Be Aware of Bogus Medical Cost Projections

Be Aware of Bogus Medical Cost Projections

Medical cost projections come in all shapes and sizes, some portraying valid content while others showcase invalid projections that do not stand up well to an insurance company or a jury.

Why is there such a big discrepancy in the validity of medical cost projections?

The short answer is that each life care planner has their own methodology for how they construct the report. This leads us to the next question, “how do you know what differentiates a valid medical cost projection from an invalid one?”  

Here are some tips to help you decipher possible red flags that may come up in the medical cost projections that come across your desk.

  1. Utilizing non-credible costing databases: If the costing database sources used are not nationally recognized databases, they are biased and do not provide accurate billing / coding information. Some companies use “their own” costing databases that only they are privy to using. This creates a bias when constructing the report.
  2. Utilizing “treatment trends” when costing:  Many costing specialists will rely on what the treatment trend has been over the last few years for a particular service in order to justify what is needed for a patient’s future care. Here is an example: Let’s say that the patient underwent follow-up appointments with their pain management physician four times per year for the last three years but they haven’t seen the physician in over a year. Some cost specialists will extrapolate out physician visits four times per year through life expectancy as a “treatment trend” even though the patient hasn’t actually seen that physician in quite some time. A phone call to the physician is critical to see if there is a continued need for those follow up visits.
  3. Overreaching to pad the costs of the cost projection: Often times you will see extraneous items that have been recommended and costed out by the life care planner that may not be a necessity for future care. You might also see additional treatments that the client does not want solely to add to the amount of future costs. Here is a common example: Adding in a gym membership through life expectancy to a client that needs this care but has told you that they will never use this. Maybe pool therapy or a stationary bicycle in their home would be more suitable especially if a client voices that they would use it over a gym membership. Future costs must be justified, and if they aren’t, it leaves the life care plan open to speculation.
  4. Opining on items that are outside the life care planner’s scope of practice: Oftentimes future items and costs are thrown into a medical cost projection that the life care planner cannot opine on due to their scope of practice. For example, a nurse life care planner is not able to opine on the future frequency and duration of physical therapy because that is out of the scope of their practice. Life care planners can get into hot water if they are adding in future treatment and costs that are out of the scope of their practice and therefore are unable to opine on these items themselves. Again, a call to the treating physical therapist is warranted to make sure the items that go into the cost projection are accurate.  

Medical cost projections are designed to follow the same methodology of a life care plan. The main difference is that medical cost projections are typically drafted for non-catastrophic injuries and life care plans service catastrophic injuries. Both reports should provide the reader with a clear and identifiable pathway to understand what their client’s future care needs are and the costs associated with them. 

Remember, the more ambiguous the report, the more susceptible the report is to failing Daubert and Frye standards. Make sure you hire a credible and expert life care planner for your life care plans and medical costs projection needs. The expert must also understand impairments / disabilities and personal injury cases in order to fully understand the needs of the client.  

Dr. Poppie has served the legal industry as a treating clinician, damages expert, and educator for over 20 years. He specializes in the evaluation and treatment of multi-trauma injuries related to motor vehicle collisions, standard of care and malpractice claims, and as a damages expert to help educate insurance companies and both plaintiff and defense counsel to provide a viable pathway for obtaining a fair settlement based on ethics, research, and evidence-based standards of care.

Dr. Poppie founded Injury Reporting Consultants to help attorneys and insurance companies resolve personal injury cases through medical analysis and reporting. Injury Reporting Consultants is a collaborative team of dedicated medical professionals using their knowledge to ensure fair outcomes for all parties in personal injury cases.

Recognized specialties include Motor Vehicle Collision, Life Care Planning, Medical Cost Projection, Functional Capacity Evaluation, Onsite Job Analysis, Functional Impairment and Disability, Workplace Injuries, Orthopedic Physical Therapy, Standards of Care, Current Best Practices, Physical Therapy Malpractice, Negligence, File and Medical Record Review, Improper Documentation, Expert Rebuttal Reports, and Expert Testimony.

