Whiplash injury which lasts longer than 3 weeks is something else. Using the Diagnostic Paradigm from www.MarylandClinicalDiagnostics.com, physicians can identify 6 commonly found medical conditions associated with a whiplash injury, even if the patient has normal X-rays, MRI and CT. Instead of a typical $10,000 settlement and no improvement, the use of the test imporves patient care, and increase the financial settlement.

1. `1
How Do You Get$200,000 From A WhiplashCase?
By NelsonHendler,MD, MS and WilliamGallagher,D.C.
(seniorauthorcontact-email NelsonHendler,MD,MS at DocNelse@aol.com)
The answerto thistitle questionissimple. Getacorrect diagnosis. Inordertoimprove yourrecovery
fromany whiplashcase,softtissue injurywithnoobjective medical findings,oracervical sprain,there
are several easy stepsatrial attorneycan follow.Firstandforemostistoobtainanaccurate diagnosis.
Often,atrial attorneyasa clientwhohasbeenrear-ended,sufferedahyperextensionhyperflexion
injury,asnormal x-rays,MRIs,and CAT scans,and has had numeroussessionsof physical therapyand/or
chiropracticcare. The treatingphysiciantellsthe trial attorney"Ican't findanythingwrong.Itmustbe
cervical sprainor strain."Nothingcouldbe furtherfromthe truth. JohnsHopkinsHospital physicians
reportthat 63% of these patientsneedsurgerytoimprove (18).
It isimportantto understandthe mechanicsof arear endcollision.Evenwithrestraints,andhead-rest,
the 20 poundball sittingontop of the neck (the head) isfirstthrustbackwards,andthenforward.
Additionally,the chesteitherhitsthe steeringwheel, oriscompressedbythe airbag,andoftenthe seat-
beltdislocatesthe 10th
rib.
These motionsresultinaconsistentpatternof injuries,whichare oftenoverlookedbytreating
physician,andmore importantly,are notreadilydetectedbyx-ray,MRI, orCAT scan.
These injuriesare:
1) Postconcussionsyndrome
2) torn ligamentsinthe cervical spine,producingeitherspinal instability,ora damageddiscs
3) thoracic outletsyndrome
4) temporomandibularjointsyndrome
5) Tietze’ssyndrome
6) Slippingribsyndrome
Each of these syndromescanbe clinicallydetected byathoroughhistory,andphysical examination,
and,more importantly,documentedbyobjective medical testingwhichcanbe usedforan early and
large settlement.
What are the stepsto followinordertoachieve thisit improvedrecovery?The firststepistodocument
that yourclienthasa validcomplaintof pain.Thisisaccomplishedusingatestdevelopedbyateamof
doctorsfrom JohnsHopkinsHospital,calledthe PainValidityTestfoundat
www.MarylandClinicalDiagnostics.com. There have beennine articlespublishedaboutthistest,
involving794patients,authoredbyfacultymembersatJohnsHopkinsUniversity School of Medicine,
and otherinstitutions (1,2,3,4,5,6,7,8,9).

