Med Legal Case : and lawyers are douchebags

[ghost dog]

I saw an unfortunate claimant awhile back for a med legal assessment.

This young gentleman was hit by a vehicle ( as a pedestrian), and incurred a serious head injury requiring a craniotomy in addition to multiple orthopedic injuries.

Fast forward 2 years later : the claimant has essentially healed from his orthopedic injuries ( i.e. pain once weekly), but is left with a significant neurocognitive deficit. This is demonstrated very clearly in the occupational therapist's notes. In particular, he attempted to return to school, and found that he could not from a cognitive perspective.

However, he has not received a neuropsych IME / assessment.

As a result, I stated that it was my opinion he was not significantly physically impaired, but he seemed quite cognitively impaired. However, this issue was outside my area of expertise, and thus I could not make any definitive statements in this regard. As such, I strongly recommended he receive a neuropsych assessment.

Apparently the lawyer has a problem with this. I say tough beans. I stick by my report ( and not to mention ethics). Pony up the dough and get a psych assessment. I would get torn apart on the stand if I ventured into cognitive territory. The lawyer now wants to meet with me in my office. Needless to say, I ain't changing the report.

Thoughts or comments ? Similiar experiences ?

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[Apollyon]

You're doing the right thing. One of the hallmarks of physician specialists is knowing where one's borders are, and referring appropriately when an issue crosses into territory where the specialist is not expert.

Recall the aphorism "99% of lawyers make all the rest of them look bad". Another is "people think lawyers are scumbags until they need one." No, if/when I need one, they are STILL scumbags and human pieces of ****, but I need the scuzziest, best/worst one to put up against the other scumbags. Just like prostitutes (but more dishonest about their work), I pay my money, I get what I need, and go away. I don't think more of you for doing what I would not (which isn't all-encompassing, but does apply in this case).

 

[Gauss]

Do not meet with the lawyer on your own, always bring your own representation. Even if you are subpoenaed you are entitled to your own representation. They will try to get you to provide expert analysis without compensating you for such and if you get trapped then they could come after you as well.

 

[101N]

I saw an unfortunate claimant awhile back for a med legal assessment.

This young gentleman was hit by a vehicle ( as a pedestrian), and incurred a serious head injury requiring a craniotomy in addition to multiple orthopedic injuries.

Fast forward 2 years later : the claimant has essentially healed from his orthopedic injuries ( i.e. pain once weekly), but is left with a significant neurocognitive deficit. This is demonstrated very clearly in the occupational therapist's notes. In particular, he attempted to return to school, and found that he could not from a cognitive perspective.

However, he has not received a neuropsych IME / assessment.

As a result, I stated that it was my opinion he was not significantly physically impaired, but he seemed quite cognitively impaired. However, this issue was outside my area of expertise, and thus I could not make any definitive statements in this regard. As such, I strongly recommended he receive a neuropsych assessment.

Apparently the lawyer has a problem with this. I say tough beans. I stick by my report ( and not to mention ethics). Pony up the dough and get a psych assessment. I would get torn apart on the stand if I ventured into cognitive territory. The lawyer now wants to meet with me in my office. Needless to say, I ain't changing the report.

Thoughts or comments ? Similiar experiences ?

You did the right thing. Meet him/her but stick to your guns. Order a neuropsych eval with validity testing and a GAF. If he has a significant cognitive impairment it will declare itself in the testing.

A few years back I was seeing a gal with an old TBI from a MCA. She had all the sequelli -
frontal, impulsive, emotional, forgetful, anger management - she was applying for disability due to CTS She couldn't hold a job because she couldn't keep up. I imaged her brain - Rt frontal lobe was gone - got neuropsych testing - GAF of 50 - and defended her disability case for TBI, not CTS.

 

[Jcm800]

You did the right thing. Meet him/her but stick to your guns. Order a neuropsych eval with validity testing and a GAF. If he has a significant cognitive impairment it will declare itself in the testing.

