Should You See a Chiropractor?

Back and neck injuries are among the most common allegations in personal injury lawsuits. Clients often seek treatment from chiropractors for these problems. But is treating with a chiropractor good for your lawsuit?

Without getting into a debate on the merits of chiropractic care from a medical standpoint, I can easily say that chiropractors are a mixed bag at best when it comes to your lawsuit. Why? Because most insurance adjusters and personal injury lawyers, including plaintiffs’ lawyers, do not have a great deal of respect for chiropractors. They are not medical doctors. The treatments they provide are expensive and administered frequently. Many chiropractors aggressively target their advertising towards accident victims. The perception of many in the legal and insurance professions is that while chiropractic treatment may provide temporary pain relief (as would, say, a nice massage), ultimately the cost of the treatment vastly exceeds the benefits provided. So, am I saying that you should never see a chiropractor? No. I am saying be smart with your medical costs and make sure you are getting the most bang for your buck.

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See a Medical Doctor First

If you have suffered a back or neck injury in an accident, I strongly recommend seeing a medical doctor before you consider seeing a chiropractor. If you have a serious injury, such as a herniated disc, you may not want a chiropractor “adjusting” your spine until you hear from a medical doctor that it is safe to do so. If you require surgery, your medical doctor can give you a referral to a specialist. If you are in pain, a medical doctor can give you a prescription for the appropriate medication (chiropractors cannot prescribe medication). From a lawsuit perspective, it looks much better if you go to a family doctor first, rather than immediately seeking a chiropractor. True or not, it is a widely held belief in the personal injury field that people who are really hurt go to medical doctors and people who just want money go to chiropractors. See a medical doctor first. If you are cleared to see a chiropractor, you can decide after that if chiropractic care is right for you.

The Truth About Soft Tissue Cases

In most personal injury cases involving back and neck pain, the pain will be caused by damage to the soft tissues around the spinal column (muscles and tendons), and not due to herniated discs or fractured vertebrae. These soft tissue cases will be the ones most likely to involve a chiropractor, as medical doctors will most often only be able to treat them with anti-inflammatory and narcotic pain medications. Because long-term use of narcotic pain medication has too many downsides to list, many people seek alternative treatments — such as chiropractic care.

The problem with most soft tissue cases is that they are often not worth very much. While the pain you feel from your soft tissue injury can be intense, and sometimes permanent, there are no sophisticated tests, like MRIs or CT scans, that can prove the existence, much less the degree, of your soft tissue injury. Without the objective evidence provided by these types of scans to back up your claim, your subjective complaints will often be the only proof of how badly you are hurt. Subjective complaints by a plaintiff without hard medical evidence are usually not well received by either insurance adjusters or juries. In these types of cases, the chiropractor can be both your best friend and worst enemy.

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The Balancing Act of the Chiropractor in Soft Tissue Cases

When you have a soft tissue injury case, you must pay special attention to how much you will owe your medical providers (and health insurance to the extent that it has paid for accident-related injuries) when it is over. You will need your attorney’s help. You must pay particular attention to chiropractic care, mainly because its costs add up rather quickly. Most chiropractors will want to treat you several times per week. This will likely go on for several months before he is willing to say whether you are at maximum medical improvement, or MMI. It is important for you to be at MMI before settling your case.

Knowing that you may need treatment for several months before your case is in a position to potentially settle, you have to ask yourself if you need as many treatments as your chiropractor is suggesting (i.e., could you go 1 or 2 times per week instead of 4?). Honestly evaluate whether the treatment is making you feel better. Discuss with the chiropractor how many treatments he expects you to need, and do the math on how much that will cost.

Consistency of treatment is important to a soft tissue injury plaintiff. You don’t want to go for any extended period of time without receiving any treatment at all. However, overtreating is almost as much a risk to your case as undertreating. If you accumulate more medical bills than your case is worth, you could wind up walking away with no money in your pocket, or worse — still owing money to your medical providers.

Ultimately, you must balance the cost of your chiropractic care against the benefit it provides to your health and your lawsuit. Ask your lawyer to keep an eye on your medical bills (he will be routinely requesting them anyway) and let you know if he thinks you’re overtreating. Let him know that you’re not asking for medical advice. You just want to know when he thinks that the cost of your medical care will exceed the fair value for your case.

