of impactSlide40
WhiplashSlide41
Whiplash
The diagnosis of whiplash remains clinical
Neck pain or stiffness, arm pain and
paresthesias, temporomandibular dysfunction, headache, visual disturbances, memory and concentration problems, and psychological distress. Slide42
Whiplash
After clearing the neck, you should initially prescribe:
Cervical Collar and immobilization
Physical Therapy and early mobilizationNarcotics for moderate painRadiofrequency ablation of the facetsSlide43
Whiplash
In the chronic phase of whiplash you should consider:
Cervical Collar and immobilization
Spinal FusionNarcotics for moderate painRadiofrequency ablation of the facetsSlide44
Summary
Make sure your intake forms and patient consultation covers whether or not the patient followed up with a primary care physician, hospital, walk-in clinic, or received roadside emergency service. Even if your patient did not go to the hospital via EMS, initial services and care provided by a person or entity who provides emergency transportation and treatment qualifies as establishing treatment within 14 days. See Florida Statute
627.736 (1)(a)1
.If the patient did receive treatment within 14 days, then you will want to know whether or not the patient owned a car. If they did own a car, PIP coverage applies and the claim must be made with your patient’s PIP insurance carrier.If they did not own a car, you will want to know: Does the patient live with a relative (blood or spouse) who owns a car?Slide45
Summary
Limited funds – use wisely
After ABC and clearance, early mobilization.
Referral to Multi-Modal Pain ManagementPhysical TherapySlide46
References
Yadla
S, Ratliff JK,
Harrop JS. Whiplash: diagnosis, treatment, and associated injuries. Curr Rev Musculoskelet Med. 2008;1(1):65–68.Cote PDC, Hogg-Johnson S, et al. Initial patterns of clinical care and recovery from whiplash injuries. Arch Intern Med. 2005;165:2257–63.Grauer JN, Panjabi MM, et al. Whiplash produces an S-shaped curvature of the neck with hyperextension at lower levels. Spine. 1997;22:2489–9.Rodriquez AA, Barr KP, Burns SP. Whiplash: pathophysiology, diagnosis, treatment, and prognosis. Muscle Nerve. 2004;29:768–81.Ronnen HR, Korte PJ, et al. Acute whiplash injury: is there a role for mr imaging?—a prospective study of 100 patients. Radiology. 1996;201(1):93–6.Borchegrevnik GE, Kaasa A, McDonagh D, et al. Acute treatment of whiplash neck sprain injuries. Spine 1998;23:25–31.
Rosenfeld M,
Seferiadis
A,
Carlsson
J,
Gunnarsson
R. Active intervention in patient with whiplash-associated disorder improves long-term prognosis. Spine. 2003;28:2491–8.
Prushansky
T,
Pevzner
E, Gordon C,
Dvir
Z. Cervical radiofrequency neurotomy in patients with chronic whiplash: a study of multiple outcome measures. J
Neurosurg
. 2006;4:365–73.
Dufton
JA, et al. Prognostic factors associated with minimal improvement following acute whiplash-associated disorders. Spine. 2006;20:E759–65.
2016
Florida Statutes §
627.736Slide47
Thank you
Michael Willens, D.O.
mwillens@painawayjax.com
www.painawayjax.com904-683-2596