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

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

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! 

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!

Cases Are Won or Lost By the Expert’s Ability to Defend their Report

Cases Are Won or Lost By the Expert’s Ability to Defend their Report

When a patient seeking treatment from a provider experiences an unfortunate injury due to the negligence and malpractice of the treating provider, they must carefully determine their next steps.

They have the choice to file a complaint with the clinic and continue treatment, or if the injuries are severe enough, they may choose to file a malpractice lawsuit. If they decide to go the malpractice route, careful consideration and screening must be given to determine what legal counsel is the right fit to represent them with their claim.

The same careful screening process must be followed when the attorney selects an expert to opine on the extent of the malpractice. The attorney may use a listserv to find an appropriate expert, analyze google reviews, or ask a referring colleague for an expert they have used in the past.

Once an attorney has someone in mind, they’ll want to research whether the expert has ever been excluded as an expert or had their report thrown out.

The Frye Test and Daubert Decision, Rule 702, and Rule 26 are the defining standards for admissible scientific evidence in trial for an expert’s testimony and reports. If the criteria and rules of evidence set forth by these rulings are not met, the court may not allow acceptance of your expert to testify on behalf of your client. Make sure you choose your experts wisely to avoid this issue at trial.

Over the course of my career, I have heard many attorneys speak poorly of some experts they have used in the past; not necessarily due to the report that they wrote, but rather that they did not testify well on the stand. An expert’s report is only as good as their ability to defend it to the opposing counsel and win the hearts of the jury.

The effective expert MUST educate the jury on the methodology they used, the conclusions they came to, and how those conclusions affect the livelihood of the client in an easy to understand manner. If this does not happen, the jury may discredit the expert and disregard their report or their testimony which could prove to be catastrophic to the case. 

No matter how seasoned the expert is at writing reports or how many years of practice they have under their belts, if they cannot translate the verbiage on the paper to the minds of the jury members, their expertise is ineffective.

Over the last two decades, I have testified for numerous cases both as a treating doctor and an expert in malpractice and personal injury cases. Understanding what evidence is admissible in trial and how to portray that evidence to the jury is imperative. It has become my personal commitment to deliver highly qualified and understandable reports to help effectively educate the jury.

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

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
Certified Strength and Conditioning Specialist

Helping your client understand the need for a Functional Capacity Evaluation

Helping your client understand the need for a Functional Capacity Evaluation

As your client progresses through their personal injury case, it’s common for them to experience heightened anxiety, treatment burnout, and mental and physical fatigue.



Personal injury cases can be very complex so keeping your clients’ interest and enthusiasm can be a challenge after months or years of treatment has passed. Many times when we as practitioners make referrals to other specialists, we hear, “why do I have to go to someone else?” or “I just want to be done with all of this.”  This is certainly understandable because client treatment often feels more like a marathon than a sprint.  Many clients describe this process as being a part time job in excess of their actual full time employment.  Running to different appointments is exhausting to say the least.



Just when your client thinks their treatment is finally done, you tell them the daunting words that they do not want to hear. Those words are, “you’re now ready for a Functional Capacity Evaluation.”  Before the steam starts coming out of their ears, here are some tips for helping your client understand WHY they need this evaluation.

  1. Start by educating them on why the test is done.  Let them know that even though they went through tons of treatment from different providers, the Functional Capacity Evaluation is the evaluation that ties everything together.  This is the industry standard of documenting their impairments and disabilities affect their ability to perform work related tasks, activities of daily living, and leisure activities. The hardest thing to prove to the insurance company is how their injuries affect their lives and this is the evaluation to showcase that.
  2. Remind them that everything has a purpose. The purpose of their medical, chiropractic and physical therapy treatment is to help them heal, decrease their pain and improve strength/range of motion, but this treatment doesn’t showcase the impact the injury has on the client’s daily life and abilities. That’s where the FCE comes in. The insurance company needs to know how these impairments relate to their life and their ability to perform life’s tasks with real-world functional task simulation and evaluative measures to understand the full impact of your clients’ collision.
  3. The Functional Capacity Evaluation tees-up the impairment rating given by the physician which plays a significant role in educating the insurance company of their overall damages.

