Author: Richard H. Adler

All too often IME and ICE examiners abuse their role as independent examiners when offering opinions that cervical sprain/strain injuries require no more than 4 to 12 weeks of treatment. These statements, embedded in the IME/ICE report, are not supported by any citation to medical literature, but are couched as the insurance examiner’s opinion. These opinions, not well founded on medical studies, are then relied upon by insurers to deny treatment bills for those with traumatic injury.

When challenging and confronting these type of opinions from IME/ICE examiners, it is important and effective to rely upon medical studies in your response, including:

1. Using accepted measurement outcomes, whiplash injuries recover over a period of two months to two years and one month with an average time of maximum improvement at seven months one week. Schofferman, Successful Treatment of Low Back Pain and Neck Pain After Motor Vehicle Accident Despite Litigation. Spine, 1994.
2. Medical review articles document that 25% of those injured in whiplash mechanisms of trauma develop chronic pain that may take two years to reach maximum medical improvement. Bransley, Lord, Bogduk, Whiplash Injury-Clinical Review. Pain, 1994.
3. Long term studies on whiplash patients document that a single whiplash injury will accelerate the degeneration of the cervical spine joints by ten years as compared to controlled populations. Gargan and Bannister, The Comparative Effects of Whiplash Injuries. Journal of Orthopedic Medicine, 1997
4. Epidemiological studies show that whiplash-injured patients are three time more likely to suffer from chronic neck-shoulder pain at seven years as compared to controlled subjects. Burglund, et al. The Association Between Exposure to Rear-End Collision and Future Neck or Shoulder Pain: A Cohort Study. Journal of Clinical Epidemiology, 2000
5. A current prospective study on whiplash injured patients indicate that whiplash injury recovery is so variable between individuals that clinical outcome can not be established until two years after an injury. Tomlinson, Gargan and Bannister. The Fluctuation in Recovery Following Whiplash Injury, 7.5-year Prospective Study. Injury, June 2005.
6. The studies on whiplash prognosis, published in the most prestigious spinal orthopedic journal in the world, indicates that between 30-49% of whiplash injured patients will have chronic pain at six months after whiplash trauma. Brison, et.al., Randomized Controlled Trail of An Educational Intervention to Prevent the Chronic Pain of Whiplash Associated Disorders Following Rear-End Motor Vehicle Collisions. Spine, August 15, 2005

Given the predictably hostile and adversarial environment of the IME process and ultimate report, it is important to note that the patient’s doctor and attorney form the first line of defense between the injured person, their debilitating physical injury, and financial loss and the cost containment practices of the insurance companies. The medical/legal connection is natural and necessary today more than ever. The interests of the patient are best served when the healthcare and legal communities work together in the best interests of the injured person. This is the only way to make insurance companies take seriously their duty to "Act in good faith, abstain from deception and practice honesty and equity".

While every patient may not ultimately need to hire an experienced personal injury attorney following a traumatic injury, every patient needs and will benefit from a legal consultation with one before an IME/ICE takes place. This is critical.

It is our honor and privilege at Adler Giersch PS to provide knowledgeable, compassionate, highly rated representation to your traumatically injured patients through our offices in Seattle, Bellevue, Everett and Kent.