Pre-Flight™ — End-to-End Medical-Legal Intelligence Demo

This demonstrates the complete Pre-Flight workflow: intake processing, clinical timeline extraction, deviation flagging, pre-existing condition analysis, and draft demand letter generation — all for a single WA State PI case.

📋 Case Overview

🧬 Clinical Timeline

🚨 Deviation Flags

⚠ Pre-Existing Review

📄 Demand Letter Draft

📊 Pre-Flight™ Scores — WA State PI Analysis

DEMO DATA

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Case Viability (1–100)

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Deviation Index (1–100)

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Record Quality (1–100)

Scores reflect Signal Loom analysis of provided records. Not legal advice. Attorney review required before case determination. All data fictitious — demo only.

📋 Signal Loom Case Summary

Demo Plaintiff T. Caldwell is a 41-year-old legal assistant who sustained a rear-end impact injury on November 3, 2024, resulting in a confirmed C5-C6 disc herniation with right C6 radiculopathy and an incidental C6-C7 degenerative disc finding. The clinical record is well-documented across five providers. The patient failed 6 weeks of conservative care and has now entered the surgical consideration window. The contemporaneous documentation supports the causal relationship between the MVA and the cervical injury. The primary flag for attorney review is the documented right shoulder pain at initial presentation that was never imaged — this represents a potential inadequately evaluated concurrent injury. The C6-C7 degenerative finding creates a pre-existing condition exposure that defense will likely raise. Surgery appears consistent with standard of care if epidural steroid injection fails.

✓

Contemporaneous
Documentation

⚠

Pre-Existing
Exposure

⚠

Uninvestigated
Shoulder Injury

📝 Intake Summary — T. Caldwell

Plaintiff

T. Caldwell — 41 y/o Female

Incident

Rear-End MVA — Nov 3, 2024

Location

Bellevue, WA (King County)

Primary Injury

C5-C6 Disc Herniation, Right Radiculopathy

Providers Seen

5 (Urgent Care → PCP → MRI → Ortho → PT)

Work Status

Off work — 32 days lost wages

Medical Bills (to date)

~$4,180 (estimated)

Insurance

PIP applied; Health (Regence); TDB Ins. Co.

🧬 Clinical Timeline — T. Caldwell

DEMO DATA

November 3, 2024 — Day 0

Motor Vehicle Accident — Rear-End Impact

Plaintiff stopped at red light, rear-ended by commercial delivery vehicle estimated 35–40 mph. Airbag deployed. Patient extracted by EMS. Ambulatory at scene. Chief complaints: neck pain 7/10, right shoulder pain, lower back 3/10. Right shoulder pain documented but no shoulder imaging ordered at ER.

November 3, 2024 — Day 0

Emergency Department — Overlake Hospital Medical Center Flag — Uninvestigated Injury

Cervical X-ray: no fracture. Diagnosed: cervical strain, acute pain. Advised to follow up with PCP in 5–7 days. Given止痛 Rx and muscle relaxer. Note: Patient reported right shoulder blade pain. No shoulder imaging performed. No referral to orthopedics documented.

November 3–19, 2024 — Days 0–16

Gap in Care — 16 Days

No documented medical contact during this period. Patient reports worsening neck pain and new right index finger numbness. Gap consistent with mild-moderate injury pattern but creates mitigation exposure.

November 19, 2024 — Day 16

PCP Follow-Up — Eastside Medical Partners Flag — Documentation Gap

Cervical pain now 9/10, radiating down right arm to index finger. Neurological exam limited to sensation only — motor strength and reflexes not documented. MRI C-spine ordered. Work restrictions documented. Refer to orthopedics.

November 29, 2024 — Day 26

MRI — C-Spine — Insight Imaging Objective Finding

C5-C6: Broad-based posterior disc osteophyte complex with right paracentral and foraminal component. Moderate right neural foraminal narrowing. Impingement of right C6 nerve root confirmed. C6-C7: Posterior disc bulge, mild bilateral facet arthropathy. No definite nerve root contact. No fracture.

December 6, 2024 — Day 33

Orthopedic Consult — Proliance Orthopedics & Spine Pre-Existing Flag

Confirmed C5-C6 disc herniation with right radiculopathy. C6-C7 degenerative disc disease noted as "possibly pre-existing given the degree of degeneration." Conservative care recommended: PT 2x/week x 6 weeks, ESI at week 4 if no improvement. ACDF C5-C6 reserved for failed conservative care. Patient off work 4 weeks.

December 6 – January 10, 2025 — Days 33–68

Physical Therapy — BenchMark Physical Therapy

12 sessions completed over 6 weeks. NDI improved from 42/100 (severe) to 28/100 (moderate). Positive right Spurling test persistent. Cervical ROM improved but radicular symptoms ongoing. ESI scheduled.