A few years back I was seeing a gal with an old TBI from a MCA. She had all the sequelli -
frontal, impulsive, emotional, forgetful, anger management - she was applying for disability due to CTS She couldn't hold a job because she couldn't keep up. I imaged her brain - Rt frontal lobe was gone - got neuropsych testing - GAF of 50 - and defended her disability case for TBI, not CTS.

if you meet with the attornery, charge up front 2 hour minimum, 400-800/hour. He may not want to meet then. And if he still does, hey, it was worth the "experience"

 

[Pain Applicant1]

if you meet with the attornery, charge up front 2 hour minimum, 400-800/hour. He may not want to meet then. And if he still does, hey, it was worth the "experience"

Are you being serious or facetious about this? If you're serious, that's what I'll do when they decide to come by my office.

 

[PMR 4 MSK]

Are you being serious or facetious about this? If you're serious, that's what I'll do when they decide to come by my office.

My clinic's fee for all docs for expert witness testimony for deposition is $1000/hour. They pay it, in advance, if they want the depo.

 

[101N]

John Edwards

 

[Pain Applicant1]

My clinic's fee for all docs for expert witness testimony for deposition is $1000/hour. They pay it, in advance, if they want the depo.

Wow, nice. I'll start implementing that.

 

[Doctodd]

My clinic's fee for all docs for expert witness testimony for deposition is $1000/hour. They pay it, in advance, if they want the depo.

what he said......make sure they pay in advance. Schedule an hour and nothing more. have your girl interrupt you after 1 hour.....if he wants more time ask for a CHECK!!!

 

[bedrock]

Are you being serious or facetious about this? If you're serious, that's what I'll do when they decide to come by my office.

Definitely charge them. They are just disrespecting you to "drop by" to chat about a case.
If the shoe was on the other foot they'd be charging you $500/hr without missing a beat.
They're just being lawyers and seeing what they can get away with. They probably joke about it with other lawyers when they are able to meet with physicians for free.

I'm not sure if I'd charge them deposition rates if they just stop by the office. $ My depo rate is $2000/hr. To discuss a case, I'd drop it down to what JCM800 suggested $400-800/hr depending on your area (rural/urban setting.)

 

[ghost dog]

Definitely charge them. They are just disrespecting you to "drop by" to chat about a case.
If the shoe was on the other foot they'd be charging you $500/hr without missing a beat.
They're just being lawyers and seeing what they can get away with. They probably joke about it with other lawyers when they are able to meet with physicians for free.

I'm not sure if I'd charge them deposition rates if they just stop by the office. $ My depo rate is $2000/hr. To discuss a case, I'd drop it down to what JCM800 suggested $400-800/hr depending on your area (rural/urban setting.)

Thanks for all the advice.

I will be calling this "counsellor" to inform him of the financial issue here.

We'll see if he still wants to meet up.

 

[facets]

Yes, be sure to show them the same courtesy thay show us, copies, $5 dollars a page, fax $3 a page, phone call minimum charge of $150. They need to prepay. They probly have meetings where they laugh at all the doctors who didn;t get payment. We are used to doing this to insurance companies, other physicians, not lawyers

 

[Jitter Bug]

You are doing the right thing by identifying the problem (cognitive deficits) and recommending appropriate evaluation by an expert. If you don't manage TBI patients as part of your everyday practice, then you are not the expert and it's okay to refer them on.

Every once in awhile I pluck out a TBI from a MVA neck and back pain case. I document the crap out of it, and send them to a general PM&R practice for TBI eval.

If the lawyer wants to meet with you, inform them your hourly or half hourly fee for personal meetings and ask them how long they want your company and then have them pre-pay. Serious. It's the way my practice does it. I don't charge alot, but even a small fee makes them think hard about how much they really want to meet with you. If they say, hey just give me your cell and we can have a quick chat, ask how long a phone call they would like, schedule a time and have them prepay for that too. Don't give them your cell, call them or have the front desk patch them through.

I assume they want a face to face meeting the better to tangle you up in your own words and try to get you to crack and backtrack on your impressions and recommendations. Be strong.

 

[Jcm800]

Are you being serious or facetious about this? If you're serious, that's what I'll do when they decide to come by my office.

dead serious.

