Low Property Damage, Real Injury: Using ER Documentation to Defeat the LPD Defense

“Low property damage means low injury.” The defense leans on that line because the photos look persuasive. But the emergency department record tells a different story when you know where to look and how to frame it. Soft‑tissue injuries don’t follow the logic of a clean bumper; they follow biology. Early ER documentation captures the body’s response in real time, and jurors and adjusters tend to trust what’s recorded at the moment a patient seeks help.

Start with the mechanism of injury. When the record describes a rear‑end impact, a side hit, rotational forces, or acceleration–deceleration of the head and neck, you have a plausible pathway for injury even at low speeds. Details like seatbelt markings, airbag deployment, or even headrest position help explain how forces transfer to the cervical and lumbar spine. When you quote this language directly in a demand and link it to accepted biomechanical principles, you shift the conversation from pictures of a bumper to physics acting on human tissue.

Next, look for early pain localization. Specific complaints documented at triage—right paraspinal neck pain, occipital headache, or focal tenderness—are far more credible than a later, broad description that everything hurts. Those first twenty‑four hours become your map. When the ER triage note, the discharge summary, and the initial primary care or physical therapy visit all point to the same regions and patterns, you’ve established internal consistency that’s hard to dismiss.

Objective findings often carry more weight than adjectives. A record that documents reduced cervical range of motion, palpable muscle spasm, guarding, focal tenderness, or a positive Spurling’s maneuver is harder to wave away than a pain score alone. Adjusters can argue about “8 out of 10,” but they struggle to ignore a clinician’s measured loss of motion or observed spasm. When you present those findings in the order they occurred and cite the exact lines, you convert a “minor crash” narrative into a documented injury story.

Coding consistency matters more than most people realize. When ICD codes align with the clinical narrative—cervical sprain, lumbar strain, or other soft‑tissue injuries—and the mechanism codes correctly reflect a motor‑vehicle collision, the record reads as coherent. Mismatches invite low offers because they signal sloppiness or uncertainty. When the narrative supports it, a simple coder clarification or physician addendum early in the case can close that gap and restore credibility.

Imaging decisions are often misunderstood. A lack of X‑rays or CT scans is not evidence of a lack of injury; it’s evidence that the clinician followed decision rules such as NEXUS or the Canadian C‑Spine criteria. When the record explains why imaging wasn’t indicated, it removes the oxygen from the familiar “no imaging, no injury” argument. Citing those guidelines in your letter helps you frame conservative care as good medicine, not minimization.

Finally, discharge instructions often do more work than they’re given credit for. Guidance about soft‑tissue injury care, red‑flag symptoms, expected stiffness, activity modification, and medications presumes that an injury exists and anticipates its course. When subsequent care—physical therapy, chiropractic, or pain management—follows directly from the ER plan, you undercut claims of unreasonable treatment or gaps.

Consider a quick example. A rear‑end collision leaves minimal trunk damage, less than a few hundred dollars in visible repairs. The ER triage note documents sudden neck pain with an occipital headache. The exam records decreased cervical range of motion and right‑sided paraspinal spasm with an intact neurological screen. The clinician follows NEXUS, explains why imaging isn’t indicated, and discharges the patient with anti‑inflammatories, range‑of‑motion exercises, and clear return precautions. Coding aligns with cervical sprain and a motor‑vehicle mechanism. When that documentation is paired with timely follow‑up and consistent complaints, the case stops looking like a nuisance and starts reading like a legitimate soft‑tissue injury—often moving value from token to meaningful.

If you want a fast read on whether your ER records support the injury despite low vehicle damage, I offer a forty‑eight‑hour ER record triage with a red‑amber‑green memo and specific addendum requests when they will help. Email me at david@grundymdconsulting.com or call me at (650) 649-5253. Turnaround is forty‑eight hours, and you’ll receive a one‑page memo with line‑cited excerpts you can use immediately.