Personal Injury, Automobile Accident and Medical Legal Issues

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Welcome to a very special page devoted to personal injury and medical legal issues. The insights you will gain are based on real world experience: Dr. Immerman's 78 trials, 20 arbitrations, 50 depositions, and 700 case reviews since 1997. Learn the key facts needed to win your cases without the unnecessary fluff, all by becoming an ACS member. 

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Table of Contents

NEW: Directory to the Complete ACS Arizona Personal Injury Package

NEW: The Standard for Measuring Crush Damage From Vehicle Photographs

  1. Introduction to This Page
  2. Dr. Immerman has retired from Expert Witness ServicesExpert Witness Alan M. Immerman, D.C. has qualified 70 times in Arizona courts in chiropractic, clinical biomechanics and accident reconstruction. In the past was a Postgraduate Faculty Instructor at Parker College of Chiropractic in Clinical Biomechanics of Whiplash Injury. 
  3. Rebuttal Reports to Defense Low Speed Impact Experts from Biodynamic Research Corporation (BRC) and local Arizona experts. ACS publishes legal documents showing funding of BRC by State Farm from 1990-1995. 
  4. Can Delta V Predict Injury Likelihood or Severity? A full comprehensive study of the issue with multiple references. 
  5. Threshold of Injury for Any Single Individual or Entire Population is Not Known: A complete analysis of the peer-reviewed literature. Click here to access study.
  6. Common Flaws in Delta V Calculations by Defense Accident Reconstructionists
  7. Exemplar Rebuttal Reports to MD IME Orthopedic Surgeons in Personal Injury Cases 
  8. Exemplar Rebuttal Reports to Chiropractic IME Defense Doctors in Personal Injuy Cases
  9. Exemplar Rebuttal Reports to Defense Biomechanical Engineers 
  10. Personal Injury Practice Tools and Documents 
  11. ACS Endorses Management of Whiplash Disorders Guidelines Which Includes Croft Whiplash Guidelines
  12. Are Spinal Range of Motion and Muscle Spasm Exams Subjective or Objective? 
  13. The Standards for Epidemiologic Determinations of Cause and Effect
  14. Methods for Attacking the Defense Biomechanist by Attorney Nicholas E. Vakula, Esq. of Phoenix 
  15. Key Resources in Personal Injury Matters with Emphasis on Low Speed Impact Cases
  16. Litigation Questions for a Typical Biomechanical Engineer 
  17. U.S. Court Cases Where Defense Biomechanical Engineers Have Been Excluded and the Theories Used
  18. Summary of Specific Human Subject Crash Papers
  19. Eighteen Studies Frequently Cited by Defense Engineers 
  20. Questions About Comparable Activities and Bumper Car Rides
  21. These Newsletters are Reviews of the Scientific Literature by Dr. Immerman
  22. Health Care Provider Lien Laws and History
  23. Affidavit From SAE Legal Administrator Steven Daum Regarding Lack Of Statistical Analysis Or Methodological Scrutiny Of Sae Articles Prior To Publication
  24. How Every Chiropractor Can Qualify As An Expert in Clinical Biomechanics
  25. A Research Synthesis of Therapeutic Interventions for Whiplash-Associated Disorders: Five journal studies from Pain Research and Management in 2010 reviewed all studies that examined interventions for whiplash. Conclusion: Mobilization, including manipulation, and exercise have the best evidence to support use for acute and chronic whiplash, and epidural injections and spinal surgeries have little evidence to support effectiveness. The studies are available here for members.
  26. The Standard For Measuring Vehicle Crush Damage From Photographs

1. Introduction To This Page

Welcome to the all new Personal Injury, Automobile Accident and Medical Legal Issues Page. Here you will find a wide range of resources as seen in the Table of Contents including all the information you will need to rebut defense low speed impact experts such as those from Biodynamic Research Corporation (BRC). Here's a complete directory to all resources that ACS has available in the area of personal injury. Interested parties not Arizona chiropractors wishing provisional access should contact ACS at (602) 284-9979 or ACS@AZChiropractors.org.

