For Texas personal-injury counsel
Care decided by the injury,
not by the policy limit.
Every referral and every charge has to stand on the medicine alone. The thresholds are published in advance, the fee basis is a stated multiple of the State’s own schedule, and the notes are written to be read aloud in court.
Three things defense counsel goes looking for in letter-of-protection medicine.
They are the same three every time. This practice is built so that none of them finds anything.
“The treatment was generated for the claim.”
Escalation runs on thresholds published before your client was ever seen: six weeks of documented conservative care before an epidural is appropriate, twelve before an elective surgical opinion, both measured from the start of care rather than the date of the collision. Patients are discharged when they improve. A visit that changes nothing does not happen, because a note identical to the last one is exactly the pattern they look for.
“The billing is inflated.”
Charges are 1.75× the Texas DWC Medical Fee Guideline for the same CPT code — the State’s own schedule for treating injured workers. One schedule applies to every patient of the practice; there is no separate letter-of-protection rate, and nothing is inflated in anticipation of a reduction. A typical twelve-week course of physician care runs about $2,050. The formula and the full table are on this site.
“The physician is a hired opinion.”
Examination findings are attributed to their source and date, never recorded as though performed over video when they were not. Imaging correlation is stated carefully or explicitly declined. No causation opinion is offered beyond what the record supports. The limits of a telehealth examination are stated in the notes rather than left to be discovered.
An independent physician assessment, and the paper to go with it.
Chiropractic records establish treatment. A treating physician’s record establishes diagnosis, causation limits, prognosis and future care — the parts of a demand package that carry the most weight and are the hardest to assemble after the fact.
- Independent diagnosis
A specific anatomic working diagnosis, reached by a physician reviewing the imaging and the referring provider’s examination — not a countersignature on someone else’s plan.
- A staged treatment plan
Named agents, doses, durations and a written reassessment date at every visit, so the course of care reads as a decision trail rather than a sequence of appointments.
- Serial functional scores
Oswestry or Neck Disability Index recorded every visit. Improvement, plateau and residual deficit are measured rather than asserted.
- Referrals that ask for something specific
Naming the diagnostic hypothesis and the procedure requested — for facet pain, dual comparative medial branch blocks at an 80% threshold, not an open request for injections.
- A discharge summary with future care
The whole course, residual findings, permanent restrictions if any, and what this patient is likely to need going forward.
We refer only when the criteria are met, and we say which criteria.
An unnecessary epidural costs your client a procedure and costs you a line item you have to defend. Every escalation from this practice is gated.
Referred, when the threshold is met
- Epidural — radicular pain, concordant imaging, six weeks of care, no progressive deficit
- Facet or sacroiliac — three months of axial pain, with diagnostic blocks requested first
- Surgical opinion — twelve weeks, or immediately on a progressive deficit
- Vertebral augmentation — acute, severe and refractory, all three
Not referred
- Injections for spinal stenosis — the evidence recommends against it
- Intra-articular facet injections — Level IV evidence, weak
- Imaging with no red flag and no clinical question to answer
- Anything whose only justification is that a claim exists
One physician on the file, from intake to discharge.
Dr. Hanna Shanar is an emergency-medicine-trained physician in Houston. Emergency medicine is the discipline of deciding what is dangerous and what is not, quickly, on incomplete information — which is the judgement injury care needs in its first weeks. Your client sees the same physician at every visit.
The limits of a telehealth examination are stated rather than glossed. Motor grading, reflexes, straight-leg raise and palpation cannot be done down a camera. Those findings come from the referring chiropractor’s documented in-person examination, attributed by source and date. Any decision that turns on one of them triggers a request for an in-person exam first, and red-flag symptoms go to an emergency department rather than to a remote judgement call.
Emergency medicine residency at HCA Houston Healthcare – Kingwood, a Level II trauma centre. Texas licensed, DEA registered; both available to referring counsel on request. Every visit on this file is his.
Send the letter of protection. We handle the medicine.
Referrals accepted from attorneys and treating chiropractors across Texas. Most clients are seen within a business day.