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Practice Area

Personal Injury — Auto, Trucking & Catastrophic

Spine, TBI, and soft-tissue cases with contested IMEs and causation disputes are where Medisprudence delivers the highest per-case value.

Founder’s Advantage

The most common defense challenge in PI cases is that the treating record does not support the claimed mechanism or surgical necessity. Our founding physician has evaluated exactly these arguments on the payer side — reviewing auto accident, trucking, and catastrophic injury claims using the same InterQual criteria that defense IME physicians apply. He knows which documentation patterns make a PI record defensible under that scrutiny, and which ones create exploitable gaps. When Medisprudence reviews a spine case, it is reading it as the defense reviewer will.

The defense challenges we address

Causation dispute

“No causal relationship between the accident and the claimed pathology.” The most common IME conclusion in PI litigation — and the most analyzable.

Surgical necessity

“The surgery was not medically necessary given the documented conservative care.” Defense reviewers apply specific criteria for conservative care completion.

Pre-existing attribution

“The pathology reflects baseline degeneration unrelated to the accident.” Used most aggressively in older clients and prior injury at same level.

Treatment gaps

“The gaps in treatment are inconsistent with the claimed severity.” A 30-day gap in physical therapy is standard grounds for challenging medical necessity.

Services for this practice area

Defense & Carrier
Services for defense teams in PI cases

The same PI documentation-threshold analysis, applied for defense firms, TPAs, and carriers. Medical exposure assessment, IME quality assurance, reserve-setting support, and causation challenge analysis.

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