A Kind Word About Chiropractors

I’ve been kind of rough on chiropractors in this article, so I will try to finish on a positive note. In my experience, more often than not, chiropractors benefit the lawsuits of soft tissue plaintiffs. They seem to take soft tissue claims more seriously than medical doctors, which makes them more vocal advocates for plaintiffs. What they may lack in credibility with insurance adjusters and juries, they can often make up for with enthusiasm — they seem to be true believers in your pain. They can often give the jury a scientific reason for believing that your soft tissue “whiplash” injury is both real and permanent. Even if the jury is skeptical of chiropractors, they will be more likely to believe your subjective complaints of pain with a chiropractor backing you up than if you were to go to trial with no medical expert at all.

So, should you see a chiropractor? If you have a soft tissue injury case and you see a medical doctor first, sure. Try it out. If the chiropractor makes you feel better, continue to see him. However, keep an eye on those medical bills!

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18 Responses to Should You See a Chiropractor?

  1. michelle hanley says:

    I am injured on my job in an auto accident, where I suffered back and neck injuries. I have pain in the back of head behind my ears from the muscles behind neck that causes a lot of headaches; pain from my neck going down my shoulders and arm; pain from lower back down my legs; difficulties sitting, standing, walking, bending because of the discs in my back and neck are bulging touching my spine causing a sharp cutting pain. The work comp Dr. is telling lies for the insurance Co. I went to a Chiropractor; he uses his hand and could feel exactly where I am hurting and point them out to me. HOW COMES A MEDICAL DOCTOR CANNOT DO THAT!!!!!!!!!?

    • fl_litig8r says:

      The chiro is likely feeling spasms in response to your pain. There isn’t a doctor or chiro out there who can diagnose bulging discs just by external feel. If you have discs which are herniated and are impinging on your spinal cord, these will show up on an MRI. As far as the workers’ comp doc goes, you can guess what his job is. If you’ve had an MRI that didn’t show disc herniation or vertebral abnormalities (spurring, fractures, etc.), it’s likely a soft tissue injury. These can be painful and can take a long time to heal, but there’s not an objective test out there that will show them. If you haven’t already consulted with a workers’ comp attorney, you should probably do so ASAP.

  2. casey mccole says:

    You make no sense by any means. For example, to say the least; Chiropractor’s are not medical doctors but you say watch out for your medical bills from the chiropractor. This is terrible. Go back to school and do a little more research on this topic before you embarrass yourself anymore. This is bad! Really bad? Research has already disproved everything you are saying. RESEARCH!!!!

    • fl_litig8r says:

      If you think I make no sense, feel free to ignore my advice. However, with respect to my reference to chiro bills as “medical bills”, every lawyer I know calls bills from any health care provider, be it a doctor, chiro, psychologist, or even ambulance driver, “medical bills.” It’s just a colloquialism. As far as “research” disproving “everything” I am saying, I can’t respond to such a broad, unsupported criticism.

  3. Dr. E says:

    An opinion on this blog, viewed by a chiropractor.

    Pretty much everything he’s said is accurate… especially the part about watching your “medical bills”. I have been a chiropractor for three years now. I own my own office and am doing okay.

    About four months ago I was contacted by a company to do Independent Medical Examinations (IME). I examine these victims of accidents, that have been seen over and over and over and over and… (I think you get my drift) and the car insurance company is just absolutely sick and tired of paying the claims. So they hire me as a 2nd opinion type of guy. I examine the patient for about 30 minutes. I look over office notes and bills presented to the insurance company for payment, and then make a determination if I agree or disagree with the previous chiropractor or physical therapist on the treatment or number of treatments.

    I can tell you I’m embarrassed as a chiropractor that my peers would abuse the insurance system like they do. While I cannot go into details about the cases, I will say that of the 10 I’ve done to date, eight of them were flat-out fraudulent. There is no reason to treat patients involved in accidents under 5 MPH 60, 70 or 80 times for more than $10,000.