If you have a client that you would like to discuss their need for an expert report, please contact me directly at 720-982-2000 or email me at: brad@injuryreportingconsultants.com

Learn more at Dr. Poppie’s educational videos!

What level of certainty is required of your medical malpractice expert?

What level of certainty is required of your medical malpractice expert?

What level of certainty is required of your medical malpractice expert?

Experts on the stand define the certainty of their opinion in two similar but vastly different terms. These terms are “Possibly related” and “Probably related”. In context, they’re voiced about the relation of the injuries to the treating practitioner and whether the injuries are the result of negligence or deviation from the standard of care.

When experts write out their opinions and opine on causation, that opinion must be expressed in terms of “probability”.  Words or phrases that convey the expert is “guessing” or is “not sure” of the correlation between the cause of injury to the negligence or deviation of standard of care will discredit the expert and make it difficult to persuade the jury to side with their opinion.  

Other terms an expert might use relating an injury to a cause include terms like “consistent with”, “possible to occur”, “reasonable to say”, “is highly suggestive of”, or that “there might be a connection with”. However, these terms lack the strength to convince a jury that “more probable than not” the negligence or deviation in the standard of care is linked to the injury. 

The job of the expert on the stand is to portray the causation of the injury to the jury in an easy-to-understand method and to speak this opinion with conviction. The jury will then decide the facts based on how certain they are in their ability to convey their opinion so it’s important to understand the impact of the words they choose. 

Dr. Poppie founded Injury Reporting Consultants to help attorneys and insurance companies resolve personal injury cases through medical analysis and reporting. Injury Reporting Consultants is a collaborative team of dedicated medical professionals using their knowledge to ensure fair outcomes for all parties in personal injury and medical malpractice cases.

Recognized specialties include Motor Vehicle Collision, Life Care Planning, Medical Cost Projection, Functional Capacity Evaluation, Onsite Job Analysis, Functional Impairment and Disability, Workplace Injuries, Orthopedic Physical Therapy, Standards of Care, Current Best Practices, Physical Therapy Malpractice, Negligence, File and Medical Record Review, Improper Documentation, Expert Rebuttal Reports, and Expert Testimony.

If you have a client that you would like to discuss their need for an expert report, please contact me directly at 720-982-2000 or email me at: brad@injuryreportingconsultants.com

Learn more at Dr. Poppie’s educational videos!

This important damages’ expert can make or break your case! Evolution of a life care planner.

This important damages’ expert can make or break your case! Evolution of a life care planner.

Determining future medical care for your client has traditionally been calculated by either a certified life care planner or by the law firm itself. In the past, a life care planner was hired toward the end of the case’s lifecycle as a last-ditch effort to avoid trial.  

While that tactic may have been acceptable ten years ago, more recently, things have started to change. Attorneys are discovering that hiring a life care planner at the beginning of the case can help provide valuable insights throughout all phases to help get the case settled in an acceptable and swift manner.

This can be especially valuable when a life care planner is hired during the pre-litigation phase as their impact can help with their cases’ outcome tenfold. Think of it this way; If a case is like a ship, the life care planner is most effective as the helmsman or navigator. The skilled life care planner can bring an element of foresight to the pre-litigated case to help guide the ship for the attorney (the captain) throughout the route to settlement. Waiting to get the life care planner involved right before the ship docks at the destination would be a mistake, because while they can help dock the boat, chances are, without a navigation specialist, time and efficiency were wasted during the journey.  

Below are some very important values that the life care planner can bring to your pre-litigation phase:

Determining any missing records that need to be requested.
All too often I receive medical records to review for a case that are missing very important records that could reveal information that is crucial for a valid and reliable report. 

Helping in the preparation of a demand package.
Oftentimes, in the pre-litigation phase, future and marginal medical costs are estimated to present a rough understanding of future damages. A simple medical cost projection produced by the life care planner will certify that the future costs are in fact accurate, required, usual, reasonable, and customary. This report will save the law firm time and money, and significantly increase the chances of getting the case settled prior to litigation.

