Paxson Question of the Month (Vol. 14: Do I Have to Accept Work Comp or PI Cases?)

Each month, we feature a real question asked by one of your fellow ICS members through Paxson, our closed-system AI assistant built just for Illinois chiropractic physicians. Paxson provides quick, accurate, and member-directed support on a wide range of topics, from insurance issues and licensure requirements to documentation, compliance to social media posts, and more.

These featured questions offer valuable insights you can use in your own practice, and serve as a reminder that help is just a click away.

Have a question? Paxson is ready when you are at www.ilchiro.org/paxson.

This month’s question focuses on both requirements and systems when choosing not to accept workers’ compensation or personal injury cases. In this example, you’ll see how Paxson answers the first question, then provides quality empathetic methods of communication.

The Question (as received)

Member:

“do you have to accept work comp or PI cases?”

Assistant:

No. Based on ICS guidance, you do not have to accept workers’ compensation or personal injury cases.

A few practical points from ICS on this topic:

• For personal injury cases, if you choose to treat them, your office should be clear about how payment will be handled.
• If the patient has MedPay, you can consider billing MedPay if the patient files the claim.
• If MedPay is exhausted, you may be able to bill the patient’s health insurance for remaining services, or for all services rendered.
• However, most PPO contracts do not allow you to bill the patient or the patient’s attorney more than the allowed amounts if you bill health insurance.
• Because of that, you need to decide whether your office is willing to accept the contractual payment arrangement. If not, ICS indicates you may choose not to bill health insurance and instead wait for settlement, or have the patient pay and wait for settlement.
• ICS also stresses full disclosure to the patient about your office policies on use of health insurance, any balance billing, and patient payment responsibility.

For workers’ compensation and third-party liability cases, ICS has also noted that some provider agreements may allow a participating provider to “opt out” of network-discounted personal injury and workers’ compensation cases, depending on the contract terms. Whether that works depends on the wording of your provider agreement.

So the short answer is:

• You are not required to accept these cases.
• If you do accept them, your billing and collection approach should be clearly defined.
• If you participate with networks, review your contracts carefully because some may affect reimbursement or allow opt-out options in PI/WC situations.

Would you like me to draft a simple office policy statement for when your practice does and does not accept workers’ compensation or personal injury cases?

06/29/2026

Member:

“what should you say to a person in the middle of a PI case that is trying to seek care elsewhere and you do not accept PI cases”

Assistant:

A simple, professional approach is to clearly tell the patient that your office does not accept personal injury cases and that they should seek care with another provider.

You should keep the communication:

• objective
• courteous
• consistent
• focused on office policy

A straightforward script could be:

“Thank you for contacting our office. At this time, our office does not accept personal injury cases. Because your care is related to a personal injury matter, we would not be able to see you for this case. We recommend that you seek treatment from another provider who accepts personal injury patients.”

If appropriate, you can also add:

“If you need your records sent to another provider, we can explain the process for requesting or transferring them.”

If the person is already your established patient, you need to be careful about patient abandonment concerns before ending care. ICS explains that abandonment issues can arise if a physician-patient relationship is terminated:

• during acute care, or
• without enough time for the patient to find a replacement provider

In that situation, ICS says:

• any discharge should be in writing
• it should be sent by certified mail or another trackable carrier to the patient’s last known address
• under normal circumstances, allow at least 30 days for termination to become effective
• include the reason for discharge
• state that it is in the patient’s best interests to seek care from another provider
• explain how the patient can obtain or transfer records
• it is good practice to provide another practitioner name or referral service and recommend follow-up care

So the key distinction is:

• If this is a new patient inquiry: you can simply state that your office does not accept PI cases.
• If this is an existing patient already under your care: you should handle it as a patient termination issue carefully to avoid abandonment concerns.

Would you like me to draft both:

1. a front-desk script for a new PI caller, and
2. a written patient notification template for an existing patient you need to transition out of care?

06/29/2026

Member:

“new patient”

Assistant:

For a new patient, you can keep it short, polite, and firm.

Suggested script:

“Thank you for reaching out to our office. At this time, we do not accept personal injury cases. Because your visit would be related to a personal injury matter, we would not be able to schedule you for this case. We recommend that you contact a provider who accepts personal injury patients.”

If they ask about using health insurance instead, you could say:

“Our office policy is that we do not accept personal injury cases, so we would not be able to schedule treatment related to that injury through our office.”