January 17, 2025 — Day 75

ESI — C5-C6 Right — Proliance Interventional Spine

Transforaminal epidural steroid injection, C5-C6 right. Patient reported 60% pain reduction at 2-week follow-up. Neck Disability Index improved to 18/100. Surgery deferred pending long-term outcome assessment.

February 14, 2025 — Day 103

3-Month Follow-Up — Proliance Orthopedics

Pain improved to 3/10 with activity. NDI 14/100 (mild disability). ESI maintained benefit. Patient returned to modified duty work. Recommending ongoing monitoring. Surgical option remains available if symptoms escalate.

🚨 Deviation Flags — Ranked by Pre-Flight™ Analysis

DEMO DATA

Uninvestigated Right Shoulder Injury

CRITICAL

Patient reported right shoulder pain at initial ED presentation on November 3, 2024. No shoulder imaging was performed. Patient has persistent right upper extremity symptoms throughout the record. The right shoulder was never evaluated as a separate anatomical site. This represents a potential missed or inadequately documented concurrent injury that may have independent diagnostic and treatment significance.

[DEMO CITATION — FICTIONAL] Source: ED Record, Overlake Hospital Medical Center, Nov 3, 2024 — "Patient reports right shoulder pain. No imaging of right shoulder performed." / PCP Note, Eastside Medical Partners, Nov 19, 2024 — "Right arm radicular symptoms extending to index finger." / Ortho Consult, Proliance, Dec 6, 2024 — Right upper extremity reviewed, no specific shoulder assessment documented.

Attorney action required: Determine whether shoulder injury claim should be added to suit. Obtain all shoulder imaging if any was performed at a later date. Review whether ED failure to image constitutes a separate negligence claim against the facility or requires supplemental expert review.

C6-C7 Pre-Existing Degenerative Disc Disease — Causation Dispute Exposure

HIGH

Dr. Patterson at Proliance explicitly noted C6-C7 degenerative disc disease as "possibly pre-existing." The defense will argue that the C6-C7 component of the claim is unrelated to the MVA. The MRI report does not clearly distinguish acute traumatic injury from degenerative change at C6-C7. This creates a causation dispute on the lower level that requires prior medical record review and possibly a radiology expert to establish whether the degenerative finding is age-related incidental or was aggravated by the incident mechanism.

[DEMO CITATION — FICTIONAL] Source: Orthopedic Consult Note, Proliance Orthopedics, Dec 6, 2024 — "C6-C7 mild degenerative disc disease — may be pre-existing given degree of degeneration." MRI Report, Insight Imaging, Nov 29, 2024 — "C6-C7: posterior disc bulge, mild bilateral facet arthropathy, no definite nerve root contact."

Attorney action required: Obtain all prior cervical spine records. Prior imaging (if any) establishing pre-incident baseline is critical. If no prior records exist, biomechanical expert may be needed to establish acceleration-deceleration mechanism consistent with multi-level disc injury.

16-Day Gap in Medical Care — Mitigation Exposure

HIGH

No documented medical contact between the ED visit on November 3 and the PCP follow-up on November 19. Washington follows a failure to mitigate doctrine — if a plaintiff fails to obtain reasonable medical treatment after an injury, their recoverable damages may be reduced proportionally. Defense will argue that the 16-day gap shows the injury was not as serious as claimed, or that delaying evaluation caused worsened outcomes.

[DEMO CITATION — FICTIONAL] Source: ED Record, Overlake Hospital, Nov 3, 2024 — "Advised to follow up with PCP in 5–7 days if symptoms persist." Patient did not seek care until Day 16. PCP Note, Eastside Medical Partners, Nov 19, 2024 — Patient reports symptoms worsening during gap period.

Attorney action required: Document patient's testimony explaining the reason for the delay. Was follow-up care inaccessible? Was patient following ED advice? Did the patient attempt to contact providers? Written explanation contemporaneous with the gap is strongest; attorney-prepared declaration is fallback.

Incomplete Neurological Examination at PCP Visit

MEDIUM

The PCP's neurological examination on November 19 documented only sensory testing. Standard of care for suspected cervical radiculopathy includes motor strength testing (0–5 scale), deep tendon reflexes, and provocative maneuvers (Spurling's test, upper limb tension test). The absence of these findings in the record is ambiguous — it may mean they were performed and not documented, or they were not performed. Either way, the record is insufficient to establish the full neurological baseline at that visit.