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BREAKING NEWS 03/26/12: $70,000 Plaintiff's award in classic low speed impact case. Patient sues State Farm directly which retains Joseph Peles, PhD, top biomechanical engineer, who argued that the forces were too minor to cause anything more than a minor injury. Plaintiff's attorney Harold Hyams retained Alan M. Immerman, D.C. as a rebuttal witness. Jury reported they did not believe Dr. Peles after hearing from Dr. Immerman and concluded the plaintiff was injured and awarded $70,000.Click here to read the entire Court's Minute Entry.


2. Dr. Immerman Retires From Offering Expert Witness Services

Dr. Immerman retired in 2015 from expert witness work. Dr. Immerman was one of the most experienced expert witnesses in the country having testified in 71 trials in the past 15 years (click here for list of trials with CV numbers and case names and dates) and having had his deposition taken 50 times (click here for list of depositions with CV numbers and case names and dates).

Areas of expertise include the clinical biomechanics of whiplash injuries, a subject he now was approved to teach as a postgraduate instructor at the Parker College of Chiropractic. He was also an expert in detecting flaws in accident reconstruction analyses, and was frequently called to opine regarding whether the treatment rendered post-trauma was reasonable and necessary.

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3. Rebuttal Reports to Low Speed Impact Experts from Biodynamic Research Corporation (BRC) and Local Arizona Defense Experts

ACS did supply expert reports to rebut defense low speed impact experts Joseph Peles, PhD, Robert Anderson and out of state experts from Biodynamic Research Corporation (BRC), San Antonio, TX (www.brconline.com) including Richard A. Allnutt, MD, Mph, MS, Karyn J. Ayers, MD, Mph, C.E. “Ted” Bain, B.Eng., MD, Robert D. Banks, B.Eng., MD, James V. Benedict, PhD, MD, Alfred P. Bowles Ii, MD, Joseph M. Cormier, PhD, PE, James R. Funk, PhD, PE, Richard M. Harding, BSc, Mb Bs, PhD, Thomas M. McNish, MD, Mph, Amy L. Mumbower, MD, James H. Raddin Jr., MD, Sm, William R. “Mike” Scott, PhD, Harry L. Smith, PhD, MD, Jeffrey Wirth, M.S., P.E. Call or email Dr. Immerman at aimmerman1@cox.net and (602) 368-9496 for more information.

BIODYNAMIC RESEARCH CORPORATION (BRC) ORIGINALLY WAS LARGELY FUNDED BY STATE FARM INSURANCE COMPANY INDICATING POTENTIAL CONFLICT OF INTEREST

State Farm Mutual Automobile Insurance Company paid Biodynamic Research Corporation (BRC) $7,676,000 for services from 1990-1995. This is based on Interrogatory Answers and Production of Documents disclosed 01/29/97 in Maricopa County Superior Court in CV 95-21280, 01/29/97. Click here to read and download the full set of legal documents revealing the payments. BRC did the original human volunteer testing later used by defense experts to argue in court that plaintiffs could not be injured in low speed impact collisions. BRC experts still travel throughout the country testifying on behalf of defendants and should be questioned about the inherent bias of BRC based on its funding source.

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4. Can Delta V Predict Injury Likelihood or Severity

Can Delta V predict injury likelihood or severity? In a word, no.

Engineer Siegmund, an authority cited by most defense engineers, lists 13 factors that must be taken into account when predicting injury likelihood and severity, and Delta V is only one . . .

Another scientific peer-reviewed published journal article concluded that in order to predict injury likelihood and severity, one would need to know information about the individual’s tissue strength and elasticity and “any multitude of variables that evade accurate determination” along with the Delta V.” Read the details in this article.

Four key journal articles from the peer-reviewed scientific literature reflect the general consensus of the clinical biomechanical and accident reconstruction communities. The journal studies and their noted conclusions are supported by numerous references cited by the authors. The conclusions drawn by these multiple authors were approved by the independent peer-reviewers and have achieved general consensus in the scientific community. They prove that the modern peer-reviewed scientific literature supports the position that one cannot calculate Delta V and then predict injury likelihood or severity. Read summaries of the articles with complete references here.