2. `2
The PainValidityTesthas beenadmitted asevidence inover30 casesin8 differentstates.The Pain
ValidityTestcanpredictwhichpatientswill have abnormalitiesonobjectivemedical testingwith95%
accuracy, and predictswhowill nothave abnormalitieswith85% to 100% accuracy. Therefore,thistest
can be usedtorefute the defense claimthatthe patientisfakingormalingering,eveninthe presence of
normal MRIs, CAT scans,and x-rays. Also,the PainValidityTestcanpredictintra-operativefindingswith
93% accuracy (8),and identifydrugseekingbehaviorwith95% accuracy (9).
Researchfroma team of doctors at JohnsHopkinsHospital indicatesthatonly6% to 13% of claimants
are exaggeratingtheircomplaintsof pain (2,3,4). More importantly, 87% to 94% of all claimantshave a
validcomplaintof pain,whichwill be documentedbyobjective medical testing. (2,3,4,5,6). Actually,
more correctly,the validcomplaintof painwill be documentedbythe correctobjective medical testing.
The x-ray,MRI, and CAT scan are not the correct medical testforposttraumaticlesions.
What are the correct medical test?A trial lawyershouldunderstandthatpainisa subjective
physiological experience,whichcannotbe measured.Youcannottake a picture of pain.The bestwayto
explainthistojuryisto ask “If I had an ovenup onthe wall,andI tooka picture of it, andI handedit to
you,couldyou tell me if the ovenishot?" Then ask"If I puta thermometerinthe upand I handedto
you,and itread 375°F, couldyoutell me if the ovenishot?" These questionsclearlyandquickly
demonstrate toa jurythe difference betweenanatomical test,suchasx-rays,MRI,CT comparedto
physiological tests,suchasfacetblocks,rootblocks,andprovocative discograms,aswell asflexion
extensionx-rays,orrotational 3D-CT,ora cine-MRIof the temporomandibularjoint,ora SPECT scan or
PET scan of the brain,or vascularflowstudieswiththe armsupinarms down.Typically,atrial attorney
may nothave a clientwhohas receivedthe lattergroupof test,orin some cases,the trial attorneywas
neverevenheardof some of the testsinthe lattergroup.
What isthe real distinctionbetweenanatomical testingandphysiologicaltesting? The MRI (an
anatomical test) missesdetectionof damageddiscs78% of the time comparedto provocative
discograms(aphysiological test) (10). UprightX-raysneverreveal the pathologyof atorn ligamentina
patientwhocomplaintsof worse neckpainwitheitherflexionorextension. Onlyflexion-extensionX-
rays can detectmotion,whichproducesthe pain. Likewise,the CTmissesboneylesions56% of the time
comparedto a 3D-CT (11, 12), and EMG-Nerve conductionsstudiesmissthe vascularcompressionwhich
ispart of the pathologyof thoracicoutletsyndrome (13). That's whyclientsare somisdiagnosed.
Once the PainValidityTestisbeenobtained, the trial attorneynow knowswhetherornotitis
worthwhile topursue medical testingforhisclient.The nextquestionbecomesdeterminingwhich
medical testisappropriate.Before proper testingcanbe obtained,the client needs anaccurate
diagnosis.Researchfromanumberof medical institutionsindicatesthat40% to 80% of chronicpain
patientsare misdiagnosed,andmayreach91% to 97% for electrical injuriesand“fibromyalgia.”
(14,15,16,17,18,19,20,21). The same group of physiciansfromJohnsHopkinsHospital whodeveloped
the PainValidityTestalsodevelopedThe DiagnosticParadigm andTreatmentAlgorithm, from
www.MarylandCliicalDiagnostics.com.Afteraclientcompletesthistest, within5min.resultsare
available,whichlistsdiagnosesthathave a96% correlationwithdiagnosesJohnsHopkinsHospital
doctors(22). Basedonthese accurate diagnoses,the correctmedical testislisted.The resultsof the