[DEMO CITATION — FICTIONAL] Source: PCP Note, Eastside Medical Partners, Nov 19, 2024 — "Neuro: sensation intact to light touch, right upper extremity." Note absence of motor, reflex, and special maneuver documentation.

Attorney action required: Request supplemental records from Eastside Medical Partners. If records are incomplete, obtain expert review of what the absent findings would typically show in a patient with documented radiculopathy at C6.

ESI Outcome — Ongoing Treatment Plateau

MONITOR

ESI at C5-C6 produced 60% pain reduction at 2-week follow-up and NDI improved to 14/100 at 3 months. This is a positive outcome suggesting the injection was helpful. However, the persistent mild disability level and ongoing symptoms mean the surgical option remains open. The question for damages is whether this represents a stable long-term outcome or a plateau before further deterioration.

Attorney action required: Request 6-month follow-up records. If symptoms remain stable at mild disability level, settlement value increases. If symptoms worsen, surgical option (ACDF) becomes more likely and damages increase accordingly. Maintain surveillance of patient's functional status.

⚠ Pre-Existing Condition Analysis — T. Caldwell

DEMO DATA

C6-C7 Degenerative Disc Disease

HIGH EXPOSURE

The C6-C7 finding was identified on MRI as a posterior disc bulge with mild bilateral facet arthropathy. The orthopedist characterized it as "possibly pre-existing given the degree of degeneration." Degenerative disc disease at C6-C7 is extremely common in adults over age 35 and is frequently an incidental finding unrelated to any specific traumatic event. However, the mechanism of injury (rear-end impact at estimated 35–40 mph with airbag deployment) is consistent with acceleration-deceleration forces capable of aggravating pre-existing degenerative changes at adjacent spinal levels.

Assessment:

The defense will argue C6-C7 is entirely pre-existing and unrelated to the MVA. The plaintiff must establish that the incident aggravated or accelerated the degenerative condition at that level. This requires prior medical records establishing the baseline pre-incident status, and potentially a biomechanical expert to opine on injury mechanism. If no prior imaging exists, establishing pre-existing status becomes more difficult for defense and the C6-C7 finding may be attributed to the incident by default.

Prior Neck Symptoms — None Documented

LOW EXPOSURE

Per patient intake declaration, no prior neck injuries, chronic cervical conditions, or ongoing cervical symptoms were reported prior to the November 3, 2024 incident. Patient's PCP records (Eastside Medical Partners) do not document any cervical spine complaints in the period prior to the incident. Absence of prior treatment for cervical conditions is favorable — defense cannot point to an established pre-incident cervical condition.

Prior MVA or Personal Injury History — None Documented

LOW EXPOSURE

Patient denied any prior motor vehicle accidents or personal injury claims in intake. Attorney should independently verify through a litigation background check and UIM/underinsured motorist carrier records, as patients do not always disclose prior claims. If prior PI history exists, it creates both causation and damages exposure — prior claims history searches are recommended before filing.

⚡ Attorney Action Items — Pre-Existing Condition Review

Obtain all prior cervical spine imaging — MRI reports, X-ray reports from any prior date
Obtain all prior PCP records from Eastside Medical Partners — minimum 5 years back
Run litigation background check and PI claim history search
Contact all prior employers for workers' compensation records
If prior records show pre-existing C6-C7 changes: retain biomechanical expert to opine on acceleration-deceleration injury mechanism
If no prior records exist: argue incidental finding vs. traumatic acceleration — expert testimony on both sides expected

📄 Draft Demand Letter — T. Caldwell v. [Defendant]

⚠ DRAFT ONLY — NOT FOR FILING

AARON JONES, JD
Attorney at Law, Washington State
[Firm Name]
[Address]
[City, WA ZIP
Tel: [Phone]
Email: [Email]

Date: February 28, 2025
Via: Certified Mail, RRR

Claims Department
[Defendant's Insurance Carrier]
[Address]
[City, State ZIP]

Re: Demand for Settlement
Our Client: T. CALDWELL
DOB: [DOB]
Claim No.: [Claim Number]
Incident Date: November 3, 2024
Incident Location: NE 8th Street & 108th Ave NE, Bellevue, WA

To Whom It May Concern:

This office represents T. Caldwell ("Claimant") in connection with the above-referenced motor vehicle accident that occurred on November 3, 2024, at the intersection of NE 8th Street and 108th Avenue NE, Bellevue, Washington. We write to demand settlement of all claims arising from this incident prior to the filing of litigation.

I. FACTUAL BACKGROUND

On November 3, 2024, Claimant was lawfully stopped at a red traffic signal at the intersection of NE 8th Street and 108th Avenue NE, Bellevue, Washington. A vehicle operated by [Defendant] struck Claimant's vehicle from the rear at an estimated speed of 35–40 miles per hour. The impact was of sufficient force to deploy Claimant's vehicle airbag. Claimant was transported by EMS from the scene. The parties' vehicle damage and the police report corroborate the severe rear-impact mechanism.

