Causation and Damages: The Battleground of PI Cases
Most chiropractors in personal-injury practice treat injuries and support patient recovery. What many do not anticipate is that their documentation will be reviewed not only by other healthcare providers, but also by insurance carriers, defense attorneys and, in some cases, the courts.
In every personal-injury case, the plaintiff’s attorney must establish duty, breach of that duty, causation, and damages. While all elements are required, causation and damages are often the most heavily disputed.
As cases move into litigation, chiropractors may receive subpoenas for deposition by written questions, requests for affidavits for medical records and billing, and subpoenas for oral depositions. In each of these settings, the documentation created during treatment becomes the foundation of the case and will be scrutinized by both sides, either to establish a strong claim or to identify and highlight weaknesses.
Mechanism of Injury Matters
Chiropractors must learn to clearly articulate that the patient’s symptoms are caused by the motor-vehicle collision. Merely stating in the chart that the patient was involved in a collision and presented the next day with neck or back pain is not sufficient. The documentation must reflect that the patient was involved in a motor-vehicle collision and that, because of that collision, the patient is now experiencing specific symptoms, supported by objective findings.
While neck and back complaints following a motor-vehicle collision may be more commonly understood due to typical whiplash-type injury patterns, extremity injuries require more detailed explanation. It is important to ask specific questions at intake, such as whether the patient’s knee struck the dashboard, how their hands were positioned on the steering wheel, or whether there was a bracing or jerking motion that could explain the injury.
When a patient cannot recall the exact mechanism, the chart should reflect that the patient had no prior symptoms and that the condition began following the collision. The record must clearly connect the injury to the incident within a reasonable degree of medical probability. Without this connection, providers risk having their opinions challenged or excluded in legal proceedings.
Functional Loss and Limitations Tell the Story
Good documentation includes not only pain assessment but also clear evidence of functional loss. This includes limitations in activities of daily living such as cooking, cleaning, personal hygiene, sleep, work capacity, and even social or recreational activities when affected. These factors directly relate to quality of life and are essential in personal-injury cases.
Functional limitations can also be used to counter common defense strategies. For example, if a defense argues that treatment is not working, documentation showing that a patient was initially able to sleep only two hours and later improved to four hours demonstrates measurable progress.
Similarly, if a defense claims excessive treatment, documentation showing that a patient has not yet returned to their pre-collision functional level supports the need for continued care. For instance, a patient who previously lifted 80 pounds but is now limited to 20 or 40 pounds has not returned to baseline and may require further treatment.
In cases involving pre-existing conditions, documentation becomes even more important. Even if a patient had prior symptoms, the provider should clearly document how the motor-vehicle collision exacerbated that condition. Asking the patient how their symptoms have worsened since the collision and documenting the change helps establish that the current condition is not simply pre-existing, but has been aggravated by the incident.
Staying Within Scope Under Legal Pressure
Chiropractors in personal-injury practice may be asked questions that extend beyond their scope of practice, particularly during depositions. These may include questions about surgical recommendations or detailed medical procedures.
It is important that documentation reflects appropriate boundaries. Chiropractors may document that a patient was referred for a medical consultation when appropriate, but should avoid charting specific medical procedures such as recommending injections, epidural steroid injections or surgical interventions. Those recommendations fall within the scope of a medical doctor and should be documented by the appropriate provider.
During deposition, if asked whether a patient requires surgery, a chiropractor can explain that conservative care was attempted and that the patient was referred to a medical doctor who made further recommendations. The chiropractor may corroborate the treating physician’s findings, but should not independently provide opinions outside their scope of practice.
Red Flag: Avoid Attorney-Driven Documentation
One of the most serious risks in personal-injury documentation is the appearance of attorney-driven care. This not only affects the credibility of the case but also may also expose the provider to issues with insurance carriers and regulatory boards.
Language such as “attorney approved the patient’s MRI” or “attorney approved the patient’s injection procedure” should never appear in the chart. Medical decision-making must remain independent, even if communication with attorneys occurs for administrative or financial purposes.
Providers should also be aware that internal notes may be discoverable. References to policy limits, case value, or indications of financial motivation can be used to argue bias and may significantly harm both the case and the provider’s professional standing. Documentation must consistently reflect unbiased clinical judgment.
Documentation: The Foundation of Evidence
The chart created during treatment may ultimately become testimony. In personal-injury practice, causation and damages define the case, and documentation must support both. At the intersection of healthcare and law, documentation is not just a routine task. It is the foundation of evidence.
Editor’s Note: The author extends her appreciation to Adam Ramji and Ryan Berchelmann of Ramji Law Group, whose practice heavily involves chiropractic cases in personal-injury litigation; as well as Will Morrey, who previously represented insurance companies as a defense attorney and now practices on the plaintiff side. Their insights helped inform the practical considerations discussed in this article.