3. `3
correct medical testare whata trial attorneyhasavailable tohimtotake to settlement.Thesetestare
readilyavailable the medical community,andprovide irrefutableevidence of pathology. Armedwiththis
information,the attorneycannowbegintoassemble the materialneeded topursue settlement.
POST-CONCUSSIONSYNDROME:Thisis a physiological phenomena,soitrequiresphysiological testing.
Pathology: The brainis like abowl of Jell-Ocontainedwithinaveryhard skull.One of the mostcommon
areas of damage is when the brainslidesforward andstrikesthe petrosalridge.Typically,thisdamages
the temporal lobe.Thiscanproduce difficultywithspeech,memory,personality,andcanproduce
partial complex seizures.The otherareasof the brainwhichare damagedor the frontal lobe,the
occipital lobe,itwastermedacoup-countercoupphenomena.Damage tothe frontal lobe will affect
smell,taste,andpersonality,whiledamage tothe occipital lobe mayproduce difficultywithvision.
Complaints:The patientoftenwillcomplaintof memoryloss,lossof smellortaste,trouble
rememberingwords,orevenperiodsof lossof consciousness.
Physical Examination: A skilledclinician willperformthe followingphysical testingona patient: testfor
sense of smell,testforsense of taste,tuningforkhearingtest,bothWeberandRhine,testeyesfor
nystagmus,checkthe pupilsreactivitytolight,andequal size,subtract7’sfrom100,give 5 cities,andask
the patienttorepeatthemin 5 minutes(alwaysgive the same 5citiessoyourememberthem),ask
similarities,I.e.howare an apple andan orange alike?(bothfruits),How are canoe anda basketball
alike?(bothfloat),Howare aflyand a tree alike?(bothliving).
Medical Tests: Whenpost-concussionsyndrome suspected, there islimitedvaluein obtaininganMRI or
CT of the brain.Thiswoulddeterminesub-dural hematomas,orotherspace occupyinglesions,butnot
the subtle intellectual changesthatare associatedwithpostconcussionsyndrome,suchasmemoryloss,
alteredspeechpatterns,change inemotion,andsometimespartial complex seizures.The objective
medical testwhichcanbe usedtodetermine elementsof post-concussionsyndrome are EEG,SPECT
scan of the brain,anda PET scan of the brain,as well asa WAISIQ test,Bender-Gestalttesting,Raven
progressive matrices,andLuriaNebraskatesting.
Treatment: There are some exerciseswhichcanhelptoimprove functionally,whereone areaof the
braintakesoverfunctionforthe damagedarea. Thisisa time consuming process,andoftennomajor
improvementisseen.
TORN LIGAMENTS IN THE SPINE OR DAMAGED DISC:
In additiontothe incorrectmedical tests,physiciansfailtoaddressthe clinical featuresof the patients
withchronicpain.One of the mostoverusedgroup of diagnosesissprainsandstrains.Sprainsare
definedasoverstretchingof the ligaments,the fibroustissuewhichholdsthe bonestogether.trainsare
definedasanoverextensionof muscle tissue,whichisattachedtothe bone by the ligaments.(23).
Sprainsandstrainsshouldlastno longerthana month.Afterthat periodof time the problemis
somethingotherthana sprainor a strain.In fact,the Departmentof HealthandHumanServicesof the
US governmenthasdefinedastrainasa disorderwhichcausesan average of 7.5 daysof restricted

4. `4
activity,twodaysof bed disability,and2.5days of work loss(24).So any “sprainor strain”which
persistsbeyondthe monthisincorrectlydiagnosed100% of the time,andrequiresamore directed
medical evaluation.
Pathology: inthe flexionextensioninjuriestypicallyseenwithwhiplash,the ligamentswhichholdthe
vertebral bodiestogetherare oftentorn.Thisallowsexcessivemotionof one vertebral bodyonthe
other,accentuatedbyeitherflexionorextension. However,the facetjointsof the neckare oriented
horizontally,soa tornligamentmayalsoresultinpainwhenturningthe headside toside. Additionally,
the inter-vertebral discmayalsobe damaged,butnotbe visibleonCATscan or MRI.
Complaints:The patientwill complaintof worse painleaninghisheadforward,orleaninghishead
backwards,worse paininthe neckand possiblythe armwithcoughingorsneezingorbowel
movements.
Physical Examination: One obviousexaminationistohave the patientleave hisheadforwardandlean
hisheadbackwardsand tell the physicianwhathe experiencesatthe time.The Spurlingtestconsistof
hittingthe patientontopof the head,to see thatreproducesthe painworsens the painthattheymay
feel inthe neck and/orthe arms. Thismovementcompressesthe diskinthe neck.Muscle tendernessis
oftenpresentinthe scalene muscles, spleniousmuscle. semi-spinaliscapitusmuscle,trapezius,and
othermusclesof the headand neck,butreallycontribute little tothe diagnosis.
Medical Tests: The patientshouldhave flexionextensionx-rayswithobliques,andopenmouth
odontoidviews. If there ispainwithturningthe neck,thena3D-CT withrotationwill show rotational
subluxation. Thenthe patientshouldhave facetblocks. A temporaryfacetblockgivenatthe level of
suspectedpain,andthe level aboveandbelow the suspectedlevel,since afacetjointhassensory
innervationnotonlyfromthe levelof the pain, butreceivescontributionsfromthe levelabove and
belowthe areaof physical damage. A facet denervationisthe treatmentof choice.
If there is paindownthe arms, rootblocks,of specificlevelsC3throughC7 shouldbe performed.
EMG/Nerve conductionstudiesare oftennormal since they donotmeasure sensorynerve damage very
well.Soa sensorynerve test,call the currentperceptionthreshold(Neurometer) will documentsensory
nerve damage. (25). If there'sassociatedheadache,painoverthe ear, radiatingtothe eyebrow,the
patientshouldalsohave aC2-C3 root block.
Finally, if the patientcomplainsof worse neckandarmpainwithcoughingandsneezing, orflexionor
extension, the patientshouldhave provocative discometry,C2throughC3 (18).
Treatment: If facetsyndrome isconfirmed,thenafacetdenervationwill provide relief.However,only
40% of patientsgetupto 2 yearsrelief. The definitivetreatmentisafusion.The same holdstrue for
root damage,althoughaforaminotomymayhelp,insteadof afusion.If there isa damageddisc,the
treatmentisdiscectomy (18). Infact, researchfromJohnsHopkinsHospital documentedthat63% of

