Take advantage of the professional and practice-building opportunities as a certified independent forensic chiropractic medical examiner
EACH YEAR, MORE THAN 39 MILLION PEOPLE ARE hospitalized or receive emergency treatment for accidental injuries, and more than 3 million sustain disabling injuries on the job. Many of these cases result in legal action. The health care delivery system requires a focused awareness of injury/pathology evaluation, an analysis of data, a concise reporting process, and the ability to testify on forensic conclusions.
The Ball Is In Your Court
This represents a substantial market for forensic chiropractic examiners who can offer their expertise. Also, it gives an opportunity for forensic chiropractic examiners to provide expert testimony to legal, special investigative units of insurers, fraud divisions of state insurance commissioners, and Office of the Inspector General health care fraud investigators.
Forensic chiropractic is a science and methodology that deals with the relation and application of chiropractic and scientific facts to legal problems. The National Board of Forensic Chiropractors (NBOFC) and the Commission on Independent Forensic Chiropractic Medical Examiner Certification (CIFCMEC) were created to promote competency in chiropractic forensics. A certified independent forensic chiropractic medical examiner (CIFCME) performs an analysis, investigation, inquiry, a test, inspection, and examination to give an expert opinion.
Qualifications Please
CIFCMEs must have scientific, technical, and specialized knowledge to assist the trier of fact in understanding evidence and determining facts.
The legal requirements for qualifying as an expert forensic examiner witness is knowing and understanding the Federal Rules of Evidence, rule 702: "If scientific, technical, or other specialized knowledge will assist the trier of fact (Judge/Gatekeeper) to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, expertise, training, or education, may testify thereto in the form of an opinion or otherwise. The forensic chiropractor (witness/expert) must be qualified by knowledge, skill, expertise, or education and assist the trier of fact to understand the evidence and determine the fact in an issue."1
Which areas of chiropractic can you be qualified as an expert? The basic common-sense rule is: if you do not feel comfortable with the area, decline the case and refuse to testify.2-4
Put to the Test CIFCME requires completion of a minimum of 120 postgraduate hours in prescribed educational areas and passing the written and oral forensic examination (www.forensicexaminers.org). It is offered once a year at the completion of the NBOFC training program. Other dates may be available as approved by the CIFCMEC. The examination consists of two parts: an oral and a written 10-section multiple-choice questions. The 10 sections are: 1) Clinical competency
2) Impairment assessment
3) Functional capacity and disability assessment
4) Forensic chiropractic analysis and algorithm
5) Statistics
6) Psychosocial and behavioral assessment
7) Law and ethics
8) Disability systems
9) Criminal investigation
10) Federal expert witness requirements |
Is There a DC In the House?
CIFCMEs are currently employed as consultants and examiners in a variety of capacities for government agencies, lawyers, other health care providers, criminal investigative organizations, and the insurance industry. Additional forensic chiropractic evaluation opportunities are available for investigating suspicious chiropractic medical claims. These medical claims filed by fraudulent practitioners become a feeding ground for practitioners who do not have valid state chiropractic licenses, and it also becomes a source of income for unscrupulous chiropractors through various kickback schemes.
As a CIFCME, you can offer fraud investigation and training for patients, attorneys, criminal investigators, government health care fraud agencies, special investigative units, and insurers in the following areas:
advise on technical aspects and proper chiropractic protocols of diagnostic testing;
identify chiropractic providers who use the procedure coding system to for financial advantages;
ascertain unnecessary diagnostic tests and procedures; and
alert the adjuster or SIU of warning signs from coding and billing practices.
The CIFCME currently performs consulting services to clarify complex issues for the following: Department of Transportation examinations; federal aviation examinations; independent medical evaluations (IMEs); medical malpractice and affidavits; standards of care issues; question preparation for depositions and trials; medical/legal research and testimony for plaintiff and defendents; and sexual sssault and battery investigations.
Fruits of Labor
CIFCMEs can offer second opinion IMEs for insurance companies and comissions, attorneys, criminal investigators, private disability policy companies, and patients. Specific findings are required for IMEs—appropriate current procedural terminology diagnoses, objective tests, degree of permanent impairment, restricted limitations of daily living, patient maximum medical improvement, additional modalities, diagnostic tests, tertiary medical referrals, and alternative treatment care paths required to stabilize the injury or pathology.
Literature searches for lucid, complex injury reports are performed to help the trier of fact understand terminology or algorithms. As a result of these unbiased forensic analyses, IMEs will increase your patient base from referrals from attorneys, insurance companies, or patients.
CIFCMEs can also perform functional capacity evaluations (FCEs) required to determine disability categories for social security and workers’ compensation. An added benefit is that very few health care providers are capable of providing this market niche.
Forensic chiropractic criminal investigations require clarification of standard of care and proper current procedural terminology coding. These can be extremely tedious and require confidentiality and protection of medical evidence. CIFCMEs have the essential skills to consult in the lucrative health care fraud investigations market. I have been frequently invited to lecture at international and national insurance fraud divisions and have received referrals as a direct result.
CIFCME consultant positions are provided on the NBOFC expert witness locator service website for graduates of the program (www.forensicexaminers.org). The fee schedule for CIFCME part- and full-time positions are:
independent medical exams— $250 to $1,500;
functional work capacity evaluations—$750 to $1,500;
simple to complex forensic chart analysis—$150 to $3,500;
legal research—$125 to $150 per hour;
forensic chiropractic expert witness—$250 to $450 per hour;
criminal investigations—$150 to $200 per hour; and
part- and full-time chiropractic directors and disability examiners for the insurance industry—$35,000 to $60,000.
Medical malpractice allegations and lawsuits require a great deal of research to determine whether there is a deviation from standard of care. If you want to expand the scope of your chiropractic career—financially and professionally—becoming a forensic chiropractic expert can be a rewarding adjunct.
About the Author
Preston B. Fitzgerald, Sr, DC, CDE I, CIFCME, is the president and CEO of the National Board of Forensic Chiropractors, and has a practice in Manning, SC. He can be reached at: 803-435-5078 or via email: omyback@gte.net.
References
1. Babitsky S, Mangraviti J, Todd CJ. The Comprehensive Forensic Services Manual. Falmouth, Ma: SEAK Inc; 2000:39.
2. Black B, Lee PW. Expert Evidence A Practitioner’s Guide to Law, Science, and the FJC Manual. St Paul, Minn: West Group; 1997:56.
3. Faigman DL, Kaye DH, Saks MJ, Sanders J. Modern Scientific Evidence The Law and Science of Expert Testimony. Vol 1. St Paul, Minn: West Publishing Co; 1997:22.
4. Faigman DL, Kaye DH, Saks MJ, Sanders J. Modern Scientific Evidence The Law and Science of Expert Testimony. Vol 2. St Paul, Minn: West Publishing Co; 1997:12–22.
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