In order to further understand why Delta V cannot be used alone to predict presence or absence of injury in an individual, it is important to understand the difference between predicting an injury outcome in the general population and in an individual. While it may be correct to state, for example, that a 5 mph Delta V rear impact collision will only result in a significant injury in 1 in 100 individuals, this low probability of injury is unrelated to the actual result of the crash in an individual, as they may very well be the one in 100 who was injured . . . The full argument is explained with references here.

Defense engineers generally place no weight on medical records, not surprising since engineers have no medical education and thus no ability to read and comprehend medical records. A case file might include records from multiple doctors documenting objective evidence of injury immediately following the subject trauma but all such records are dismissed as irrelevant by the engineer. This denial of medical reality has been legally banned in Arizona which requires “genuine reliance” on medical records in all biomechanical/accident reconstruction analyses . . . The legal citation is provided here.

This full PDF report complete with references by clicking here.

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5. Threshold of Injury for Any Single Individual or Entire Population Not Known

The defense engineer’s entire analysis is predicated on the assumption that scientists know how much Delta V is required to cause injury to all people and to each individual in particular. The truth is that insufficient testing has been performed to date on human volunteers to know how much force is required to cause injury to any particular individual. This renders the entire engiineer's analysis invalid. Dr. Immerman has rebutted engineers more than 400 times in litigated cases and included three of his responses to engineers on the threshold of injury issue in this report with references. This is essential rebuttal material for your cases. This full PDF report with forty nine references is available by clicking here.

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6. Common Flaws in Delta V Calculations by Defense Accident Reconstructionists

There are a number of common flaws in the analyses conducted by defense accident reconstructionists when they calculate Delta V in automobile accidents. This usually leads to an underestimation of the Delta V. These same flaws are seen in reports across the country and are based on methodology originally developed by Biodynamic Research Corporation (BRC) of San Antonio, TX, an organization that received more than $7.6 million in funding for services during its formative years from 1990-1995. In this report, all of the common flaws will be thoroughly analyzed. These include reporting a Barrier Equivalent Velocity (BEV) as if it were a Delta V, minimizing or ignoring the medical records and practicing beyond engineering bounds, underestimating Delta V in vehicles with foam, honeycomb and deformable strut bumpers, relying solely on photographs and not performing a physical inspection or reviewing repair estimates, and many other tactics which result in an underestimation of the Delta V. This fact-filled, fully referenced PDF report is available by clicking here

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10. Personal Injury Practice Tools and Documents

30 – Ethics Opinion 98-06 which requires PI lawyers to pay your bill if they know it exists (constructive knowledge) even if there is no written agreement.

31 – Balance Billing in PI Cases: Why balance billing to a third party insurer is almost always allowed in PI cases including citations to legal authorities.

32 – PI Attorney’s Explanation of Healthcare Provider Liens: Detailed explanation of the law.

33 – Sample form for Notice and Claim of Medical Lien: Fill in the blanks with your office information.

34 – Sample form for Release of Medical Lien: Fill in the blanks with your office information.

35 – Arizona Department of Insurance Circular Letter 2000-02 mandating fair investigations of low speed impact automobile accidents. Use to combat insurance company fraud.

36 -- Forms:

Assignment of Benefits and Payment Agreement Form

Attorney Lien Form: Be sure to read the two explanatory articles about how to use this lien by clicking here and here, along with the services of an attorney to make sure lawyers honor your lien.

Lien Acceptance Policies: A form which includes all of the policies of your office which your patient must accept for you to agree to work on a lien basis including having all medpay payments sent directly to your office.

