Insurers are ignoring objective medical technology tools that prove spinal ligament injuries to avoid paying claims


CNN's Anderson-Cooper 360 television program exposed the insurance industry’s hardball campaign that began in the mid-1990's to “Delay - Deny - Defend” all motor vehicle collision claims involving connective tissue injuries of the neck and back. Fortunately civil justice attorneys now have scientific medical tools to overcome such abusive insurance defense tactics by providing objective evidence to support fair jury verdicts for injury victims.

What are the objective medical techology tools?

Digital Motion X-ray (DMX) and computerized radiographic mensuration analysis (CRMA or x-ray digitization) are scientific tools developed to aid in the diagnosis and treatment of connective tissue injuries (ligament, tendon, muscle and disc).

How do doctors use these objective tools?


Treating physicians should consider referring patients for objective testing when  the physician suspects spinal instability as part of the physician’s  differential diagnosis process. This may occur immediately after an injury or 6-8 weeks following the injury, which is the amount of time it takes a strain or sprain of the spine to resolve.

The best type of proof is objectively demonstrated by DMX, plain film x-rays, digitized x-ray analysis, MRI, CT, EMG, SEMG, NCV, myelography, discography and other objective medical tests (however, all tests are not created equal — certain tests are better for certain injuries than others). Additional objective evidence is provided by the treating physician’s  clinical examination that should include standard orthopedic and neurological tests, and palpatory clinical findings. The treating physician must then correlate the patient’s history, pain  complaints and  physical examination with the objective test results. Specialized training in identifying functional (as opposed to surgical) impairment and treatment of the spine is commonly associated with neurologists, chiropractic physicians, osteopathic physicians, and physical therapists.

The victim’s treating physician should also explain why future treatment is needed to manage recurring biomechanical spinal dysfunction. The goal of continuing treatment is to keep mobility restored in permanently damaged joints, which helps control chronic pain and minimize flareups and aggravations. Regular treatment also helps to minimize advanced disc degeneration. Periodic tests, including x-ray and MRI, will be needed to monitor the progression of any permanent injuries so the treating physician will know when to refer the patient to a specialist for further treatment.

How is the nature and extent of the injury measured?


The American Medical Association publishes a book telling how to measure all kinds of injury. It's called Guidelines to the Evaluation of Permanent Impairment. Part of the book provides objective ways to measure normal and abnormal motion caused by spinal instability, and it includes Tables assigning a ratable permanent impairment. Arkansas law requires that Courts follow the AMA Guides in workers compensation cases, and they are generally followed in all types of injury cases.

The AMA Guides defines a motion segment of the spine as two adjacent vertebrae, the intervertebral disc, the apophyseal or facet joints, and ligamentous structures between the vertebrae. Permanent impairment to the spine is based upon spinal instability as established by a slippage or translation of one vertebra in relation to another vertebra shown by flexion and extension x-rays. For example, translational movement of 3.5 millimeters between cervical vertebrae, or 11 degrees of angular motion between cervical vertebrae, establishes a “whole person” impairment rating of 25 - 28 percent.


Through the use of x-ray digitization computer software, either plain film x-ray flexion and extension views, or the same static views saved from a DMX study, can be precisely measured and correlated to such AMA Guides impairment ratings. Such x-ray digitization software also provides reference to “Lines of Mensuration” methods used to analyze x-rays that establish other normal and abnormal objective values for the patient’s x-ray analysis. Abnormal findings provide additional objective evidence of permanent ligamentous injuries. The National Guidelines Clearing House gave an “established” rating to x-ray digitizing in 2003, and it is also supported by numerous professional organizations, peer reviewed articles and texts.

DMX and x-ray digitization are important tools to help achieve justice for injury victims by providing objective medical evidence of spinal instability caused by permanent ligamentous injuries. Their use also promotes better patient care and patient safety by providing an accurate diagnosis of the patient’s spinal instability, and which helps the treating physician develop a proper treatment plan for each patient. The use of these medical technology tools to achieve courtroom justice for injury victims should eventually lead the insurance industry to abandon its hardball blanket denial of connective tissue injury claims, and to embrace these tools that clearly show which injury claims are meritorious and should be paid, and which claims should be “Delayed - Denied - and Defended.”

How are insurers ignoring this objective evidence?

 In a word, the insurance companies "disregard" this objective medical evidence. In at least one Arkansas case, an insurance company's decision to consciously disregard objective evidence was considered 'bad faith.'

In many instances, insurance companies will hire a doctor to perform a medical examination or review the injury victim's records. In practice, a few doctors in our state have made millions of dollars representing the insurance industry. Their reports always say the person isn't hurt as bad as he or she says she is — or the person is faking — or the person is motivated by greed. But the insurance companies don't ask these doctors to do a digitized x-ray report, because those reports objectively show injuries.