5. `5
patientswithnormal MRI,CT and X-ray,whowere diagnosedwith“whiplash”reallyhaddamageddiscs
and neededsurgerytoimprove (18).
THORACIC OUTLET SYNDROME:
Anothercommonlyoverlookeddiagnosisafterarear-endcollision isthoracicoutletsyndrome.In90% of
these cases,compressionof the brachial plexusbetweenthe anteriorandmedial scalenemuscle isthe
source of the symptoms(see Figure 1below). Only10% have vascularcompression(26,27).
FIGURE 1-Anatomyof the thoracic outlet
Pathology: The nerve,arteryand veinsupplyingthe armpassesbetweenthe anteriorandmedial
scalene muscles,but34%of the time,nerve goingdownthe armalsopass betweenthe posteriorand
medical scalene muscle(17).
Complaints: Typically,the patientcomplaintsof painand/or numbnessinthe armgoingto the lasttwo
fingers,orperhapsall fingers.The symptomsworsenwithholdthe armselevatedfor3minutesormore,
oftenseenwhentryingtohanga picture or brushinghair,or paintingaceiling,Extensionof the heador
rotatingthe headwill alsoworsensymptoms.
Physical examination:

6. `6
Since the pathologyof thoracicoutletsyndrome ismostlyneurological,orcombinationof neurological
and vascularpathology,the bestclinical testsisthe Roosmaneuver (26,27). A Roosmaneuverconsistof
askingthe patienttoelevate theirarms,withtheirelbowsashighastheirshoulders,andbent90° at the
elbow.The patientisthenaskedtoholdthatpositionfor2 min.,andthenaskedwhat theyfeel intheir
fingertips.If the fingertipsare numb,thenthisisa positive Roostest.The Adsonmaneuverconsistsof
feelingthe radial pulse andaskingthe patienttoturntheirheadinthe opposite direction.A diminution
of the pulse isindicativeof apositive Adsonmaneuver. Obviously, thismaneuverdetectsvascular
compression,whichoccurslessthan10% of the time in thoracicoutletsyndrome, andeventhenitis
unreliable80%of the time.
FIGURE 2- Clinical testsforthoracicoutlet
Medical tests
However,whenvascularcompressiondoesaccompanythoracicoutletsyndrome,the Roos maneuveris
a bettertestthan the Adsonmaneuver,asdemonstratedbyvascularflow studieswiththe armsupand
arms down,inthe bruise position,comparedtothe Adsonmaneuver.Over80% of the time,vascular
compressionwillbe demonstratedbythe Roos maneuver,butmissedbythe Adsonmaneuver.Again,as

7. `7
istrue withall sensorynerve damage,the neurometerstudiesare useful fordetectingsensorynerve
damage,andare especiallyvaluable,if the studiesare conductedwhenthe patienthastheirarmsin the
Roos position,comparedtobeingatrest(28).
FIGURE 3- Vascularflow studies
The EMG-nerve conduction studiesare of little use intryingtoestablishthe diagnosisof thoracicoutlet
syndrome. because the distance acrossErb’spointislessthan5 inches,whichdoesnotproduce reliable
EMG nerve conductionvelocitystudyresults. Neurometerstudieswiththe armsupand downwill help
documentsensorynerve compression.
Treatment: Resectionof the firstribto decompressthe thoracicoutletisthe definitivetreatmentof
choice. Some surgeonsdecompressthe brachial plexusfromabove,andresectthe anteriorandmedial
scalene muscle,andfirstrib(29).