Automobile Accident Report Form

Injury Causation Checklist

Informed Consent

Outcome Assessment Tools for Neuromusculoskeletal Conditions

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11. ACS Endorses Management of Whiplash Disorders Guidelines Which Includes Croft Whiplash Guidelines

ACS has endorsed the Management of Whiplash Disorders Guidelines which include the Croft Whiplash Guidelines. These guidelines have been accepted by the prestigious National Guidelines Clearinghouse and can be accessed through their webpage by clicking here. Dr. Jerry Kennedy's webpage has the Croft Guidelines displayed in an extremely usable format at http://www.drjerrykennedy.com/lawyer-info/croft-guidelines-for-treatment/

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12. Are Spinal Range of Motion and Muscle Spasm Exams Subjective or Objective?

The simplest of all exams are the most revealing and objective. See the peer-reviewed scientific literature supporting the validity of range of motion and muscle spasm evaluations to document your patient's condition. Click here to read this four page paper written by Dr. Immerman.

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13. The Standards for Epidemiologic Determinations of Cause and Effect

“Any expert opinion that addresses the probability, risk, incidence, or prevalence of an event occurring or not occurring in an individual or a population is an opinion that must have a foundation in valid epidemiological concepts and data. Epidemiology is most simply defined as the scientific study or analysis of populations having similar disease or injury characteristics. The proper application of epidemiological concepts and data to forensic issues is the practice of Forensic Epidemiology.” (Freeman et al, 2008)

The standards for epidemiologic determinations of cause and effect comprise three basic elements . . . Read the full two page statement from Dr. Immerman's reports by clicking here. The reference to the journal article is provided.

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14. Methods for Attacking the Defense Biomechanist by Attorney Nicholas E. Vakula, Esq. of Phoenix

The first Arizona attorney to challenge low speed impact defense experts in the late 1990's was Nicholas E. Vakula, Esq. of Phoenix. He has been perfecting his methods ever since and explains in detail his methods for attacking the defense biomechanist who argues there was not enough force to cause the injuries diagnosed by the patient's doctor(s). Click here to read his entire twelve page document. His work is unparalleled in the country in the field of low speed impacts. He can be contacted at Vakulalawfirm@aol.com.

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15. Key Resources in Personal Injury Matters with Emphasis on Low Speed Impact Cases

In the case of Hallmark v. Eldridge, July 24, 2008 Nevada Supreme Court (2), the Nevada Supreme Court barred the testimony of a biomechanical expert. The arguments are priceless in forming your own. Read the entire ruling by clicking here.

The California Court of Appeals has excluded testimony by an insurance company expert who concluded there was not enough force in an automobile accident to cause the injuries diagnosed by the patient’s doctor after the trauma. This is a landmark case since it was decided in an appellate court, but was not published and so may not serve as a precedent in California. The case, posted here, is Harrison v. Smith, A114436, First Appellate District, Division Five, California Court of Appeals. Again, the arguments and research are priceless.

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16. Litigation Questions for a Typical Biomechanical Engineer

This is a six page document of questions and answers between a biomechanical engineer and a plaintiff's attorney. It was developed by Lawrence S. Nordhoff, Jr., D.C., a veteran expert witness in the fields of biomechanics, accident reconstruction and whiplash injury. He has written one of the best books on whiplash available today. His website is http://www.chiropracticofficeforms.com/index.html. To link to Dr. Nordhoff's six page list of questions and answers, click here.

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17. U.S. Court Cases Where Defense Biomechanical Engineers have been Excluded and the Theories Used

The have been eight major U.S. court cases in which defense biomechanical engineers have been excluded. The rulings have been based on sixteen theories. Read summaries of the cases and the theories by clicking here. This material was developed by Lawrence S. Nordhoff, Jr., D.C., a veteran expert witness in the fields of biomechanics, accident reconstruction and whiplash injury. He has written one of the best books on whiplash available today. His website is http://www.chiropracticofficeforms.com/index.html. To link to Dr. Nordhoff's four page list of court cases and theories, click here.