    Anybody reading this, and has had an accident… chiropractic can absolutely help you… but you have to find the right chiropractor, one that does muscle work. I do muscle work on all my patients, and then I adjust them. I spend between 7 to 12 minutes on just about each patient. Many chiropractors would laugh at that length of adjustment, because they know they can get away with doing a crappy one in under two minute for the same amount of money, but see three to four times what I do. Well what I want to know is how they sleep at night. Currently I have patients flocking to my clinic from a few of the one’s in town because word is getting out my patients get great results and fast. I’ve have people that have gone to other area chiropractors for years feel better with just one adjustment from me. I don’t think I have any special powers… in fact, I think any chiropractor can do what I do… but they don’t because they are lazy.

    I was taught by a great instructor in college… when treating patients, it should be your focus to get them feeling significantly better within two weeks (say from an 8/10 down to a 4 or under). If after two weeks the patient hasn’t really progressed, the chiropractor needs to change the treatment plan and try something else… maybe a new modality or different chiropractic technique. If after two more weeks you still don’t feel like you’ve made significant progress… the chiropractor needs to refer you to someone who can help you.

    Depending on the state you live, auto insurance gives you a certain amount of money for Personal Injury Protection (PIP). In my state… Delaware, PIP is at least $15,000 (except for motorcycle accidents… where you may have NOTHING). You should not have to worry about running out of money unless you have really serious injuries. Beware of how much your office visits are going to be.

    A benefit for doing IME’s is I get to see how much chiropractors and physical therapists are charging. Let me tell you, you’d be shocked if you knew. There are chiropractic clinics in my town that charge almost $300 per visit and of course they want you to come in three times per week, even if you really don’t need to. And physical therapists need to be watched like a hawk too… the one case I’ve had regarding physical therapists, the guy was charging over $400 each session.

    When I am seeing a MVA patient and I feel they need modalities like electric muscle stimulation, traction, or therapuetic ultrasound besides the adjustment and/or extremity adjustment my charges are usually between $100 to $140. It is an extreme difference when you consider coming to my office for approximately $400 a week for three sessions, versus going to the other chiropractor that charges $900 a week for three sessions… or the PT that charges more than $1,200 for that week. Besides my costs being half or less than several others in this area, I also get them better faster… so it’s a win-win for the patient for sure.

    Just like the OP said… make sure you watch those bills… because there are a lot of greedy medical professionals that don’t know when to say when.

    If you’ve been in a fender-bender (under $1,500) of damage… if you are going to see a chiropractor, treatment should probably be between six to 15 visits… not 60 or 70.

    If you’ve been in an accident that caused $2,000 to $6,000 or so, and you have quite a bit of soreness for days to weeks, you really should see a chiropractor. The initial pain and symptoms of whiplash is NOTHING to what it can do to you long term if you don’t get rid of muscle guarding. Long term damage from whiplash could end up giving you chronic pain and limited motion from arthritis. In cases like this, the chiropractor set out a treatment plan between 12 visits to 30 visits.

    In cases where you’ve had a significant car accident… totaled and/or flipped car… you might have to go for treatments up to about 50 visits. I try not to go over 30… and that’s for the major MVA patients.

    You should be getting better… and if you feel like you’ve plateaued over a period of visits with your chiropractor or physical therapist… don’t be afraid to look at other options. Sometimes they don’t want to let you go because they are raking in the money… but this shouldn’t be benefiting them… it should be benefiting you… for you to get better.

    Sorry to ramble… but I’m shocked what some are charging. Call around and ask about the prices. You’ll be able to eliminate a few quickly… when they don’t know quite what to say when you call, like you pulled their pants down or something.

    Good luck.

    • fl_litig8r says:

      Thank you for your comment. I appreciate you sharing your knowledge. I’m sure my readers will, as well.

    • Samantha Zysett says:

      This has been very helpful! Thank you for sharing! I am in month 10 of a car accident recovery (totaled the vehicle) and have been seeking chiropractic and PT treatments. Progress has been slow, but steady and pain is decreasing. One thing I have noticed is the difference between chiropractors that do muscles work with adjustments like you mentioned, as this is the only way I see progress for my injuries. You mentioned that you had some special training in college for this – is there a special concentration, or term that someone could use, or are there specific questions to ask to determine when meeting a chiropractor if he/she advocates and is qualified in administering this type of chiropractic adjustment? I have come right out and described this type of treatment when consulting and trying to find a care provider, but have never gotten good responses as most say they don’t know what I am talking about in regards to muscle manipulation with adjustment, so I am just wondering if there is a specific medical term to use for this? Thanks again!