The investigating officer documented [Officer Name], Badge [#], from the Bellevue Police Department. A copy of the police report is enclosed as Exhibit A.

II. LIABILITY

Liability is clear and undisputed. [Defendant] was operating a vehicle at an unsafe speed and failed to maintain a safe following distance, striking Claimant's stationary vehicle from the rear. This constitutes negligence per se under RCW 46.61.145. No contributory negligence can be attributed to Claimant, who was lawfully stopped at a red light. [RCW citation and applicable case citations to be inserted by attorney]

III. MEDICAL HISTORY AND DAMAGES

Following the incident, Claimant sought immediate medical care at Overlake Hospital Medical Center's Emergency Department, where she was diagnosed with acute cervical strain and referred for follow-up orthopedic evaluation. Over the following [X] months, Claimant has undergone the following treatment:

Documented Medical Treatment and Special Damages

Date	Provider / Facility	Service	Amount
Nov 3, 2024	Overlake Hospital ED	Emergency Department evaluation, cervical X-ray, medications	$[amount]
Nov 19, 2024	Eastside Medical Partners — PCP	Evaluation, neurological assessment, MRI order	$[amount]
Nov 29, 2024	Insight Imaging	MRI C-Spine without contrast	$[amount]
Dec 6, 2024	Proliance Orthopedics	Orthopedic surgical consultation	$[amount]
Dec 6 – Jan 10, 2025	BenchMark Physical Therapy	12 sessions physical therapy	$[amount]
Jan 17, 2025	Proliance Interventional Spine	ESI C5-C6 right	$[amount]
Total Documented Medical Specials			$[TOTAL]

Claimant incurred 32 days of total disability from employment as a legal assistant, resulting in lost wages of $[WAGES CALCULATION]. Claimant is a [X]-year-old legal assistant with a [X]-year work history and annual earnings of $[ANNUAL INCOME]. [Employer verification letter and pay stubs to be enclosed.]

Claimant continues to experience ongoing cervical pain and right upper extremity radiculopathy, and has been advised that future surgical intervention (anterior cervical discectomy and fusion, "ACDF") at C5-C6 may be required if her current level of improvement does not sustain. Future medical care, including the possibility of surgery and related rehabilitation, is reasonably estimated at $[FUTURE CARE ESTIMATE — EXPERT REQUIRED].

IV. INJURY AND CAUSATION

MRI imaging confirmed a disc herniation at C5-C6 with impingement of the right C6 nerve root — consistent with the acceleration-deceleration mechanism of the November 3, 2024 rear-end collision. This diagnosis has been confirmed by an orthopedic spine specialist. The mechanism of a rear-end impact at the described speed produces sufficient cervical loading force to cause disc herniation in individuals of Claimant's age, independent of pre-existing degenerative findings at adjacent levels. [Orthopedic expert narrative on causation to be appended.]

Claimant had no prior cervical spine injuries, surgeries, or chronic pain conditions prior to this incident. Her pre-incident medical records, enclosed as Exhibit B, confirm the absence of any prior cervical spine complaints or treatment.

V. SETTLEMENT DEMAND

Based on the foregoing, Claimant's documented special damages, ongoing and future medical care, lost wages, and pain and suffering, we demand settlement in the amount of [DEMAND AMOUNT — TO BE SET BY ATTORNEY] in full and final resolution of all claims arising from the November 3, 2024 incident.

This demand includes all past and future medical expenses, lost wages, loss of earning capacity, pain and suffering, and all other damages recoverable under Washington law.

We allow 30 days from the date of this letter to respond before we proceed with the filing of a complaint in King County Superior Court. This letter constitutes a formal demand for UIM/underinsured motorist benefits under RCW 4.22.040 and a reservation of all rights under applicable UIM coverage.

We look forward to your prompt response.

Respectfully submitted,

[AARON JONES, JD]
[Firm Name]
Attorney for Claimant T. Caldwell

Enclosures:
Exhibit A — Police Report
Exhibit B — Prior Medical Records
Exhibit C — Medical Bills and Receipts
Exhibit D — Wage Verification
Exhibit E — MRI Report

⚠ This draft demand letter was generated by Signal Loom Legal Pre-Flight™ as a starting point for attorney review. All bracketed items [like this] require attorney verification, insertion of actual amounts, and independent legal judgment before use. This document is attorney work product and is not legal advice. All facts, amounts, and citations must be verified by counsel before transmission.