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18. Summary of Specific Human Subject Crash Papers

This is a summary of the specific human subject crash studies usually relied upon by defense engineers to establish a threshold of injury in terms of Delta V for all people and for a particular plaintiff patient in a case. Review of these studies reveals how it is impossible to use these studies in this matter. This material was developed by Lawrence S. Nordhoff, Jr., D.C., a veteran expert witness in the fields of biomechanics, accident reconstruction and whiplash injury. He has written one of the best books on whiplash available today. His website is http://www.chiropracticofficeforms.com/index.html. To link to Dr. Nordhoff's six page list of studies and analyses, click here.

Most of these studies were published by the Society of Automotive Engineers (SAE) whose administrator has confirmed in an affidavit that the results of the human volunteer studies cannot be applied to the entire population or any particular individual. Some of the key studies were performed at Biodynamics Research Corporation in San Antonio, Texas and later legal filings proved that State Farm Insurance Company provided over $7 million in funding to BRC throughout the 1990's to develop its low speed impact defense strategy with in-house studies.

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19. Eighteen Studies Frequently Cited by Defense Engineers

There are eighteen key studies that are frequently cited by defense engineers in support of their hypothesis that injury likelihood and severity can be predicted from Delta V. Analysis of these studies reveals this not to be the case. This material was developed by Lawrence S. Nordhoff, Jr., D.C., a veteran expert witness in the fields of biomechanics, accident reconstruction and whiplash injury. He has written one of the best books on whiplash available today. His website is http://www.chiropracticofficeforms.com/index.html. To link to Dr. Nordhoff's eight page list of studies and analyses, click here.

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20. Questions about Comparable Activities and Bumper Car Rides

Many defense engineers claim the subject accident was no more severe than an amusement park bumper car ride collision or other comparable activities of daily living like stepping off a curb, sneezing, plopping into a chair, etc. This article comprehensively examines the literature underpinning these arguments and reveals why they rarely apply. This material was developed by Lawrence S. Nordhoff, Jr., D.C., a veteran expert witness in the fields of biomechanics, accident reconstruction and whiplash injury. He has written one of the best books on whiplash available today. His website is http://www.chiropracticofficeforms.com/index.html. To link to Dr. Nordhoff's seven page list of studies and analyses, click here.

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21. These Newsletters are Reviews of the Scientific Literature by Dr. Immerman

Mechanisms of injury following rear-end collisions are well understood

Defense biomechanists and accident reconstructionists regularly underestimate Delta V by up to 50%, February, 2007

The best peer-reviewed medical journal whiplash review article ever, January, 2007

The best medical journal low speed impact studies ever, December, 2006

Factors predicting outcome after whiplash injury in subjects pursuing litigation, September, 2006

Summary of recent medical journal studies regarding low speed impacts and injuries, April, 2006

"You can't predict the past" -- a low speed impact automobile accident commentary, March, 2006

Still another new low speed impact article published in peer reviewed medical literature, February, 2006

New low speed impact article published in peer-reviewed medical literature, January, 2006

Excerpts from a rebuttal to a defense accident reconstructionist/biomechanical engineer, November, 2005

Review of medical journal article "Seeing through the MIST (minor impact soft tissue injury," October, 2005

Circular Letter from Arizona Department of Insurance provides strong ammunition in low speed impact cases, September, 2005

Is cervical spinal manipulation contraindicated due to risk of stroke? August, 2005

New 2005 Journal Article: "A Review of the Literature Refuting the Concept of Minor Impact Soft Tissue Injury," July, 2005

What is your response when a defense lawyer shows pictures of minimal property damage to an arbitrator? June, 2005

Major flaw found in defense engineers' analyses, May, 2005

New research ends the debate on low speed impacts, April, 2005

Breakthrough low speed impact article published in The Spine Journal, March, 2005

How to respond when an IME doctor concludes that a patient "has subjective complaints with no objective findings," February, 2005

U.S. Department of Transportation issues new vehicle head restraint requirements which comport with our conclusions regarding whiplash injuries, January, 2005

Because of our ongoing involvement in personal lnjury litigation, we must stay current with all peer-reviewed literature relating to whiplash, low speed impacts, chiropractic, treatment of injuries, etc. Contact Alan M. Immerman, D.C. at 602-368-9496 or aimmerman1@cox.net for the most recent literature and advice.