    • karelys says:

      Thank you for your comment! I am trying to figure it out myself with the chiro visits. I’m 27 weeks pregnant and got rear ended last weekend. The thing is, I don’t have lots of pain. Mostly I feel disoriented and like my head is in water.

      The first visit to the chiro he used this gun on my spine at certain spots and said it was to stimulate the vertebrae. I felt extremely nauseous but 5 minutes later after it was over I felt completely aware and like something had popped.

      After work all I wanted to do was sleep. I slept pretty soundly and woke up refreshed this morning. Something that seemed impossible after no matter how much sleep during the weekend.

      The accident did a number on me but the weird thing is that there is not a huge amount of pain so I feel like I should tough it out. I just want to make sure this won’t affect my baby.

    • Dr. T says:

      I know I’m a few years late to this comment (I just found the site and I really like it)… But I just wanted to say “Wow!”. Dr. E, I can see why the insurance companies want you to do IMEs for them. It appears that you are under the same impressions about MVAs and their resulting injuries as they are.

      1. You determine injury existence / severity based on the amount of vehicle damage. This is not possible to do and several studies support that. (Centeno CJ, Freeman M, Elkins WL. A review of the literature refuting the concept of minor impact soft tissue injury. Pain Res Manag 2005;10:71-4) (Croft AC, Freeman MD. Correlating crash severity with injury risk, injury severity, and long-term symptoms in low velocity motor vehicle collisions. Med Sci Monit 2005;11:RA316-21) (Foreman SM, Croft AC. Whiplash injuries : the cervical acceleration/deceleration syndrome. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002) (Robbins M. Lack of Relationship Between Vehicle Damage and Occupant Injury. SAE Technical Paper 1997;970494) (Ros SP, Martens CA, Herman BE, et al. Can emergency physicians correlate between vehicle damage and velocity change? Pediatr Emerg Care 1995;11:277-9)
      2. You determine frequency and duration of treatment based on the value of vehicle damage. This type of treatment plan development is contradictory to common and widely used guidelines. (Croft’s Guidelines for the management of CAD trauma) (International Chiropractic Association’ Best Practices Guidelines) (International Chiropractors Association of California’s Management of whiplash associated disorders) (Chiropractic Quality Assurance and Practice Parameters [Mercy]) (Council on Chiropractic Practice [CCP])
      3. You make similar determinations based on “speed” at the time of impact. Not only can you refer to my earlier references, but it is quite easy to search and find many more. Additionally, I possess a copy of a signed affidavit from the Florida Dept of Highway Safety and Motor Vehicles that states that the years 1994 – 1999 there were 1910 FATALITIES and well over 250,000 injuries in car crashes where no vehicle was moving faster than 10 mph.
      4. You also do not appear to charge what is “usual and customary for your area”. (Wasserman’s Physician Fee Reference) (PMIC’s Medical Fees in the United States) (Data Management Ventures’ Fee Facts)

      If determining severity, care, treatment, frequency, duration based on the dollar value of vehicle damage is clinically sound, why don’t hospitals examine the car before rendering treatment to MVA patients? If you have one patient that was driving a 1994 Toyota Corolla, and another patient driving a 2014 BMW or Mercedes, and both cars received the same exact amount of “physical damage” (yet the BMW and Mercedes will have a *significantly* higher damage value), how do you determine their separate injury severities and treatment plans based on those values? Will the Corolla driver be “less injured” because his car costs less to repair? This is the same game that insurance companies want to play in order to reduce payout.

      If you have *anything* documented that supports what you are doing, PLEASE post that information. I would sincerely love to examine it.

      I would also like to suggest that if you continue to treat PI patients that you attend some PI specific CEUs.

      Now, a kind word about Dr. E. I totally agree that many chiropractors treat excessively. I also agree that a $10,000 bill is quite excessive. I rarely go above half that figure. I agree with Dr. E that “muscle work” is important in MVA injuries. I agree that patients should improve measurably within the first 2 weeks, if not then the doctor should modify treatment… and if still little to no improvement after another 2 weeks that patient should be referred out.