8. `8
TEMPRO-MANDIBILAR JOINT SYNDROME:
Tempro-mandibularjointsyndrome (TMJ) maymanifestaspaininthe temple,the TMJ,and a clickwith
openingthe jaw.Itmay be associatedwithassociatedbruxism, whichisgrindingof the teeth.Thiscan
be causedby damage to the ligamentsand/ordiscof the jointbetweenthe skull andthe headof the
jaw. The temporomandibular(TMJ) jointisaveryunusual joint. Itslidesforward,slidessidetoside and
hinges. Itisformedbythe headof the condoyle of the jaw (mandible) insertingintoarecessinthe skull
rightbeneaththe temporal bone.
Pathology: The jawis heldagainstthe skull byligaments. The temporomandibular(TMJ) jointisavery
unusual joint. Itslidesforward,slidesside toside andhinges. Itisformedbythe head of the condoyle
of the jaw(mandible) insertingintoarecessinthe skull rightbeneaththe temporal bone. Excessive
motioncan be causedby damage to the ligamentsand/ordiscof the jointbetweenthe skull andthe
headof the jaw. In an accident,when the headisthrownforward,the jaw moveswiththe head,buthas
enoughmomentumtocontinue togoforward,evenwhenthe headstopsgoingforward,whichtears
the ligamentsholdingthe jawtothe skull. These are the stronglateral temporomandibularligaments
and twoweakermedial ligaments (8). The nervesthatsupplythe jointare the auriculotemporal and
branchesof the thirddivisionof the trigeminal nerve (8). Irritationof these nervesproducespaininthe
jaw,cheek,and/ortemple.
Complaints: Tempro-mandibularjointsyndrome (TMJ) maymanifestaspaininthe temple,the TMJ,
and a clickwithopeningthe jaw.Itmay be associatedwithassociatedbruxism, whichisgrindingof the
teeth.The patientmayalsohave ringingintheirears,andtendernessinthe sternocleidomastoid
muscle,anda sensationof a stuffyearwithreducedhearing. Othersymptomsmaybe facial pain,inthe
cheek,paininthe area of the joint,paininthe jaw line,dizziness,paininthe templeand clicksinthe jaw
on openingorclosingthe jaw (30).
Physical Examination: The patientmayfeel tendernessoverthe massetermuscle,the temporalis
muscle,andthe sternocleidomastoidmuscle.There maybe aclickin the TMJ withopeningof the jaw.
Medical Tests: If there issevere ligamentousdamage,the discwill be displaced,whichisbestseemon
cine-MRI,whichisa movie takenusinganMRI machine,while the patientopensandshutshisjaw.
Triggerpointinjectionsintothe sternocleidomastoidmusclemaygive temporaryreliefandserve asa
confirmatorytest.
Treatments: A bite plate mayhelpthe grindingof the teeth.Undernocircumstancesshouldthe teeth
be ground downto“line upthe bite.” Onlyinrare and extreme caseswouldsurgical repairof the
ligamentsbe indicated.

9. `9
FIGURE 4: (Image fromradiopaedia.org-usedwithpermission). Normally,the discresidesasacushion
betweenthe fossainthe skull andthe headof the mandible,calledthe condyle. The image showsan
anteriorlydislocateddiscwithoutrecapture onmouthopening.The bestwaytodetermineif the disc
displaceswithmovementistouse a Cine MRI. Thisis a MRI movie of the TMJ as the patientopensand
shutshisor her jaw.The patientisperformingthe veryactivity(openingandshuttingthe jaw) which
producessymptoms,sothe physicianhasthe opportunitytosee whatactuallyhappenswhenthe
patientopensandshutshisor herjaw.
SLIPPING RIB (“ABERRANT TIETZE’S SYNDROME”) FROM A SEAT BELT INJURY: ThisIs an often
overlooked sequelaof anauto accident. Seatbeltinjuriesoccuronthe side where the seatbeltinserts
Disc isdisplacedhere
Disc belongshere