Helping to assist in identifying the appropriate experts needed:  
While working through medical records, I often come across gaps in care, archaic records, or inadequate practitioners that can make it difficult to provide a sound and accurate life care plan. The last thing you want to discover as an attorney walking into trial, is that your life care planner uncovered that all along your client was experiencing post-concussive / cognitive symptoms and they never saw a neuropsychologist for an evaluation. By getting a life care planner involved early-on in the process, they can help you avoid roadblocks and setbacks as you prepare your case. 

Educating attorneys on the proper questions to ask opposing experts:
No member of your team will understand the case better than your life care planner. You can bet that treating practitioners will be disconnected from the varying practitioner opinions of the case relative to their prescribed care for your client. A skilled life care planner is well versed in the collaboration of multiple specialties and can help determine the most appropriate questions to ask both your retained and opposing experts to help educate the jury of their findings.

As you can see, retaining a life care planner early on in your case, can improve the process and prevent last minute scrambling to put future medical care costs on paper. I can assure you that leaving a life care planner out of the process will prove to be a disservice to your client as many important items may be left undiscovered and therefore not taken into consideration.  

If you have a case that could benefit from the insights of a life care planner, reach out to one today. You’ll receive valuable information and insight throughout the process to support a more thorough case. 

Dr. Poppie has served the legal industry as a treating clinician, damages expert, and educator for over 20 years. He specializes in the evaluation and treatment of multi-trauma injuries related to motor vehicle collisions, standard of care and malpractice claims, and as a damages expert to help educate insurance companies and both plaintiff and defense counsel to provide a viable pathway for obtaining a fair settlement based on ethics, research, and evidence-based standards of care. 

As a certified life care planner, Dr. Poppie helps to guide attorneys through all phases of their case and projects accurate and reliable future medical costs. Evidence-based practice guidelines are utilized in all reports in order to ensure the needed criteria is met to withstand scrutiny within all legal jurisdictions. 

Dr. Poppie founded Injury Reporting Consultants to help attorneys and insurance companies resolve personal injury cases through medical analysis and reporting. Injury Reporting Consultants is a collaborative team of dedicated medical professionals using their knowledge to ensure fair outcomes for all parties in personal injury cases.

Recognized specialties include Motor Vehicle Collision, Life Care Planning, Medical Cost Projection, Functional Capacity Evaluation, Onsite Job Analysis, Functional Impairment and Disability, Workplace Injuries, Orthopedic Physical Therapy, Standards of Care, Current Best Practices, Physical Therapy Malpractice, Negligence, File and Medical Record Review, Improper Documentation, Expert Rebuttal Reports, and Expert Testimony.

If you have a client that you would like to discuss their need for an expert report, please contact me directly at 720-982-2000 or email me at: brad@injuryreportingconsultants.com

What do you get when you combine a certified life care planner with a doctor that has 20 years of experience treating personal injury patients?

What do you get when you combine a certified life care planner with a doctor that has 20 years of experience treating personal injury patients?

The answer to this question is simple. You get the only life care planner you can trust.  

When someone suffers an impairment they may be facing both a physical and functional abnormality, loss, or disfigurement, as well as the potential for psychological damage from their injury or incident. It must be determined whether these impairments will be permanent of resolve over time. 

If an impairment is likely to be permanent, one of the challenges of getting an adjustor to compensate a client’s future medical care is adaquately answering the adjustors’ question of “possibilty vs. probability of lifetime impairment”. 

How do you achieve this?  You must first prove to the insurance company that your client has suffered permanent impairment and that ongoing care will be needed to manage those impairments. While it’s relatively easy to prove the presence of physical impairments such as, decreased range of motion, weakness, muscle spasms; etc., the real difficulty lies in proving how these impairments will affect the patient throughout the rest of their life. It takes a very seasoned clinician with experience treating these types of impairments over the course of many years to have the ability to know and opine on how these impairments may affect the patient in the future. 