The main goal is to:

• clearly state your office policy
• avoid sounding accusatory
• avoid debating fault, billing, or legal issues
• direct them to seek care elsewhere

For staff consistency, you may want your team to use the same language each time.

A slightly warmer version:

“Thank you for calling. I’m sorry, but our office does not accept personal injury cases. Since your condition is related to a personal injury matter, we would not be able to schedule you. You would need to seek care from a provider who accepts those cases.”

Would you like me to draft a few versions for different situations, such as phone, text, and email, that your front desk can copy and paste?

06/29/2026

Member:

“now write me an acknowledge statement for them to sign”

Assistant:

Absolutely — for a new patient who is being told your office does not accept personal injury cases, you could use a brief acknowledgment statement like this:

Personal Injury Case Acknowledgment

I acknowledge that I informed [Clinic Name] that my injuries and/or requested treatment relate to a personal injury matter.

I understand that [Clinic Name] does not accept personal injury cases and, for that reason, the office will not provide evaluation or treatment for this matter.

I understand that it is my responsibility to seek care from another provider who accepts personal injury patients.

I acknowledge that [Clinic Name] has advised me to seek care elsewhere for this personal injury-related condition.

Patient Name: ______________________________

Signature: _________________________________

Date: _____________________________________

If you want, you could also add this optional line:

I understand that this office’s decision is based on office policy regarding personal injury cases and not on an opinion about the seriousness of my condition.

If you plan to use this regularly, you may want a slightly more polished version for staff consistency:

Acknowledgment of Office Policy Regarding Personal Injury Cases

I acknowledge that I have informed [Clinic Name] that my condition, injuries, and/or requested services are related to a personal injury matter.

I understand that [Clinic Name] does not accept personal injury cases and will not provide care for this matter under its office policy.

I understand that I have been advised to seek evaluation and treatment from another provider who accepts personal injury cases.

Printed Name: ______________________________

Signature: _________________________________

Date: _____________________________________

Would you like me to also draft a matching short front-desk note your staff can place in the chart to document that the patient was informed and declined scheduling?

06/29/2026

Member:

“what do you do if the client lies to you about it”

Assistant:

Based on ICS material, the safest response is to focus on documentation, disclosure, and office policy, not accusation.

If a patient lies or withholds information about a personal injury matter, ICS emphasizes that omitted facts can be uncovered later and can have serious consequences. In related insurance and PI discussions, ICS points to the importance of obtaining complete history and documenting what the patient tells you.

Practical steps supported by the material:

• Ask directly about prior injuries, auto crashes, and personal injury matters. ICS recommends asking about:
  • prior auto crashes or other personal injuries
  • date and type of crash
  • extent of injury
  • treatment rendered
  • residuals or permanent impairment
  • prior history of current complaints
• Explain why full disclosure matters. ICS notes that patients may hesitate to provide past information because they fear it may hurt their case, but omitted information is often discovered later with damaging results.
• Document the history carefully. ICS stresses recording as much information as possible and documenting all prior treatment history in chronological order.
• If you later learn the condition is part of a PI case, document that discovery and your communication with the patient. If your office does not accept PI cases, document that the patient was informed of the office policy once the issue became known.
• Do not rely on future insurance coverage if facts were withheld. ICS specifically warns that a patient cannot withhold information in an effort to obtain insurance coverage, and you should not rely on future coverage in that instance to pay for treatment.
• Document recommendations and patient decisions. Similar to the non-compliance guidance, ICS recommends noting recommendations in the patient record and also noting when a patient declines advice or does not follow through.

A professional way to address it with the patient could be:

“When we scheduled your visit, we understood this was not a personal injury-related matter. We now understand that your condition is related to a personal injury case. Our office does not accept personal injury cases, so we would not be able to continue/schedule care for this matter. You will need to seek care from another provider.”

If this is a new patient, you can decline to schedule based on office policy.

If this is an existing patient relationship, be more careful. ICS notes that ending care can raise abandonment concerns if it occurs during acute care or without enough time for the patient to find another provider. In those cases, termination should be handled in writing with appropriate notice and instructions for records transfer.

Would you like me to draft:

1. a patient acknowledgment stating they confirmed the case was not PI-related, and
2. a staff chart note for when you later discover it actually is a PI case?