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22. Health Care Provider Lien Laws

Arizona Revised Statutes 33-931. Lien of health care provider on damages recovered by injured person receiving services; hospital priority

Arizona Revised Statutes 33-932. Perfecting lien; statement of claim; recording; effect

Arizona Revised Statutes 33-933. Recording and indexing lien claim

Arizona Revised Statutes 33-934. Release of claim by injured person ineffective as to lienholder; action to enforce lien

Arizona Revised Statutes 33-935. Workers' compensation cases exempted

Arizona Revised Statutes 33-936. Release of hospital lien; liability

HISTORY

In 1999, insurers found a loophole in the lien laws that allowed them to require doctors to file liens every 30 days on each patient. ACS brought this issue to the Legislature and asked for relief. HB 2090, Health Care Liens, was introduced by then-Rep. Tom Horne to solve the problem. An intern explained "the bill allows costs for continuing care incurred after the filing of a health care lien to be added to the lien. It further requires the health care services provider to include in the verified statement, concurrently recorded with the lien, information regarding the termination of continuation of the injured person's care and treatment." Mr. Horne is the newly elected Arizona Attorney General for 2011.

As a result of ACS' work to pass this bill, you now only need to file one lien for the entire course of care rather than one lien every 30 days. This change brought great relief to all Arizona chiropractors.

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23. Affidavit from SAE Legal Administrator Steven Daum Regarding Lack of Statistical Analysis or Methodological Scrutiny of SAE Articles Prior to Publication

Certain experts rely largely or exclusively on articles published by the Society of Automotive Engineers (SAE). Click here to read an affidavit from Steven Daum, the legal administrator for SAE. Mr. Daum confirms that SAE articles are not subject statistical analysis or methodological scrutiny. In fact, SAE takes the position that any opinions or positions advanced by an author of a paper published by SAE are not necessarily statistically representative of the response of the general public. Therefore, one cannot apply the results of these studies to any single individual, nor can one in most cases rely upon these studies in the formation of an expert opinion.

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24. How Every Chiropractor Can Qualify as an Expert Witness in Clinical Biomechanics

ACS has developed a document that thoroughly explains how any chiropractor can successfully argue that he or she is a courtroom expert in clinical biomechanics. Click here to read the document, and click here and here for the supporting documents. Dr. Immerman has knowledge regarding this matter since he has qualified has an expert in clinical biomechanics in Arizona Superior Courts 63 times in the past 12 years. Click here for his testimony list and here for his CV.

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25. A Research Synthesis Of Therapeutic Interventions For Whiplash Associated Disorder

This compendium of five journal studies from Pain Research and Management in 2010 reviews all the studies that have examined non-invasive and invasive interventions for whiplash. The conclusion is that mobilization, including manipulation, and exercise have the best evidence to support use for acute and chronic whiplash, and that steroid epidural injections and spinal surgeries have very little evidence to support effectiveness. The studies are available free full-text online and reproduced here for members:

  1. “Toward an evidence-based approach to whiplash injuries”
  2. “A research synthesis of therapeutic interventions for whiplash associated disorder -- Part 1 overview and summary”
  3. “A research synthesis of therapeutic interventions for whiplash associated disorder -- Part 2 interventions for acute WAD”
  4. “A research synthesis of therapeutic interventions for whiplash associated disorder -- Part 3 interventions for sub-acute WAD”
  5. “A research synthesis of therapeutic interventions for whiplash associated disorder -- Part 4 noninvasive interventions for chronic WAD”
  6. “A research synthesis of therapeutic interventions for whiplash associated disorder -- Part 5 surgical and injection based interventions for chronic WAD”

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26. The Standard for Measuring Vehicle Crush Damage From Photographs 

Many defense engineers guesstimate the amount of crush damage by eyeballing photographs. This is an unscientific method that cannot result in an accurate figure for the amount of crush damage. Physical measurements of the vehicle are necessary. Read this fully documented position paper for proof.

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602-932-8113.