Who is the “worst nightmare” of every insurance company?

Who is the “worst nightmare” of every insurance company?

by | Jan 10, 2023 | Expert Reports, IRC Services

As personal injury cases continue to become more complicated, insurance companies will continue to have the leverage and “hold the cards” in terms of the nature of the settlement and its amount. Attorneys today don’t exude the same “fear factor” power to get the insurance companies’ attention that they once did. Cases are taking longer to settle and sometimes for subpar amounts.   

Who is the “worst nightmare” of every insurance company?

The main reason this is happening is that insurance companies today aren’t taking attorneys seriously simply because they don’t have to. The insurance companies have deep pockets and will do everything in their power to avoid paying on claims. Oftentimes they are able to take advantage of the standard demand package or trial documents presented that do not portray the client’s true impairments, disabilities, and how these two affect the client’s livelihood. 

So, who is the insurance companies’ worst nightmare? Someone like me, a doctor that has the personal injury know-how and certifications to back it up. I have decades of experience educating insurance companies about client impairments and disabilities and explaining demand letters and trial documents from a doctor’s perspective. 

At Injury Reporting Consultants, we specialize in providing expert reports such as functional capacity evaluations, vocational and earning capacity evaluations, medical cost projections, and life care plans that will support your legal documents in order to help obtain a swift and fair settlement.      

Dr. Brad Poppie has over 20 years of personal injury experience not only as a treating doctor but as an expert witness in trial.  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: dr.bradleypoppie@physicalrehabspecialists.com

Visit IRC on Youtube for educational videos on this process! 

The Role of the Rehabilitation Doctor in a Personal Injury Case

The Role of the Rehabilitation Doctor in a Personal Injury Case

by | Jan 10, 2023 | Expert Reports

From a healthcare standpoint, personal injury cases can involve a wide array of professional disciplines ranging from medical, chiropractic, physical therapy, speech therapy, and psychology to name a few.

The Role of the Rehabilitation Doctor in a Personal Injury Case

These different healthcare specialties not only treat the patient to help them return to their prior level of function, but each discipline can offer specific insight into the patient’s progress and future prognosis.

Many times, however, an expectation is put upon the treating medical doctor to give an opinion about the overall prognosis of a patient. While medical doctors can say whether they think a person has achieved “Maximum Medical Improvement”, they typically have to consult with the patient’s rehabilitation doctors to determine the patient’s actual rehabilitative potential. The difference here is that medical doctors diagnose and treat pathology and rehabilitation doctors such as physical therapists, evaluate and treat dysfunction.

The reason why this collaborative opinion with the rehabilitation doctor is so important is because of their unique training. For example, if you ask a physical therapist to prescribe certain medications or read an MRI report, they are not able to do this because it is out of the scope of their practice and they are not trained to do so; not to mention they are not licensed in this field. On the other hand, if you asked a medical doctor to perform a physical therapy rehabilitative treatment regimen they would not be able to successfully treat this patient because they simply aren’t trained in doing so. Each respective discipline, both medical and rehabilitative, have their own unique set of skills and training which gives them credibility to opine on different aspects of the patients’ overall prognosis.  

Oftentimes in trial, the question “what is the patients’ rehabilitative potential” comes up and whether or not they have reached their “Maximum Rehabilitative Potential” and/or achieved “Maximum Medical Improvement”. If the appropriate experts are not in line to give an expert opinion on this topic, it will be difficult to prove to a jury if “Maximum Medical Improvement” or “Maximal Rehabilitative Potential” have been achieved.

As a Doctor of Physical Therapy, I have testified in trial numerous times against medical doctors ranging from orthopedic surgeons, physiatrists, and interventional pain physicians. Quite often the opposing experts have differing opinions than mine regarding the improvement of the patient. It’s not necessarily that their opinion is wrong, but more often that it comes down to their opinion being based off of the patient’s pathological condition and whether or not that diagnosable condition has been cured or if there is an impairment that still exists. From the rehabilitation doctor’s perspective, we are looking at the overall rehabilitation potential of the patient and whether their function will improve or regress over time; thus providing a rehabilitative prognosis.

Medically, the patient may have reached “Maximum Medical Improvement” from a disease or pathology standpoint, but the doctor of physical therapies’ standpoint considers whether the patient has reached “Maximum Rehabilitative Potential”.  The physical therapist has the education, experience, and expertise to opine on this question with certainty and should be integrated into determining the overall prognosis of the patient. 

Make sure you provide the insurance company and/or jury members both the medical doctors’ AND rehabilitative doctors’ opinions in order for an accurate and well-rounded prognosis to be made.  

Dr. Brad Poppie has over 20 years of personal injury experience providing care as a treating doctor, coordinating rehabilitative case management, and expert trial testimony services.  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

Be Aware of Bogus Medical Cost Projections

Be Aware of Bogus Medical Cost Projections

by | Jan 3, 2023 | IRC Services, 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!

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

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

by | Dec 15, 2022 | IRC Services, Medical Malpractice

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.

by | Dec 1, 2022 | Expert Reports, Life Care Plan

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