How to Document Your Medical Injuries in a Personal Injury Case

When you are involved in an auto accident, trucking accident, or any other personal injury case, it is critical that your treating physicians thoroughly document the full extent of your injuries. This includes listing details about: your physical pain, your physical impairments, your mental suffering or anxiety, and your inability to perform usual activities. It is critical that you provide your treating doctor with all of the details relating to your injuries, limitations and restrictions, and mental suffering and anxiety.

Details in Your Diary

After your accident, it is critical that you maintain a diary that thoroughly documents all of your injuries, pain, impairments, restrictions, and your inability to perform your usual activities both at home and at work. It is essential that your diary also details the emotional impact of your accident. Particularly, how has the accident impacted your ability to drive? Are you more anxious and / or nervous when you drive by the scene of the accident? Do you have nightmares about the accident? Does the increase in your pain cause you to be extremely tired, emotionally distraught, nervous, and anxious? You must outline for your doctor in detail all of your mental distress and anxiety relating to all of your worries concerning your injuries and pain.

Doctor Visits

Whenever you see your treating physician, you must always advise your doctor about your injuries by going from the top of your head to the bottom of your feet. Please list all of your injuries and describe in detail what those injuries feel like. Use descriptive words to describe what the pain feels like inside your body. For example, many of my clients describe their neck pain as an aching, throbbing sensation that is constant or comes and goes. Many clients describe their back pain as a burning, radiating pain that sometimes causes shooting pains that radiate into their legs.

In addition to describing your injuries and being descriptive about what your pain feels like inside your body, you also have to describe to your doctor all of your limitations and restrictions—including if you have experienced temporary or permanent loss of function of any body part. Also, be sure to describe any inabilities to perform normal life activities, such as driving your vehicle, doing work in the yard, or caring for family members.


If you still have questions about your personal injury case, The Law Office of Tom Somos, LLC has helped numerous people like you. As always, feel free to contact our office with any questions.

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