      Now… a word about this article. I completely agree that the public’s view and the insurance company’s view about chiropractors is… less than favorable, and that the view of an MD is much more favorable. Anyone reading this may be surprised to learn that a chiropractor’s education is on-par with a medical doctor’s education. Please search for and review the many instances where the education between the two professions is compared. Most of the classes are the same and chiropractors receive more cumulative academic hours of education than medical doctors.

  4. frank says:

    I had a work injury 2 years ago. I had surgery which didn’t help
    now the dr. wants me to have L4-L5,L5-S1 fusion but i’m afraid
    to have it done. The PTP report said all the restrictions and that
    he wants to leave the surgery option open because of the spine instability and he put on MMI with 68% WPI. IC send me to a QME
    and he agrees with the all the PTP findings and also to leave open
    the surgery option but he only gave me a 24% WPI can someone
    tell me why is the WPI % so far apart if they agreed on all the findings? and what percent has more weight on the WCB?
    Thank you

    • fl_litig8r says:

      First, a disclaimer. I do not, and never have, practiced workers’ compensation law. I have a passing familiarity with it just because I’ve been practicing so long and I know workers’ comp lawyers.

      As to how your treating doctor and the QME doctor can arrive at different Whole Person Impairment ratings, the bottom line is that the AMA guide leaves a lot of room for subjectivity to enter into the rating process. In some states, doctors are allowed to deviate from the AMA guide ratings if they can show that following the AMA guidelines would produce an inequitable result (i.e., they don’t truly reflect the person’s ability to work and perform ADLs).

      If you have a workers’ comp lawyer, it may be in your best interest to depose the QME doc to learn his underlying rationale for the lowball rating. Your lawyer may be able to poke holes in his logic by doing this, and show that your treating doc’s evaluation better followed the AMA guide and best reflects your abilities. If you don’t have a lawyer, I’d suggest consulting with one ASAP about this issue. Most WC lawyers will give a free consultation, and you really should get advice from someone who knows the ins and outs of your state’s WC laws.

  5. charlie says:

    I understand that most of these articles are geared toward plaintiffs, but any advice to a defendant?
    In Feb I was involved in a rear end collision at a red light (I was driving a full sized pick up) and the car struck was a small honda. damages to both vehicles occured. Immediately after the accident, both the driver and passenger were out of their cars on phones (obviously shaken but no acute injuries apparent). When police/EMS arrived, the passenger sat in her car and whole demeanor changed to putting on quite a show. I have been informed that the passenger and lawyer are seeking a settlement of 91000 but my limits per passenger is 50,000. I do not own my truck or home, have huge student loans and have no inheritance or other assets to seize if they wish to persue further monetary compensation. To my knowledge, this passenger had imaging at the local ED, and then sought treatment with a chiro (amount unknown) for soft tissue injuries. From speaking to the insurance agent assigned to the claim, she thinks that this package is way overblown and I fear that the case will see court. I am all for someone being compensated a FAIR amount, but worry that this individual is going to try to bleed me for all I’m worth. Not to get into details of the person, but seems to have a shady past/character.

    ANY ADVICE IS APPRECIATED!

    • fl_litig8r says:

      My advice to you would be to relax. It sounds like the plaintiff’s original demand was just posturing, maybe to put them in a position to negotiate down to a policy limits settlement. Honestly, if the plaintiff’s lawyer really thought that his client’s case was worth more than $50,000.00, he would have made a 30-day demand for policy limits in the hopes that your insurance company would either reject it or miss the deadline, setting them up for a bad faith claim. Unless you’re rich, a bad faith claim (or the plaintiff’s own UM insurance) is the only realistic chance of the plaintiff recovering more than policy limits in an auto accident case. So, I suspect that because the plaintiff’s lawyer doesn’t see any possibility of a bad faith case (because the case isn’t worth more than $50,000.00), he asked for more than policy limits as purely a negotiating tactic.

      If the plaintiff was only seen at the ED and a chiropractor, it doesn’t sound like like this is a $50,000.00 case. Unless there’s some surgery in the plaintiff’s future, it’s unlikely that this case is worth anything near that amount.

      Expect that there will be several offers thrown back and forth between your insurer and the plaintiff’s lawyer. If the plaintiff’s lawyer doesn’t get down to at or below policy limits, he knows that the case won’t settle, so I’d expect negotiations to get into that range before he’d file a lawsuit.

