What is “normal” medical treatment for my car crash injury?

I am not a doctor, and I cannot offer medical advice. But a common issue I see in cases over and over again is my clients having a hard time navigating the medical system to access the care they need to address their injuries. So I thought it would be helpful to write a guide explaining what the different options are for post-traumatic spine issues, and how you can advocate for yourself to access the care you may need.

After you’re in a car crash, sometimes your doctor’s office is not very helpful in coordinating your care. In most places, the medical system is not designed in a user friendly way. Many times doctors of one kind of medicine are not able to provide more than a simple referral to another specialty, and expect you to advocate for yourself, fight with your insurance company, and schedule everything you may need. This happens over multiple locations over a months-long period.

In many cases, treatment starts at the emergency room. Many people report to the emergency room because they experience a sudden onset of symptoms that are usually worse than the normal aches and pains they may experience in daily life. Sometimes the symptoms are way worse. It is important to understand that emergency rooms are meant to stabilize injured people, and not cure conditions. They usually just aim to keep you stable long enough to see your regular doctor. So they typically are not as thorough as your regular doctor or a specialist, and likely will offer only very narrow care. On the other hand, some people may not go to the emergency room at all. I have many clients whose pain set in over a time period of a few days or even a few weeks. At that point they don’t often report because its not an emergency, just another part of daily life.

After a potential emergency room trip, people take many different paths. Some go directly to a non-medical doctor like a chiropractor or acupuncturist; others go to their primary care physician. A chiropractor is a type of medical professional who will make adjustments to your spine and surrounding structures to promote healing. An acupuncturist is someone who applies special needles to block energy stagnation in the body to help the body heal itself. A primary care physician is unlikely to directly deliver care, but instead may prescribe some medication and refer you out to another medical professional.

Typically (though not always), a medical doctor will refer you out to a physical therapist. Physical therapy is a separate style of healing from chiropractic and acupuncture, but with the same goal in mind: to aide the body in healing itself. Physical therapy is a guided set of exercises meant to strengthen the body’s supporting structures so that additional injury is avoided as the body heals.

In the event that chiropractic, acupuncture, or physical therapy don’t fix your symptoms, most providers will send you out for advanced imaging. This is usually an MRI. An MRI is a device that can give a medical professional a scan of soft tissue, usually in the spine, to identify a potential cause for the ongoing pain symptoms. Some insurance companies require you to get an X-Ray beforehand. An X-Ray can only see bone, which is usually not the problem in a car crash situation.

That MRI may show a structural issue causing pain – usually the tissue from the spine being deformed and pressing against the spine. Even if that is the case, sometimes treatment of chiropractic care, acupuncture, or physical therapy can resolve the symptoms so nothing further needs to be done. However, if those treatments don’t work, a responsible medical provider will refer you out to a specialist, usually a doctor who is either a neurosurgeon, orthopedic spine surgeon, or physical medicine and rehabilitation doctor. They will perform a physical exam, look at the diagnostic imaging on their own, and review your medical records. They may recommend additional treatment, like a steroid injections. The steroid injection is actually a combination of an anesthetic and an anti-inflammatory medication which will hopefully reduce swelling in the area, which should relieve pressure on your nerve. Sometimes the anesthetic alone can help alleviate symptoms.

A specialist may repeat this procedure a number of times, as sometimes it takes a few rounds before the procedure is fully effective. If the injections failure to provide relief, or provide incomplete relief, a doctor may also consider a rhizotomy. In this procedure, a doctor uses a needle to burn the nerve fibers sending pain signals to your brain. This procedure may also be repeated.

If all these treatments do not resolve your symptoms, the doctor will likely conclude that “conservative measures” have failed. They may consider surgery. This isn’t a guarantee, even if all the conservative treatments fail, but oftentimes if a surgeon can identify a specific part of the tissue in the spine that is impacting the nerve, they may recommend removing that tissue surgically to relieve the pressure, and therefore improve your symptoms. This is, of course, a huge simplification of all the options for surgery, but the bottom line is if all prior treatment fails, a surgeon may consider operating. For the purposes of your legal case, even if you opt not to have surgery, having a surgical recommendation dramatically changes the way an insurance company will view the value of your case.

As you may be able to tell, there are a lot of steps and options through this process. Unfortunately, depending on the facility and clinic, there may be no one available to help you move from one step to the next. You may encounter issues with your insurer. You may not have health insurance at all.  No one may tell you there are additional options after a particular course of action fails. This can happen where, for example, you see a physical medicine specialist who cannot perform surgery. Or if you have a very conservative surgeon who rarely recommends operating.

As with all medicine, it is good to advocate for yourself and get multiple opinions on the same issue. And it is also very important to work with an experienced attorney in this area, who has seen this process play out over and over again, knows the best clinics to refer to, can help get you to the right doctors to avoid your case getting stuck, and can work with insurers to provide coverage to this treatment.

Anthony Marsh is a Principal Attorney at Herrmann Law Group specializing in mass torts, wrongful death, and insurance bad faith.