California Whiplash and Personal Injury with Dr. Lloyd

In my practice, I see a lot of patients who have severe psychological disturbances as a result of their car crash. Sometimes this turns chronic, and it seems to make the neck pain even worse.

This excerpt from Whiplash, Headache, and Neck Pain examines the complex interplay between psychological and physical factors in neck pain, particularly whiplash. The authors explore the relationship between pain, disability, and psychological distress, including anxiety, depression, and post-traumatic stress. Studies investigating the predictive value of psychological factors in transitioning from acute to chronic neck pain are reviewed, highlighting the importance of considering both physical and psychological impairments in assessment and treatment. The text emphasizes the need for a biopsychosocial approach, advocating for multi-professional care in complex cases where physical and psychological factors are intertwined. Finally, the authors discuss the implications for clinical assessment and management of neck pain, recommending a comprehensive approach to ensure appropriate care.

This excerpt, from a physical therapy textbook, discusses the relationship between neck pain and dizziness. The authors argue that neck pain, especially after whiplash injury, can cause dizziness due to disruptions in the neck's sensory receptors, which provide the brain with information about head position and movement. The authors explain how these disruptions in sensory input can impact postural stability, eye movement control, and overall sense of balance. The text explores various causes of dizziness, including vertebral artery insufficiency and vestibular disorders, and provides diagnostic tools for differentiating between these conditions and cervical vertigo. The authors also discuss potential treatment strategies for addressing dizziness and sensorimotor disturbances associated with neck pain.

This research excerpt explores the complex relationship between the cervical spine, sensorimotor control, and neck pain. The authors examine how disturbances in cervical somatosensory input, which originates from sensory receptors in the neck muscles and joints, can lead to impairments in balance, eye movement control, and overall postural stability. The text investigates the morphology and central connections of these receptors, as well as their role in various reflex pathways that influence head orientation, eye movement, and posture. It also analyzes how pain, trauma, and muscle dysfunction can affect cervical somatosensory input and ultimately contribute to sensorimotor control disturbances. The authors conclude that these disruptions in somatosensory information play a crucial role in the development of neck pain and associated symptoms.

Physical testing in patients with acute whiplash-associated disorder

The majority of physical tests achieved good or excellent test-retest intra-rater reliability when tested

in patients with acute WAD. Findings must be considered with caution for those tests which demonstrated

systematic bias. Additional research is warranted to evaluate inter-rater reliability.

This episode remixes Chapter 4 of Jull's book on whiplash injuries and neck pain. "Whiplash, Headache, and Neck Pain."

This podcast examines the effects of neck pain on cervical muscle function. It describes how neck pain alters muscle activation, coordination, and strength, leading to various neuromuscular adaptations. The article explores the mechanisms behind these changes, including pain's direct impact on motor neuron output and the role of sensory input. Furthermore, it analyzes the relationship between motor control alterations and peripheral muscle property modifications, such as fatty infiltration and muscle fiber transformation. Ultimately, the episode emphasizes the importance of selective and specific therapeutic exercises in rehabilitating individuals with neck pain, targeting both central and peripheral adaptations to promote muscle function recovery.

Overview of Pebley v. Santa Clara Organics, LLC

This case concerns the admissibility of evidence regarding medical expenses when an insured plaintiff seeks treatment outside of their insurance plan.

In Pebley, the plaintiff (Pebley) opted to receive medical treatment from providers outside of his health insurance plan after he was injured in an accident caused by the defendants. The defendants argued that Pebley should have been limited to recovering the amount his insurance company would have paid had he treated within his insurance plan. The trial court disagreed and allowed evidence of Pebley's full medical bills, including the unpaid bills of providers who treated him on a lien basis.

The California Court of Appeal for the Second District upheld the trial court’s ruling. The court held that an insured plaintiff who receives medical treatment outside of their insurance plan should be treated as uninsured for the purpose of determining economic damages. The court reasoned that because Pebley was personally liable for the cost of his medical care, he was entitled to present evidence of his full medical bills as proof of the amount incurred and the reasonable value of his medical expenses. The court further determined that evidence of Pebley’s insurance was irrelevant and inadmissible because it could confuse or mislead the jury.

