Chiropractic practices get paid on personal injury cases at settlement, which on a typical case is twelve to eighteen months after treatment — longer than twenty-four months on complex ones. Until then the practice has delivered the care, paid its staff and covered its rent without being paid for any of it.
The practices that grow through that do four things: they decide deliberately what share of their book personal injury should be, they standardise intake so every case is documented the same way, they give records requests a named owner and a standing rhythm with their top referring firms, and they stop financing the gap out of their own operating cash.
The first three are free. The fourth is what makes the first three possible.
Three things have moved at once, and they explain most of the pressure practices are describing right now.
Chiropractic Economics has run an annual salary and expense survey for twenty-eight years. It is self-reported with a small sample, so it should be read as a direction rather than a measurement. The direction is consistent.
| What moved | 2023 | 2025 |
|---|---|---|
| Personal injury share of payer mix | 12.5% | ▲16% |
| Average billings | $663,000 | ▲$723,000 |
| Average collections | $489,000 | ▼$450,000 |
| Reimbursement rate | 71% | ▼62% |
Source: Chiropractic Economics 26th and 28th Annual Salary & Expense Surveys.
Billings up. Collections down. And the slice of the book growing fastest is the one that pays last.
The backdrop matters too. There are roughly 61,700 chiropractors working in the United States, a number the Bureau of Labor Statistics expects to grow about 9% over the next decade — faster than the average occupation. Fifty-seven percent of practices in the survey were solo.
So: a growing profession, mostly small practices, absorbing more of the slowest-paying work in healthcare. The squeeze is structural. It is not a reflection of how well any individual practice is run.
Because payment is tied to the resolution of a legal case, not to the delivery of care.
When a practice treats under a letter of protection, it agrees to be paid out of the eventual settlement. That settlement depends on liability being established, the treatment picture being complete, a demand being built and a negotiation concluding — none of which the practice controls or can accelerate. Twelve to eighteen months is the normal path. Complex cases commonly run past twenty-four.
A surgical practice extends credit once, on one large bill. A chiropractic practice extends it across a long course of visits — accumulating week by week, before a single dollar arrives.
There is no correct percentage. There is a correct process, which is deciding rather than drifting.
Personal injury behaves nothing like the rest of a chiropractic book. Cash patients pay today. Health insurance pays in weeks. Personal injury pays in a year or two, and only if a number of things outside the practice go right. Those are three different businesses operating under one roof.
Drift is the expensive version, and it never feels like a decision. A firm sends two cases, they go well, it sends four more. A paralegal starts using the practice’s number. A second firm hears about it. None of that looks like something to manage — it looks like the referral flow every practice works for years to build.
But twenty open cases is a materially different business from five, and sixty is different again. Nothing announces the crossing.
The practical question is simply: what share of our work is personal injury today, and what share do we want it to be? Most practices have a feeling about the first number rather than the number itself.
A high share is not a problem. Personal injury is often the most valuable book in chiropractic, and the strongest practices are frequently built around it. The point is not to have less of it. The point is to know it has been chosen, and to run it accordingly.
Three documents, done the same way every time.
This is the document connecting the injury to the incident. At the first visit the patient can describe what happened accurately. Months later it becomes a reconstruction rather than a record, and where it is thin the connection has to be built from whatever else exists.
Not an individual provider’s name, not a shortened trading name — the same name on the practice’s W-9 and on its bills. This drifts most in practices that are growing: a second location opens, the practice starts trading under a shorter name, a restructure changes the billing entity while the letterhead stays as it was.
Clinical notes are usually written in shorthand that makes sense to whoever wrote them. In a personal injury case they are read by people with no context, assessing what the treatment was worth. That does not mean writing more — it means writing so an outsider can follow what was done and why, with bills that match what the notes describe.
None of these require money, software or a hire. They require deciding once and not drifting. A fuller treatment of what each document has to prove is in our guide to what makes a personal injury receivable fundable.
Give them a named owner, and put a rhythm on the firms that send the most work.
In most practices records requests land on whoever is free, which means nobody owns them, which means they slip in the weeks the practice is busiest — the same weeks the most requests arrive.