10. `10
intothe restraint.Typically,thiswill be onthe rightside fora driverandleftside fora front seat
passenger.
Pathology: The 2nd
through9th
ribjointhe sternum.However,the 10th
,11th
rib and 12th
ribhave a
cartilage joiningthesebones tothe ribabove it.Thiscartilage can tear as the resultof trauma.
Complaints:The patientwill feelpain inthe loweroutsideribcage withbendingoverortwisting,or
pressure onthe 10th
and 11th
rib. Painwill be inthe side of the chestat the level of the 10th
ribin line
withthe nipple.
Physical Examination: The “hook sign”isthe bestwayto determine slippingribsyndrome. (31). A
physicianputshisfingersunderthe ribcage of a patient, atthe 10th
rib, and liftsup. If thisreproduces
the pain,thisis a positive hooksign,andthe patienthasslippingribsign.Also,if pressure atthe site of
the painintensifiesthe pain,thisiscompatible withslippedribsyndrome.
Medical Tests: Althoughwidelydiscounteddue tooveruse,thermographyoftenwill show a“hotspot”
at the site of dislocationandinflammation.
Treatment: Steroidinjectionsatthe site mayhelp,butthe ultimate treatmentisexcisionof the ribtipof
the 10th
rib, 11th
riband 12th
rib.
TIETZE’S SYNDROME (COSTOCHONDRITIS) FROM HITTING THE STEERING WHEEL OR AIRBAG:
Tietze’sSyndrome (Costochondritis)occurswhenthere is inflammationatthe junctionof the ribbones
2 through9, and breastbone (sternum).There iscartilage joiningthese bones.Thiscartilage cantearas
the resultof trauma.
Pathology: Costochondritiscanbe foundaftera traumatic injury.Typically,thisisafteracar accident,
where the driver'scheststrikesthe steeringwheel,orfromthe air bag deployment.
Complaints:Most patientswithcostochondritisexperiencepainoverthe frontof the upperchest(the
area of the breastbone).Because of seriousconditions,mostimportantlyconditionsrelatedtoheart
problems,costochondritisshouldonlybe diagnosedafterexcludingothermore seriousproblems.
Costochondritispainisusuallyworsenedbyactivityorexercise.Oftenthe painisworsenedwhentaking
a deepbreath.Thisstretchesthe inflamedcartilage andcancause significantpain.
Physical Examination: Touchingthe area involvedbycostochondritiscanbe extremelypainful forthe
patient.
Medical Tests: Althoughwidelydiscounteddue tooveruse,thermographyoftenwill show a“hotspot”
at the site of dislocationandinflammation.
Treatment:
Costochondritisusuallyrespondswell to rest. Inorderto decrease the inflammation, avoidactivities
whichcause pain,such as lifting. Applyingheat severaltimesaday to the chestcan be helpful in

11. `11
relievingsymptomsof costochondritis.Nonsteroidal anti-inflammatorymedications(I.e.Motrin,Advil)
may helpdecrease inflammation,whichisthe primaryproblem.While symptomsusuallyimprove within
a fewweeksandresolve completely withinafew months,some patientshave thisproblempersistsfor
months. Inpersistentcases, costochondritismaybe treatedwithcortisoneinjections.
The bestexample of whatto expectfromathoroughevaluationof whiplashandcervical spraincases
was reported inanarticle by a teamof physiciansfromJohnsHopkinsHospital,ledbyDonlinLong,MD,
PhD,who wasthe chairman of neurosurgery (18). The article wastitled“FusionforOccult
Posttraumatic Cervical Facet Injury,”andwaspublishin Neurosurgery Quarterly(Volume 16,Number
3, September2006, pages129-134). Dr. Long and histeamevaluatedseventypatientswithnormal MRI,
CT and X-Rays, whohad persistingpainafter injury(median1.7y),who hadfailedall usual conservative
formsof care.Theyhad beentoldbytheirreferringphysiciansthatthere wasnothingmore todo to
helpthem. The patients were offeredadiagnosticblockprotocol todetermine the originsof the
persistingpain.BlocksincludedC-2-3rootsbilaterally;C-2-3-4zygapophyseal joints(facetjoints) and
provocative discographyatC-3-4,4-5, 5-6, 6-7. Of the 70 patients,68 completedthe blockprotocol,and
of these 68 patients,44 of them(65%) wentonto have posteriorcervical fusionsof C-l,2,3, 4 inseveral
combinations. Seventy-nine percentof patientsachievedcomplete painrelief,while 14% received
satisfactorypainrelief.
If the trial attorneyhastheirmedical personnel evaluate their“whiplash”orcervical sprain casesafter
an auto accidentforeach of the 6 commonlyfounddisorders,thereisastronglikelihoodthatmanyif
not all 6 of the disorderswill be found,and63% will likelyneedacervical fusiontoimprove. Thiswill
provide betterpatientcare,and certainlyincrease recovery,whichhelpsbothpatientandattorney
alike.
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