What AI-assisted claims platforms score inside personal injury medical records, and how to build files they respect.
Your client was injured. Your client is treating. But is the injury clearly established by the records? The carrier’s claims platform might disagree.
On the newest episode of the Trial Lawyer View by Synergy podcast, I sat down with Brett Chance, D.C.,CCSP®,CSNC, a board certified chiropractic physician in Orlando who spends much of his time teaching attorneys and providers how injury documentation holds up under modern claims review. His position is blunt. Most legitimate cases lose value in the record, not in the facts.
“It’s not that the patient wasn’t hurt, it’s just that the record didn’t fully support it.”
Here is what he sees inside PI cases every week, and what to do about it.
The Gap Between Treating and Proving
Chance treats personal injury as a subspecialty, separate from general clinical practice. The reason is simple. A chart has two jobs. It has to work medically, and it has to hold up in a claims environment run increasingly by technology.
Most medical charts do the first job and fail the second. The provider knows the patient is hurt. The record never says so in language the defense reviewer recognizes. By the time the demand goes out, the file reads like pre-existing degeneration with a complaint log attached.
Your cases is only as good as your treating provider’s notes.
Pain Language Versus Injury Language
Low back pain. Cervicalgia. Neck pain. Headache. These terms appear in nearly every PI file, and Chance considers them appropriate. He also considers them insufficient on their own.
Pain describes how the patient feels. It does not identify what was injured.
A defensible record names the tissue:
• Ligamentous injury
• Disc pathology
• Neurological involvement, including radiculopathy
• Muscle instability
His framing: pain language describes the complaint, injury language explains the case.
More codes do not fix this. Stacking multiple codes for the same complaint triggers cluster diagnosing flags. The fix is specificity, not volume.
Acute Coding Versus Degenerative Coding
Every injury starts with a mechanism. The mechanism produces a derangement pattern. Acute traumatic language, the S codes in ICD-10, ties findings to the event. Degenerative language points to something long standing.
Once degenerative terms enter early in a file, the narrative shifts. You have handed the defense room to argue pre-existing conditions, non-specific pain, and age-related findings. What is coded becomes what the case is.
Chance sees this constantly. Providers reach for degenerative or symptom language because acute coding strategy was never taught to them.
The Coding Timeline Should Move
A record documented well tells a story with a beginning, a middle, and an end.
• Day one: mechanism of injury documented, acute traumatic codes applied, symptom codes used as placeholders
• Early weeks: definitive diagnosis replaces placeholder language once exam findings support it
• Re-evaluation: codes change to reflect response to care
• Later stages: sequelae and residual language, impairment findings, MMI determination
A file coded acute for two straight years tells the reviewer something is wrong. Repetitive coding paired with repetitive billing gets flagged. Ask one question of every chart you review: did the diagnosis evolve, and do the CPT codes track it?
The Imaging Step Most Files Skip
This was the sharpest practical takeaway of the episode. Chance wants flexion extension views on every motor vehicle and slip and fall patient. These views assess spinal mechanics, alignment, and ligamentous integrity. They are standard training for MDs, DOs, and chiropractors, and they are rarely ordered in the PI market.
Instead, the typical medical evaluation goes like this. The patient goes to the ER in pain. The ER runs CT imaging of the brain, cervical spine, and lumbar spine, finds no acute emergency, and discharges. Soft tissue never gets worked up. Weeks later, someone orders an MRI with thin documented necessity behind it.
When Chance reviews a file and sees an early MRI with no supporting neurological findings, no dermatomal complaints, and no functional testing, he knows the workup was weak. The MRI then becomes the diagnosis instead of supporting it.
Build the objective foundation first:
• Orthopedic and neurological exam findings tied to specific dermatomal patterns
• Flexion extension imaging to assess mechanics and ligament damage
• Documented numbness, tingling, or focal deficits before advanced imaging
• Medical necessity stated in the record, not assumed
What the Claims Platforms Score
In previous articles, I have written about carrier AI overlays in the Peak Practice newsletter, and I asked Dr. Chance about the practical mechanics.
Chance named Colossus along with Injury IQ, Medeco, and other proprietary systems. He was careful to add a disclaimer worth repeating. Nobody outside those companies knows the exact scoring logic, the models change, and everything he discusses comes from what is publicly known.
At a high level, these platforms evaluate documented inputs. Not assumed ones. They read:
• Diagnosis codes and their progression over time
• Treatment duration and frequency of care
• Functional capacity measures and activity limitations
• Impairment findings and permanency indicators
• Comorbidities and pre-existing conditions
• Whether the CPT codes align with the diagnoses
They reward three things: structure, consistency, and supportability. A medical case file showing a short term sprain with minimal follow up reads differently from a file showing progression into ligament dysfunction, disc pathology, and radiculopathy.
His summary line deserves a place on your case management wall:
“Technology evaluates the record that was built, not the severity.”
Function Is a Value Driver
Carriers weigh functional loss heavily, because chronic disability is expensive to fund. Chance documents it at three points in every case: early, midway, and at resolution.
The tools he uses:
• Outcome assessment tools such as the Oswestry Low Back Pain Scale and the Headache Disability Index
• Loss of enjoyment of life documentation
• Duties under duress documentation
He cited research showing severe whiplash carries roughly a 50 to 60 percent chance of long-term chronic pain. If your file contains no functional measurement, you are asking a reviewer to price permanency with nothing to price it against.
Repairing an Inherited File
During the podcast, I asked the question every firm faces at some point. How much of a poorly documented case is salvageable?
Chance’s answer was honest. Some of it. New objective testing based on complaints nobody worked up. Different imaging strategy. Third party review of existing films. He looks first at what imaging was performed, because the answer usually explains the rest of the file.
What you do not get back is the early window. Soft tissue heals or fails to heal in the first weeks. Clean acute documentation from that period is either there or it is not.
What to Build Into Your Firm Now
I asked what firms should be building over the next two to three years. The answer was less about technology and more about relationships and process.
• Set documentation expectations with your treating providers before the next referral, not after the demand
• Schedule provider check ins during active treatment rather than at the end
• Review charts at 30, 60, and 90 days for coding progression and CPT alignment
• Train intake staff and case managers to flag pain only charting and unchanged re-exam language
• Ask whether flexion extension views were obtained on every MVA and slip and fall workup
• Confirm functional documentation exists at three separate points in the file
Chance noted he knows by the second or third visit whether a patient has a rateable condition and cited whole person impairment ratings in the five to 25 percent range on that early read. Firms with real provider communication get that information during treatment. Firms without it learn at mediation.
The Takeaway
Chance framed the mission behind his Injury Decoded program in terms of alignment rather than combat with carriers. His words:
“It’s not about fighting the insurance carriers. It’s about eliminating confusion in this already very confused market.”
For trial lawyers building firms designed to scale, the operational lesson is bigger than coding. The medical record is a product your firm depends on and does not control. Firms treating it as paperwork to collect will keep losing value in files with real injuries behind them. Firms treating it as a system with inputs, standards, and quality control will not.
As Chance put it to the audience directly: you do not need to be doctors, but you do need to understand when the chart is helping you and when it is hurting you.
🎧 Listen to the full podcast conversation on Trial Lawyer View here: https://partnerwithsynergy.com/podcast/dr-brett-chance/
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