After 22 years as a personal injury attorney there is one key principle that stands out when it comes to getting what a case is worth:
Identify all injuries and make sure each is properly diagnosed and treated.
"What?", you say, "Isn't that the doctor's job?"
Maybe. But is it the doctor's job to make sure you get maximum recovery on your personal injury case?
In this day of information overload doctors are challenged to stay on top of developments in their field and to perform their specialty competently. An orthopedic surgeon, for example, can be expected to spot a bone break. But is it realistic for him to also know symptoms of "TMJ"?
TEMPOROMANDIBULAR JOINT DISORDER (TMJ)
The temporomandibular joint is one of two joints connecting the lower jaw bone to the temporal bone (think "temples") of the skull. It is a combined hinge and sliding joint. Temporomandibular joint disorder is an abnormal condition with facial pain and poor function of the lower jaw.
I once represented a Chinese client. He came to this country to go to school and decided to stay. While cruising the freeway in his Volkswagen bus one night, he was struck from behind by a large semi-truck.
His injuries were numerous and various. One day, after he had seen many doctors, he was visiting with me in my office discussing his personal injury case. My attention was drawn to an audible "pop" sound which coincided with the opening of his mouth.
TMJ? You better believe it. One of the worst cases I had ever seen (or heard).
Here's a checklist of TMJ symptoms that was provided by a TMJ specialist:
1. Is there pain in or around your ears, jaw, head or neck?
2. Are there any TMJ joint noises such as popping, clicking, or cracking sounds or feelings?
3. Is it painful to eat or difficult to open your mouth?
4. Do you have frequent headaches?
Very minor TMJ ailments can sometimes be treated adequately by a chiropractor but if the disorder continues beyond several chiropractic adjustments a referral should be made to a dentist who specializes in TMJ. The dentist can fit a bracket for the patient which will, hopefully, provide lasting rehabilitation and relief.
HEAD INJURY
Another common malady in personal injury cases (especially after auto accidents) is a closed head injury. A closed head injury occurs when there is trauma (injury) to the brain that does not result in a skull fracture. One type of closed head injury is a "concussion," which is a violent jarring or shaking injury to the brain.
Closed head injuries are actually quite common after car accidents and can occur even though the injured person is not hit on the head.
A rapid acceleration and deceleration of the head can force the brain to move back and forth across the inside of the skull. The stress from the rapid movements pulls apart nerve fibers and causes damage to brain tissue. This type of injury often occurs as a result of motor vehicle crashes and physical violence, such as Shaken Baby Syndrome. (Source: Brain Injury Association of America.)
There at least twelve (12) common symptoms of closed head injury. I obtained a list of these common symptoms from a neuropsychologist. (A "neuropsychologist" is the medical professional who specializes in the diagnosis and treatment of closed head injuries.) The list was developed for a research project: "Behavioural Outcome in Head Injury" by Sureyya Dikmen, Ph.D., Principal Investigator.
Here are the symptoms:
1) headaches;
2) fatigue;
3) dizziness;
4) blurred vision;
5) trouble concentrating;
6) bothered by noise;
7) bothered by light;
8) irritability, lack of patience;
9) loss of temper easily;
10) memory difficulty;
11) anxiety;
12) insomnia.
For head injuries involving injury to the brain the recognized specialist is the neuropsychologist. If the patient shows some of the above symptoms and, especially if these symptoms persist for longer than 18 months, a referral should be made to one of these experts who can perform a battery of tests to accurately assess how the accident has affected the mental abilities of the injured person.
WHERE DO YOU HURT?
In addition to these checklists, one way to spot undiagnosed injuries is to ask yourself: "where am I still in pain?". Let your doctor (or lawyer) know and get a referral to a doctor who is skilled in treating that part of your body.
Here's an example: pain radiating down arms or legs can be a symptom of a disk herniation. Intervertebral disks are soft "pads" that separate the bones of your spine. An accident can rupture the disk's outer covering (annulus fibrosis) causing the inner substance (nucleus pulposus) to push outward. This is called herniation and it can create pressure on surrounding tissues, most importantly the nerves which exit from your spinal cord. This pressure at the spinal level can cause pain all the way into your fingers or toes. Sometimes surgery is required to fix it.
The point here is that if you have the symptoms of a disc herniation you probably need an MRI or CT scan. (Note: symptoms of disc herniation need to be observed by a competent medical professional to determine if one of these tests is needed.) If you have a disk herniation which is properly diagnosed through one of these "imaging studies" your case will increase in value.
More importantly for you, in the long run, something can be done to treat it. If no MRI or CT scan is done then you don't get compensated for the injury and you suffer from it without proper treatment.