Typically, maximum medical improvement (MMI) or maximum rehabilitative potential (MRP) determinations will be made by medical and rehabilitative specialists during the patient’s treatment. After the patient has reached MMI or MRP, the remaining impairments are labeled as permanent. 

It’s common for opinions on “permanency of impairment” to vary among doctors and therefore conflicting opinions can arise in regards to what impairments are permanent and what future treatment, if any, those impairments will require throughout the rest of the patient’s life.  

So how do we know which doctors’ opinions are correct (or most plausible) for the continued or future care of the impairments? It really comes down to the doctor and their experience treating these impairments over the course of many years.  A doctor that has been in the trenches with these types of patients throughout their treatment, is the one that has the credibility to make these determinations. They can also back up their opinion with decades of clinical decision making processes, which in essence, provide the best insight into clinical outcomes. 

Who better to opine on the future care requirements of your client than a doctor life care planner who not only understands your client’s injuries, but also their response to treatment, diagnostic pathophysiology, and their impairment progression over time. Dr. Poppie has served the legal industry as a treating clinician, damages expert, and educator for over 20 years. He specializes in the evaluation and treatment of multi-trauma injuries related to motor vehicle collisions, standard of care and malpractice claims, and as a damages expert to help educate insurance companies and both plaintiff and defense counsel to provide a viable pathway for obtaining a fair settlement based on ethics, research, and evidence-based standards of care. 

As a certified doctor Life Care Planner, Dr. Poppie helps to guide attorneys through all phases of their case and documents impairments with accurate associated costs that are reliable in educating opposing sides as to the true extent of injury. Evidence-based practice guidelines are utilized in all reports in order to ensure the needed criteria is met to withstand scrutiny within all legal jurisdictions. 

Dr. Poppie founded Injury Reporting Consultants to help attorneys and insurance companies resolve personal injury cases through medical analysis and reporting. Injury Reporting Consultants is a collaborative team of dedicated medical professionals using their knowledge to ensure fair outcomes for all parties in personal injury cases.

Recognized specialties include Motor Vehicle Collision, Life Care Planning, Medical Cost Projection, Functional Capacity Evaluation, Onsite Job Analysis, Functional Impairment and Disability, Workplace Injuries, Orthopedic Physical Therapy, Standards of Care, Current Best Practices, Physical Therapy Malpractice, Negligence, File and Medical Record Review, Improper Documentation, Expert Rebuttal Reports, and Expert Testimony.

If you have a client that you would like to discuss their need for an expert report, please contact me directly at 720-982-2000 or email me at: brad@injuryreportingconsultants.com

A medical diagnosis is only as good as the functional assessment that backs it up

A medical diagnosis is only as good as the functional assessment that backs it up

Typically, a medical diagnosis will determine the nature or cause of a disease or impairment. 

Diagnosis may be clinical in origin based on signs, symptoms, imaging, or laboratory findings. These findings can also be found by physical examination, patient interview, medical history; etc.  It is so important to remember that a medical diagnosis is only as good as the functional assessment that backs it up! 

While the informational pieces listed above can certainly help an insurance adjuster or jury member understand what pathological condition the patient is suffering from, it by no means helps them understand the INTENSITY or MAGNITUDE of their suffering. A medical diagnosis alone does not clearly depict how a patient’s facet sprain, partial rotator cuff tear, or bulging lumbar disc impedes upon their ability to perform work related tasks, activities of daily living, or leisure activities. 

Here is where solely relying on a medical diagnosis alone provides insufficient information towards the true injuries your client is experiencing. Over the course of 20 years as a treating doctor, I have received numerous physician referrals with the diagnosis “lumbago” or “cervicalgia” written at the top.  These diagnoses are also known as “low back pain” and “neck pain”, respectively. While the patient may indeed be suffering from such pain and there may be a real and underlying pathological condition as to why they are suffering from them, a medical diagnosis alone does not provide enough impact to alarm the reader of the true functional effect the diagnosis has on the person.