It is al lot more for a deposition, and that is pre-paid, 2 weeks in advance, or i cancel them...if its a "drop by for 15 minutes" charge for a full hour, pre-paid, and tell em, they paid for the hour, lets talk...

 

[Pain Applicant1]

dead serious.

It is al lot more for a deposition, and that is pre-paid, 2 weeks in advance, or i cancel them...if its a "drop by for 15 minutes" charge for a full hour, pre-paid, and tell em, they paid for the hour, lets talk...

Excellent advice! I had no idea. Thanks.

 

[Pain Applicant1]

Definitely charge them. They are just disrespecting you to "drop by" to chat about a case.
If the shoe was on the other foot they'd be charging you $500/hr without missing a beat.
They're just being lawyers and seeing what they can get away with. They probably joke about it with other lawyers when they are able to meet with physicians for free.

I'm not sure if I'd charge them deposition rates if they just stop by the office. $ My depo rate is $2000/hr. To discuss a case, I'd drop it down to what JCM800 suggested $400-800/hr depending on your area (rural/urban setting.)

dead serious.

It is al lot more for a deposition, and that is pre-paid, 2 weeks in advance, or i cancel them...if its a "drop by for 15 minutes" charge for a full hour, pre-paid, and tell em, they paid for the hour, lets talk...

what he said......make sure they pay in advance. Schedule an hour and nothing more. have your girl interrupt you after 1 hour.....if he wants more time ask for a CHECK!!!

Excellent advice! I had no idea, thanks.

 

[Jcm800]

MOVE TO PRIVATE FORUM!!!!!!!! Please

 

[bedrock]

Ditto

MOVE TO PRIVATE FORUM, PLEASE

 

[ghost dog]

Ditto

MOVE TO PRIVATE FORUM, PLEASE

Update: the legal eagle cancelled this meeting after my request for payment of said meeting.

 

[Jcm800]

Update: the legal eagle cancelled this meeting after my request for payment of said meeting.

what did i tell ya!!!

i have had so many meetings "cancelled" this way. i don't want em, so in my case, mission accomplished.

good for you.

 

[Jcm800]

Can Isis please be moved to private forum!

 

[ghost dog]

Can Isis please be moved to private forum!

I think the discussion has reached it's natural conclusion, no ?

 

[Jcm800]

I think the discussion has reached it's natural conclusion, no ?

Yes, but those comments are sitting in the public forum thus the need for the transfer

 

[ampaphb]

SERVICE HOURLY RATE

REVIEWS
Hourly rate - Review of films and/or case materials $xxx
(1 hour minimum)

CONFERENCES – TELEPHONE OR IN-OFFICE
1st hour rate - Additional time billed in 15-minute increments. $xxx
(1 hour minimum)

DEPOSITIONS- Discovery $xxx
Additional time billed in 15-minute increments
Pre-trial preparation, travel time portal to portal, & time spent being deposed are all considered for billing.
Confirmation of depositions requires two checks at scheduling - the first for $xxx (review and preparation), and the second for $x,xxx (travel and deposition testimony). The first check will be non-refundable if the deposition is cancelled with less than 7 business days notice. Both checks will be non-refundable if the deposition is cancelled with less than 2 business days notice. (2 hour minimum)

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Pre-trial preparation, travel time portal to portal & court appearance are all considered for billing.
Confirmation of scheduled court appearances requires two checks at scheduling - the first for $xxx (review and preparation), and the second for $x,xxx (travel and court appearance/deposition testimony). The first check will be non-refundable if the court appearance is cancelled with less than 7 business days notice. Both checks will be non-refundable if the court appearance is cancelled with less than 2 business days notice. (3 hour minimum)

COURT APPEARANCE (OUT OF TOWN)
The fee represents loss of daily revenue. Expenses incurred due to travel are also to be reimbursed (i.e. airfare, hotel accommodations for stay over, ground transportation and any additional miscellaneous expenses incurred for court appearance).
PREPAYMENT REQUIRED PRIOR TO COURT APPEARANCE - HALF DAY RATE $x,xxx, FULL DAY RATE $x,xxx



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