Most chiropractors who have dealt with minor impact soft tissue cases (MIST) as a result of a motor vehicle collision know that there is a definitive bias against these claims from auto insurance payers.  Put simply, the payers operate with the erroneous belief that amount of vehicle damage is somehow proportionate to the amount of injuries that can be sustained. While experts like Art Croft,DC or  Dan Murphy,DC and many others can point out enough research to choke a cat that disproves the auto insurance attitude towards MIST cases, I’d like to go another route to help you in handling these cases for your chiropractic patients.

Understanding the Payer Perspective

The first step in winning this battle is to truly understand the payer’s perspective.  In a nutshell, it’s less about the injury and more about the income – theirs, to be specific.  From the outset, low impact personal injury cases are immediately identified via the payer’s claims processing software (such as Colossus) and promptly shipped over to the special investigations unit for review where the claims adjuster will immediately gear up an aggressive campaign against the patient’s claim.

Be forewarned that your patient may receive misleading and mildly threatening letters like this one:

I am the examiner responsible for the handling of this claim. Our investigation indicates that your claim arises from an accident in which their vehicle sustained $719.23 in property damage. The property damage included damage to the rear bumper. The repair estimate indicates that there was no structural damage to the vehicle. As such, it is difficult to relate injuries to this low impact collision.

 After review of the physical evidence in this matter, we do not believe that you sustained the injuries described and that these injuries are directly related to this claim.
Based upon the information obtained to date, we maintain our denial of your injury claim. If you have evidence that supports the causal relationship between this impact and your injury claim, we are willing to review any new information to reassess our position. We maintain the right to reconsider our current position if new information becomes available.


After reviewing such a letter, your patient is likely to either refrain from seeking treatment, drop out of care or immediately opt for a small settlement offer which may be immediately offered.

Since the Department of Transportation estimates that greater than 80% of all vehicle collisions occur at less than 20 miles per hour, there’s a lot of money at stake for the payers if they were obligated to pay for every injury sustained in a crash. As a result, the adjusters are trained to get these claims closed fast before the payer’s profits are compromised. (See here for a lovely example of 10 step plan for claims adjusters to fight your MIST cases.)

Winning the War Against MIST Cases

Some chiropractors and attorneys shy away from the MIST claims because they are notoriously difficult to navigate.  But, in addition to the wealth of research on your side, proper procedures for handling these claims can enable you to win the war.  Here are a few essential steps you need to take:

1.     Empower Your Patient to Understand Their Injuries – letters like the one above are designed to scare your patient into self-doubt or submission to the payer’s agenda.They even make low impact injuries appear impossible, when in fact, research shows just the opposite. Your job as their treating physician is to educate them to the nature of their injuries and towards their resolution.  In this, you can share some simple research regarding injury biomechanics and some simple examples of how it is possible to sustain an injury even in a low impact collision.  Here are a few important facts to share, backed by research and expert opinions who do not have a financial conflict of interest like the payers do:

·       As far back as 1964, Ruth Jackson MD noted in the American Journal of Orthopedics that “the damage to the vehicle involved in the collisions is no indication of the extent of injuries imposed on the passenger.

·       In 1982, Ian Macnab MD came to similar conclusions stating that the amount of damage to the car bears little relationship to the damage of the spine and noted that there were multiple factors at work that determine the extent of an injury.

·       In 1990, Emori & Horiguchi went even further noting that whiplash injuries can occur at speeds as slow as 2.5 km/hour (=1.55mph)!

·       In 2006, Rene Calliet MD reinforced previous research and even emphasized that low impact injuries are remarkably common by stating that “in many instances, a person experiences whiplash after a vehicle accident that has sustained little significant damage to either vehicle.

·       There are many more such studies disproving the MIST myth of “no damage, no injury” that you could and should share with your patients!

2.     Arm Your Patient to Do Battle – once you have explained the injuries to the patient, you must prepare them for the battle they may face with the auto injury payers.  Here, you need to make them aware of any scare tactics that may be used and educate your patient on how a personal injury claim works and explain the financial conflict of interest regarding how auto insurance works so they understand their rights and the process.

3.     Forecast the Future – the final step with your patient is to forecast the future for them.  By this, I simply mean to warn them about what might happen and the fact that they may need an attorney to help them handle their case.

4.     Lead them to the Lawyers – if it becomes apparent that the aggressive stance taken by the auto injury insurance will need an attorney to represent your patient, then you must recommend a few good attorneys who are not afraid to litigate or handle MIST cases. It would be nice to think that you can convince a payer of their error or of the reality of your patient’s injuries. Unfortunately, this will typically result in a lot of wasted time. You are the expert with the experience here, so don’t be afraid to take the lead and let your patient know that a lawyer will be required. Most patients persist with the belief that their insurance is fair and everything will be ok.  You have handled enough MIST cases to know how things work and that the fair handling of their claim is immediately in jeopardy based on the fact that it was the result of a minor impact collision.

5.     Work With The Best – in MIST cases, any attorney will not do.  You need attorneys who are not afraid to litigate and ones who have experience representing patients with these claims. Unfortunately, MIST claims are not high dollar cases, but a skilled attorney can still help you with a successful resolution that protects your patients, gets you paid and ensures that they are compensated for their assistance as well.  Unskilled attorneys shy away from these claims or botch them entirely; so be sure to work only with the best here.

6.     Protect Your Own Assets – in all of this, don’t forget to protect the work that you are doing.  It’s essential to have proper procedures in place to make sure that the paperwork for your chiropractic personal injury cases is all handled promptly and properly – but especially so in MIST cases.  “Back office” systems that smoothly route your PI claims through your procedures will save you lots of time and trouble in preventing these cases from going sour and from yourself from going unpaid. At a minimum, you should have well-defined procedures regarding how these claims are handled from a lien perspective, attorney involvement and, of course, your financial terms and agreements.

Final Tips

In the end, the biggest asset in your court (and the patient’s) is awareness and education.  If you understand these injuries, can help your patient understand them and work with attorneys who understand how to handle these claims, you will come out ahead.  As with much in the chiropractic personal injury arena, mistakes are too costly to remain ignorant!

Here, knowledge truly is power and can go a long way towards a successful resolution of your patients injuries.

Want more knowledge AND power?  Check out our upcoming Chiropractic Personal Injury POWER Seminars coming to Seattle and Portland where you’ll learn how to rapidly improve your MVA coding, documentation, case management, billing & business strategies for a bigger, better, more profitable PI practice!