The court in Pebley distinguished prior case law, like Howell v. Hamilton Meats & Provisions, Inc., that limited the admissibility of medical bills in cases involving insured plaintiffs. Howell held that an insured plaintiff can only recover the amount paid by their insurer for medical services and not the full amount billed, which is often higher. Pebley distinguished itself from Howell by reasoning that Pebley was personally liable for his medical bills, and his situation was analogous to that of an uninsured plaintiff.

This case is important because it clarifies the rules regarding medical damages for insured plaintiffs who choose to treat outside of their health insurance plans. The court’s holding allows those plaintiffs to introduce evidence of their full medical bills to prove their damages, placing them in the same position as uninsured plaintiffs.

This is based on Chinese Journal of Traumatology 2009; 12(5):305-314 , Biomechanics of whiplash injury

Despite a large number of rear-end collisions on the

road and a high frequency of whiplash injuries reported, the

mechanism of whiplash injuries is not completely

understood. One of the reasons is that the injury is not

necessarily accompanied by obvious tissue damage detect-

able by X-ray or MRI. An extensive series of biomechanics

studies, including injury epidemiology, neck kinematics,

facet capsule ligament mechanics, injury mechanisms and

injury criteria, were undertaken to help elucidate these whip-

lash injury mechanisms and gain a better understanding of

cervical facet pain. These studies provide the following

evidences to help explain the mechanisms of the whiplash

injury.

This material describes legal and ethical considerations for attorneys regarding medical liens in personal injury cases in California.

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Attorneys have ethical and legal obligations to protect the interests of third parties, including medical lienholders, when they hold funds for the benefit of a client.

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Rule 1.15 of the California Rules of Professional Conduct outlines the ethical duties of attorneys regarding safekeeping client funds and property. This includes funds held for third parties to whom the attorney owes a contractual, statutory, or other legal duty.

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An attorney's legal obligations can arise from both express liens, created by contract, and equitable liens, which arise from principles of fairness.

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Case law in California provides guidance on equitable liens, with some cases finding that an attorney can be held liable for disbursing funds without satisfying a medical lien, even if the attorney was not a party to the lien agreement.

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The seminal case Zerin v. Farmers Insurance Exchange emphasizes that a mere promise to pay from a specific fund is insufficient to create an equitable lien. Equitable considerations, like detrimental reliance or unjust enrichment, are also necessary.

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When an attorney signs a lien agreement with a medical provider, they are contractually obligated to protect the lienholder’s interest. If a conflict arises between the client and the lienholder, the attorney should consider interpleading the funds.

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If only the client signs a lien agreement, whether the attorney has a legal or ethical duty to protect the medical lienholder’s interest is a fact-specific inquiry. Factors to consider include the relationship between the attorney and the provider, any promises made by the attorney, and whether the provider forwent other remedies in reliance on the attorney's representation.

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Attorneys should advise their clients about the implications of treating on a lien. This includes explaining the potential impact on medical damages, particularly in light of cases like Howell and Pebley, which address the limits on recoverable medical expenses.

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Attorneys should also caution clients against treating on a lien when the provider accepts their health insurance, as this could undermine arguments for seeking treatment outside of the insurance plan.

This material also provides an overview of various types of liens that attorneys may encounter, including contractual liens, statutory liens like those arising from Medi-Cal or Medicare, and equitable liens.

The case McCafferty v. Gilbank illustrates how an attorney can be held liable for conversion if they disburse settlement funds without honoring a valid equitable lien. The attorney in this case was found to have wrongfully exerted dominion over the plaintiff's share of the settlement proceeds, which were subject to an agreement that created an equitable lien.

Sometimes pain becomes worse because there is a third party involved that may or may not bring compensation to a patient.

Although there is debate regarding whether any single posture is

ideal, healthy sitting posture is often argued to involve maintenance of

physiological spine curves (Szczygiel et al., 2017), characterized by

head position with the eyes aligned horizontally, cervical lordosis,

thoracic kyphosis and lumbar lordosis with smooth transitions between

them, and an alignment with respect to gravity that places the C7 over

the sacrum such that there is limited net moment in any direction.