Millions of people are walking around today with neck and lower back pain that have never been in a car accident, work-related incident, sports trauma incident; etc.  

Medical Diagnosis

Insurance adjusters are aware that while a diagnosis helps to decipher what is wrong with the patient medically, it doesn’t give any information from a functional standpoint as to how that diagnosis affects their ability to carry on a normal life. In terms of functional loss, I am referring to disability. 

In fact, according to the Guidelines to the Evaluation of Permanent Impairment 5th edition, the American Medical Association defines, “ability and disability can and should involve non-medical practitioners in such determinations.” It was also stated that, “it is not possible for a physician, using medical information alone, to make reliable predictions about the ability of an individual to perform tasks or to meet functional demands…when functional ability is assessed by a standardized non-medical procedure in a vocational rehabilitation setting, the physician may have confidence in the determination.”

According to the Orthopedic Section of the American Physical Therapy Association, a Functional Capacity Evaluation (FCE) is noted as a comprehensive battery of performance-based tests that are used commonly to determine one’s ability for work related tasks, activities of daily living, and leisure activities.  

As you can see, while it is important to have a medical diagnosis, the diagnosis itself is only as powerful and objectively reliable as the functional assessment that backs it up. In personal injury, the hardest aspect to prove to an insurance adjuster or jury member is how the person’s accident and subsequent diagnosis affect their daily life.  

This is why it is imperative to obtain a Functional Capacity Evaluation in concert with a medical diagnosis in order to not only confirm the medical diagnosis but to quantify its severity as well. A Functional Capacity Evaluation allows the insurance adjuster to understand why the patient is hurt and what they are or are not able to do because of their injuries and thus a viable pathway for settlement is created.

If you have a case that you feel as though you may need more objective data in order to properly educate an insurance adjuster or potential jury, please reach out to discuss your clients’ needs.  

Dr. Poppie has served the legal industry as a treating clinician, damages expert, and educator for over 20 years. He specializes in the evaluation and treatment of multi-trauma injuries related to motor vehicle collisions, standard of care and malpractice claims, and as a damages expert to help educate insurance companies and both plaintiff and defense counsel to provide a viable pathway for obtaining a fair settlement based on ethics, research, and evidence-based standards of care. 

As a certified Functional Capacity Evaluator, Dr. Poppie helps to guide attorneys through all phases of their case and documents functional objective data that is reliable in educating opposing sides as to the true extent of injury. Evidence-based practice guidelines are utilized in all reports in order to ensure the needed criteria is met to withstand scrutiny within all legal jurisdictions. 

Dr. Poppie founded Injury Reporting Consultants to help attorneys and insurance companies resolve personal injury cases through medical analysis and reporting. Injury Reporting Consultants is a collaborative team of dedicated medical professionals using their knowledge to ensure fair outcomes for all parties in personal injury cases.

Recognized specialties include Motor Vehicle Collision, Life Care Planning, Medical Cost Projection, Functional Capacity Evaluation, Onsite Job Analysis, Functional Impairment and Disability, Workplace Injuries, Orthopedic Physical Therapy, Standards of Care, Current Best Practices, Physical Therapy Malpractice, Negligence, File and Medical Record Review, Improper Documentation, Expert Rebuttal Reports, and Expert Testimony.

If you have a client that you would like to discuss their need for an expert report, please contact me directly at 720-982-2000 or email me at: brad@injuryreportingconsultants.com

Sincerely,

Dr. Brad Poppie, DPT, CLCP, CFCE, CSCS
Doctor of Physical Therapy | 
Certified Life Care Planner
 | Medical Cost Projection Specialist | 
Certified Functional Capacity Evaluator | 
Certified Strength and Conditioning Specialist. 

Learn more at Dr. Poppie’s educational videos!