      If he does file a lawsuit, it’s not the end of the world. Your insurer will hire a lawyer to defend you. At worst, you’ll have to answer some discovery, give a deposition, attend mediation (you may not even have to do this), and — this sounds like a remote possibility given the case as you’ve described it — testify at trial. Settlement discussions don’t end just because a lawsuit is filed. Many times, settlement discussions don’t get realistic until a lawsuit is filed.

      While I know it sucks to have the possibility of a judgment hanging over your head, keep in mind that the plaintiff’s lawyer knows he can’t get blood from a stone. He won’t want to take this case to trial just to get an uncollectible judgment against you personally. Just ride it out and expect that the case will settle within your policy limits.

      Don’t get caught up in the plaintiff’s “shady character” or possible exaggerations. Just tell the truth about what happened and let your lawyer handle the rest. If you were at fault for the accident, don’t lie about that just because you think the plaintiff is lying. As a former defense attorney, I know that often admitting liability (fault), but challenging the plaintiff’s damages, is the best tactic in defending a case. If it comes to a jury trial, the jury will appreciate your honesty and it will lend credibility to your damages arguments. If you deny liability when it is clear, the jury could get pissed off and award the plaintiff more than he deserves.

  6. Tammy says:

    My Chiropractor and I had a contract that was up in June. He at that time was to do the x-rays on June 29th. He did not do the x-rays. He continued to tell me to come in and set my appointments. He finally did my x-rays the end of July, and still has not shown them to me. He wanted to do another contract with me but being on a fixed income and no insurance I can not afford the next one and let him know this. He told me that I owed him 3,100.00 for the month of July? I asked him why I would owe him this money? He said because my contract was up in June and gave me services until the End of July.

    I do not believe this is ethical. He said that he had to extend my services due to unforeseen circumstances. He pointed out 3 times that I had twisted wrong, and had documented it. With out telling me this, continuing my treatment for another month and not letting me know it was costing me more money. He is the person that did not follow the contract: he did not do the x-rays when they were to be done, and charged me full price for services for a month without getting my permission or consent. Please let me know what I can do. I need to know what I can legally do.

    • fl_litig8r says:

      While I can’t say that your chiropractor acted properly from a moral standpoint, I don’t see that he did anything illegal. While he treated you beyond the time frame that was initially agreed upon, you knew he was doing this — just as you knew when he didn’t take X-rays at the time he had said. You could have stopped seeing him at that point, but you chose to continue treating with him for an extra month. Even in the absence of a written contract, you would owe him the reasonable value of his services for the treatment which you accepted. Did you really expect to get an extra month’s worth of treatment at no charge?

  7. Lizzy says:

    First, thank you for your advice, love the free legal information. I have a soft tissue case in CA going on for 8 months. Got referred to chiro by attorney and got a final bill of about $3500. My attorney said I will only get $1k after all fees. I told him no, he said he will not negotiate and the ins final offer is $5K and he will not spend anymore time on it. Take it or leave it, and he will hand me my file and collect only his expenses to file with the court. I tried to find a case number, which he did not give me, but couldn’t. He told me to come pick up the file and handle it myself because he will not pursue it further. Should I have just taken my file and made a run for it? I can’t find a signed retainer from him, will I still have to pay his fees? Thanks

    • fl_litig8r says:

      With respect to the contingency fee contract, CA law does require that it be in writing: CA BPC §6147. Of course, when you say “I can’t find a signed retainer from him”, that doesn’t sound like “I know we never entered into a signed contract.” In any event, it sounds like he only wants his expenses reimbursed, which is different than his fee.

      Not to be too critical, but you may have made a mistake in not taking the settlement and the $1,000.00 net to you. A soft tissue claim where you only received $3,500.00 in chiropractic care doesn’t sound like a particularly valuable case. As discussed in this article, chiropractic care really isn’t taken very seriously in the world of personal injury claims. You may not be able to find another lawyer willing to take such a small case, particularly if you have your sights set on a larger settlement. You may wind up collecting nothing if the insurer pulls its offer off the table and you can’t find a new lawyer. I’d suggest giving this some serious thought, and if you haven’t completely burned your bridge with this lawyer, you may want to see if he’ll still be willing to accept the offer on your behalf.

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