Treatment Guidelines: Does One Size Fit All?

High school science students are taught Sir Isaac Newton’s Laws of Motion. Whether these laws are remembered is another question, yet we know that these mechanical laws described in the late 17th Century apply to all large object motion on Earth.

Even still, Newton’s work often flies out the window — the car window — when it comes to determining the relationship between physical damages to a vehicle in a collision and injuries to the vehicles’ occupants. Why?

People who have been in a routine minor rear-end collision, for example, are not always objective judges of what has happened in an accident. They can’t accurately quantify the mechanics of the accident. They’re not trained to do so.

For that matter, few physicians have been trained to either.

Say a patient arrives in his or her doctor’s office complaining of neck pain. The physician will say, “Let me examine you. Yes, you should have some pain; you’ve strained a muscle somehow.” Such injuries and strains are not as clear-cut as a knife wound or a bullet wound, where the cause of such an injury is a given and there’s no debate over the diagnosis.

While physicians know how to evaluate, diagnose and treat, they may not have the experience and expertise in injury causation analysis, or understand how the laws of physics relate to injuries from auto accidents. In these low-velocity impact environments where people claim that they are hurt when in some cases they are not, physicians are trained to believe them, setting forth unfounded hypotheses that can ultimately influence diagnosis.

Diagnosis Problem

The problem lies in the breakdown between the role of the physician to treat a patient and the injury, and the position of assigning the cause of the injury for an insurance claim. This issue is exacerbated once treatment is pursued as physicians are bound to follow guidelines published by the American Medical Association (AMA). Such guidelines require physicians to assign diagnostic codes to injuries, which are often broad and one-size-fits-all, versus specific to individual injuries.

Unless a physician is trained in the field of human subject testing for tolerance to low acceleration vehicular impacts, he or she may not properly understand mechanics of the collision that could cause a condition such as whiplash.

Assume for a moment a bumper is lightly tapped versus a “big hit” in which the rear of a vehicle is caved in. The acceleration field to which the occupant is exposed is entirely different. The AMA guidelines do not help the physician in this regard; the guidelines ignore the physics and magnitude of the collision.

And the devil is in the details. The physics of accidents and the understanding of how injuries are caused — known as injury science — make a difference in whether an injury a motorist claims is possible under the accident’s circumstances.

Questionable Claims

Many people who have been in accidents allege they have experienced injuries or exaggerate their injuries. These allegations result in the filing of questionable, even fraudulent claims.

The Insurance Research Council reported in 2008 that insurance fraud added up to $6.8 billion in auto injury claim payments in 2007. As a result, policyholders paid more than $100 extra in annual auto insurance premiums; a hidden tax.

If you examine scientific data from low-speed crash tests, the impact of collisions does not typically result in injuries. Injury Sciences conducted a meta-analysis of more than 20 years of crash test research data and found that more than 75 percent of tests conducted did not result in injury.

When you consider just how far-reaching the impact of misdiagnosed injuries and fraudulent injury claims extend, it’s not surprising that the insurance industry is increasing its use of predictive analysis to help improve fraud referrals and allow “right tracking” of claims assignments.

Predictive analytics help to identify questionable claims by combining scientific data from physical damage to vehicles with data from low-speed crash tests.

Automated analytics are available to predict or determine acceleration and deceleration of vehicles in accidents to calculate the injury potential, as well as to help identify questionable claims. These advancements give adjusters access to actionable information to use when handling claims and to support decision-making — a welcome relief for many, including consumers paying the hidden tax.