“MEDICAL PLATEAU”: What Does It Mean for the Case?

Medical Maximum Diagnosis and Stability.burman law

Once injuries are fully diagnosed and relatively stable, what does Burman Law do next?

This article explains:
  • the term “medical plateau”
  • typical steps taken in a case after medical plateau is reached
Every case goes through phases.  The first phase – the acute trauma phase – begins when the injury occurs.  In the acute trauma phase, the patient is rushed to the Emergency Room (ER). At the ER, some injuries are inadequately addressed, or missed altogether.  ER patients must be “triaged,” with the heart attack victim getting more attention than someone less critical. But over time, as medical professionals provide quality treatment, an injury case evolves from the acute trauma phase, into the medical plateau phase of the case.  In the medical plateau phase, all injuries are identified and all injuries are relatively stable. And so, after the medical plateau phase of the case, Burman Law begins gathering information and supporting documentation to establish:
  • diagnostic codes
  • medical bills for past charges
  • prognosis (how the injury will progress over time)
  • impairment (how the injury will affect physical function)
  • lost earning capacity (how the injury will affect future income)
  • future medical expenses (how much future medical services will cost)
After the above information and documentation is gathered, a settlement demand letter is prepared for the case.  A settlement demand letter outlines the claim for the adjuster in charge.  The settlement demand letter sets forth, in writing, the medical evidence of injury, and proof of damages resulting from the injury.  



What is this article about?

  • soft tissue
  • difficulties in diagnosis
  • injury to soft tissues
  • tips for good treatment

Soft Tissue

Some parts of the human body are movable and some are not.  Bone is not movable.  Soft tissue is movable.  Bones can fracture.  Soft tissues stretch and tear.  Soft tissues include:

  • muscles
  • tendons
  • ligaments
  • nerves
  • the brain

Soft Tissue Injury Can Be Hard to Diagnose

Trauma from an injury causes the brain  to produce adrenaline and endorphins that rush needed energy throughout the body.  This process can “mask” the affects of injury.  Commonly used X-rays show bones, but lack diagnostic value for most soft tissue injuries.  And so, soft tissue injuries are often under-reported or over-looked at the ER.  Additionally, the brain tends to detect injury closest to the brain.  For example, injury to the neck and the low back may be equally serious, but the brain detects the neck injury is “more painful” than the low back injury.  As the neck injury subsides, the back injury may suddenly become more prominent.  Soft tissues are very small, and can be hard for the doctor to detect.

Soft Tissue Injury Involves Sprain and Strain

Injury occurs because some force acts on the human body.  In the ER room, the force acting on the human body is called trauma.  High school physics teaches that strain is a measure of of how much soft tissue deforms (usually tears) as a result of stress (trauma).  Stress (trauma) produces strain.  Stress measures the average deforming force exerted over a defined area of soft tissue.  It is important to remember that:

  • Stress is the force.
  • Strain is the result of that force.

A “Crash” Course on Soft Tissues

Skeletal Muscles move joints. Skeletal muscle are composed of fibers.  These fibers are composed of protein filaments (actin and myosin) that slide over each other to cause a muscle to shorten. Several hundred filaments form a myofibril, hundreds of myofibrils form a muscle fiber, 20-80 muscle fibers make a fascicle and several fascicles make a muscle. When damaged, muscle fibers bleed causing inflammation and pain.

Tendons and Ligaments are generally made up of collagen fibrils.  Collagen is a protein made up of amino acids link together something like rope.  Ligaments connect bones to other bones.  Tendons attach muscle to bone.  Tendons and ligaments generally have less of a blood supply than muscle, and so, it is harder for tendons and ligaments to heal from an injury.

Brain matter is somewhat like jello, and is cradled in the skull.  The brain is surrounded by liquid.  When forces act on the head, the brain can be thrown against the inside of the skull causing injury to the nerve cells, called axons that make up the brain.  The axons act as transmission lines carrying messages to and from various parts of the body.  Axons are very small and hard to image.  Axonal injury is especially difficult to diagnosis.  Common symptoms include:

  • headache
  • changes in speech, smell or memory
  • distorted vision
  • irritability

Soft Tissue Healing:  Getting a Good Result

Following an injury, soft tissues generally heal in 3 distinct phases:

  1. Inflammatory 
  2. Reparatory 
  3. Remodelling

Each phase in the healing process is enhanced by proper treatment.  Under the direction of a skilled physician, anti-inflammatory medications, proper dosages of pain medication, physical therapy, and chiropractic care  are crucial to a good result.  Good communication with your doctor is always a good place to start.  Here are some practical tips:

  • before a visit to the doctor, write down what body part hurts and describe the pain for each body part
  • write down what increases pain to that body part and what decreases the pain
  • carefully answer all questions the doctor asks
  • be direct and to the point with the doctor
  • ask the doctor to identify the parts of the body injured
  • ask the doctor for a diagnosis of each injured body part
  • understand what treatment the doctor recommends
  • as soon as possible, write down what the doctor said
  • do what the doctor recommends
  • let the doctor know if you can cannot do what the doctor recommends

Here is a more in-dept article on communicating effectively with your doctor.   Please contact Mike Burman for answers to any questions.



Courthouse larger photo

TRIAL BY JURY: An Easy to Understand Outline

Injury or Wrongful Death Trial Kentucky or Tennessee

  • The Judge enters Courtroom; everyone stands out of respect for the rule of law.
  • Judge or Court Clerk calls potential Jurors who take seat in jury box.
  • Attorneys on both sides question potential Jurors.
  • Jurors are chosen and seated; those not chosen are allowed to leave.
  • Attorneys give opening arguments; the party bringing the lawsuit goes first.
  • The party bringing the lawsuit puts on evidence and enters exhibits.
  • The party defending the lawsuit puts on evidence and enters exhibits .
  • After all evidence is presented, the Attorneys for each side give closing arguments but this time, the party defending the lawsuit goes first.
  • After closing arguments, the Judge instructs the Jury on the law.
  • The Jury deliberates in the jury room over the jury instructions and evidence.
  • Once the Jury reaches a verdict, the verdict is read by the Judge.
  • The Attorneys are allowed to make legal arguments regarding the verdict.
  • The Judge enters the verdict onto the Court records.
  • Lastly, the Judge dismisses the Jury and thanks them for their service.