This matters more than it sounds. When a law firm builds a demand it assembles what it has in front of it, and what is in the package is what gets argued for. Records and bills arriving afterwards need a supplemental demand, which firms resist and sometimes do not pursue. A slow response can quietly leave delivered treatment outside the number under negotiation.
The failure is almost always ordinary. A request arrives on a Tuesday, the front desk is short that week, the follow-up lands while someone is on leave, and the demand goes out with whatever the firm already had. Nobody behaved unreasonably at any point, which is exactly why it is hard to catch.
Partial responses are worse than slow ones. Sending what is easy to find now and the rest later feels responsive; from the other end it restarts the request, and it is the version most likely to leave something out permanently.
The highest-return habit, and the one fewest practices have: pick the three or four firms sending the most work and put a standing monthly fifteen-minute touchpoint on the calendar with each. Not chasing — scheduled. It converts unpredictable interruptions into one predictable conversation and surfaces problems while they are still small. A firm running dozens of cases at once is not optimising for excellence; it is optimising for predictability.
Because all of them are free, and all of them require time the stretched practice does not have.
When a practice carries twelve to eighteen months of unpaid treatment on its own balance sheet, the owner absorbs the gap personally — not with money, with attention. Admin moves to the evenings. Records slip because the person who pulls them is covering two roles. Intake gets inconsistent because the person who owned it left and was not replaced.
What is actually happening is worth naming plainly. A practice treating personal injury patients on a lien is lending. Care is delivered today, staff and rent and supplies are paid today, and payment arrives in a year. A practice with a meaningful personal injury caseload is running a small finance operation alongside a clinic — and funding it out of the cash and insurance side of the book.
The patients paying today are, in a real sense, financing the patients who will pay in two years.
That holds until something ordinary happens: a lease renewal, an equipment failure, a staff absence. With no slack anywhere, the ordinary thing becomes a squeeze, and the squeeze lands on exactly the habits above.
The practices opening second locations are not better at absorbing that. They stopped absorbing it.
The three habits are worth building whether or not a practice ever works with a funding partner. What funding changes is whether there is room to build them.
Golden Pear’s healthcare solution closes the gap between delivering care and being paid — practices are paid on their personal injury receivables now, rather than at settlement. There are two ways to structure it.
Straight purchase
The practice takes the certainty of being paid up front, and that is the end of it. Usually the fit for a practice that wants to stop thinking about personal injury cash flow altogether.
Advance + back-end split
The practice is paid now and stays in the deal — when the case settles, it shares in the outcome. Usually the fit for a practice with conviction in its own case mix.
Golden Pear works across thirty-five markets: thirty-four states and the District of Columbia.
Capital Checkup
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Get a free personalised analysis of what is currently sitting in your personal injury accounts receivable — or comment “Capital Checkup” on our LinkedIn page.
Request your Capital CheckupHow long does it take a chiropractic practice to get paid on a personal injury case?
Payment comes at settlement, which is typically twelve to eighteen months after treatment and commonly past twenty-four months on complex cases. The practice delivers and pays for the care throughout that period.
What percentage of a chiropractic practice’s revenue is personal injury?
Around 16% of the payer mix in the most recent Chiropractic Economics annual survey, up from roughly 12.5% two years earlier. Practices built around personal injury run far higher.
Why are chiropractic collections falling while billings rise?
The same survey shows average billings rising to about $723,000 while collections fell to about $450,000, with the reimbursement rate dropping from 71% to 62% in a year. Part of that is the growing share of personal injury work, which is billed now and collected much later.
What is a letter of protection?
A document under which a provider agrees to treat a patient and be paid from the eventual settlement rather than at the time of care. It should be issued in the practice’s correct legal entity name and should assign the receivable, not only acknowledge a lien.
Why does the accident description have to be written at the first visit?
It is the document connecting the injury to the incident, and it cannot be accurately reconstructed later. Where it is thin the connection has to be built from whatever else exists; where it is missing it may not be buildable at all.
Can a chiropractic practice get paid before a personal injury case settles?
Yes — through medical receivables funding, structured either as a straight purchase of the receivable or as an advance plus a share of the outcome when the case settles.