February 21, 2006

ABC INSURANCE COMPANY
Suite 0
ANYTOWN, USA
Attn: Jane Adjuster

CLAIMANT: Ms. Claimant
INSURED : Myra Jones
CLAIM # : 00049
D.O.I. : 08/26/05
ERI # : RDD040586

Dear Ms. Adjuster:

I have reviewed records forwarded regarding Ms. Claimant. Presented at this time is accident reconstruction report; Personal Injury Protection Form dated 8/29/05; notes from Acme Hospital where this patient was seen approximately twenty-three hours post-accident; office notes, billing records and initial examination report from the Rehabilitation, the office of Dr. Quaky, where this patient underwent 32 chiropractic dates of service from 8/30 to 12/23/05.

Also reviewed at this time are notes relative to two other individuals, ages 36 and 30, who received 31 and 34 chiropractic dates of service at this facility. Please refer to those reports for additional information.

According to the chiropractic narrative, this individual, reported to be a 19 year-old female, was the restrained right rear-seat passenger of a 1995 Buick Regal that was rear-ended by a Ford pick-up truck. No other data is presented relative to the mechanism of injury or the extent of mechanism of injury in the chiropractic records. The accident reconstruction report describes the striking vehicle as a 2001 Ford F150. The conclusion of the report reads as follows: The condition of these vehicles supports the low speed contact scenario reported and is consistent with a contact speed differential approximately 5 to 7 miles per hour, which had little capability of causing occupant disruption. Consequently, claims from the occupants of the 1995 Buick Regal that they were injured by force of the collision on 8/26/05 are not supported by the condition of the vehicles or by the results of well documented studies on low speed impacts with human volunteers that the human body can easily withstand a change of velocity of 5 to 8 miles per hour, probably much more, without sustaining injury.

There was no head trauma or loss of consciousness. Presumably she was ambulatory at the scene and apparently did not receive any emergency assistance at or from the scene.

The next day at approximately 7:00 p.m., all three individuals whose records are reviewed presented to Acme Hospital. There this individual complained of pain graded a 9/10 in severity described as generalized body aches into the neck, shoulders and arms. There was some tenderness in the trapezius musculature bilaterally. She received a diagnosis of multiple strains. She was also advised to follow-up regarding her irregular or infrequent menses (unrelated to accident).

On 8/30/05, all three individuals whose records are reviewed presented to the Rehabilitation. There, this individual complained of headaches accompanied by nausea and dizziness graded a 7/10 in severity, constant neck pain radiating into the left arm as far as the elbow graded a 10/10 in severity, low back pain graded a 9/10 in severity, mid back pain graded a 10/10 in severity radiating anteriorly to the chest near the fourth and fifth ribs. Page two of the initial examination report is not presented.

According to the billing record, she received a diagnosis of cervicocranial syndrome, pain in the thoracic spine, pain in the low back, and cervical subluxation. Records indicate that she underwent 32 dates of service through 12/23/05.

PRIOR HISTORY: There is no report of previous neck pain, back pain, motor vehicle accidents or chiropractic treatment.

OCCUPATIONAL HISTORY: The chiropractic report indicates that she is employed at Ann's Secret as a retail clerk. The Personal Injury Protection Form indicates that she missed no wages or salary.

DIAGNOSIS: Motor vehicle accident.

CAUSALITY: I am not able to establish that the presentation of this individual on 8/30/05 is reasonably relatable to the motor vehicle accident of 8/26/05. The presentation of 8/30/05 is accompanied by reports of severe headache with dizziness, nausea, as well as the worst pain imaginable in the neck and mid back, as well as nearly the worst pain imaginable in the lower back, in this 19 year-old individual following what appears to be a very low speed accident. Furthermore, the odds that even one individual would have such a presentation three days following this accident are exceptionally remote. The odds that three individuals would have these types of presentations and subsequently be determined to require 30 or more chiropractic dates of service are so outside the realm of probability that it is difficult to take these records seriously.

In my opinion, a concurrent review of all three sets of records presented suggest an exceptionally high probability of magnification or simulation of complaints and/or fabrication of findings and/or presentation related to some other phenomenon other than the motor vehicle accident of 8/26/05.

DISCUSSION: An end result has been reached. In my opinion, the presentation of 8/30/05 and the subsequent treatments cannot be related to this motor vehicle accident given the data reviewed.

Therefore, none of the treatments or evaluations can be considered reasonable, necessary or relatable at the present time.

If you have any additional questions please feel free to contact me.

I certify that I am a licensed chiropractic physician in the Commonwealth of Massachusetts and have reached the above conclusion to a reasonable degree of medical certainty.

Subscribed and sworn this ____ day of ______ in the year _____ under the pains and penalty of perjury.


Sincerely,


SAMPLE
_________________________
Chiropractic Reviewer, D.C.