It is also important for the client to understand the intricacies of the evaluation itself. For instance, if the attorney has not educated the client as what to expect the day of the evaluation, the client may be surprised to learn:

  1. The evaluation takes approximately 4 hours to complete.
  2. They need to wear comfortable clothing due to the physical functional tasks that are required in the test.

I actually had an attorney refer a client for an FCE years ago and reassured me that they had prepped the client about the test.  When the client arrived, they were wearing 4” stiletto heels, a dress, and asked how long the evaluation would take as they had a meeting in 30 minutes. Needless to say, the evaluation had to be rescheduled.

If you’re uncertain about how to adequately prepare your client for the Functional Capacity Evaluation, please don’t hesitate to reach out to the evaluator so they can inform your client as to why the evaluation is being done and what to expect.

If you have a client that you think may need a Functional Capacity Evaluation in order to help educate the insurance company of how their impairments and disabilities affect their life, feel free to reach out to us at Injury Reporting Consultants.  We specialize in the preparation and documentation of easy-to-read and understandable reports to help with a swift and fair settlement process.

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

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
Certified Strength and Conditioning Specialist

Functional Capacity Evaluations confirm the diagnosis and quantify injury severity

Functional Capacity Evaluations confirm the diagnosis and quantify injury severity

In today’s ever-evolving personal injury world, insurance companies are also changing the way they relate diagnoses to an injury as well as how they equate those diagnoses to an impairment.

What does this look like? Well, when someone gets injured in a car accident, they typically endure soft tissue injuries such as damage to the muscles, ligaments, and tendons. Many times these types of injuries are not considered serious or life changing and can be a challenge to prove their severity to an insurance company. With soft tissue injuries it can be difficult to verify severity because of the subjective nature of the tissue which can’t be quantified in medical reports. For example, a doctor cannot document that your lower back is 50% more stiff after your car accident because that is purely a subjective complaint from the patient. There is no way to objectively measure or quantify the subjective severity of the increased stiffness.

Patients can also suffer from more severe injuries that cause a higher degree of pain and suffering. These injuries are more catastrophic in nature such as head injuries, broken bones, spinal cord injuries, amputations; etc. These types of injuries are more easily documented and are objectively quantifiable through diagnostic testing measures.

Whether your client has sustained a soft tissue injury or a catastrophic injury, you must always go a step beyond getting the diagnosis to win your case. The problem with solely relying on a diagnosis is that the diagnosis often describes the type of injury sustained but not the full extent of the damage. Without a full understanding of the extent of the injury(ies) how can you prove the impact of the injury and/or what care the client will need long term?

Confidence in the injuries sustained in the client’s accident must come from a correct diagnosis as well as how that diagnosis affects the injureds’ life.  The only trial-proven test to confirm the diagnosis and prove the impact is the FUNCTIONAL CAPACITY EVALUATION (FCE).  During this 4-hour evaluation, the client’s impairments and disabilities are discovered which confirms not only the diagnosis itself but it also quantifies the severity of the diagnosis.

As a certified functional capacity evaluator, I have encountered numerous cases where a client has come in with a diagnosis and discovered through the FCE that this particular diagnosis has caused numerous other impairments and disabilities that would never have been discovered had the diagnosis been the only form of artillery that the attorney presented to the insurance company in their demand letter.

Arm your case with double barrels ablazing. One barrel is the diagnosis and the other barrel is the functional capacity evaluation.  Both fired together produce a tremendous force that launches a substantial impact.

Want to learn more about IRC and the services we provide? Visit our channel, Personal Injury Today for informative videos, or visit our website to set up a free case consultation.