MSK med legal case advice from the experts

[ghost dog]

Hey folks,

Wondering if some peeps could weigh in here.

I've been getting some pretty horrible MVA related / MSK med legal cases recently. A fair number of the claimant's I have seen are not disabled in any sense of the word.

A recent case: 31 yr old lady with chronic back pain 2 years post MVA. She states that she is unable to work her desk job, yet is attending the same number of hours at ESL school ( and missing roughly 2 days / month due to back pain symptoms). Minimal physical findings - i.e. mildly decreased ROM and moderate lumbar paravert tenderness (i.e. the usual ).

Plus the usual story: claimant attempted Tyl 325 mg + 19 months of physio ( yes 19 months). No prescription meds attempted.

Being the ethical dude I am, I will either flat out deny any form of disability or will rarely hedge my bets and recommend some form of formal tests (i.e. housekeeping assessment +/- FAE).

I find it shocking the lack of ethics out there in regards to med / legal reports (i.e. " rent a doc "). Or perhaps I'm being too strict with my definition of disability ( although I doubt it) .....

Any thoughts on this ???

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[Gauss]

hold the line...
they are not disabled from all work and while they may have limitations to their functional abilities, pain is not a primary disability
I tell these patients about SCI, stroke, amputees, TBI, burns as examples of far more disabled individuals

 

[ghost dog]

hold the line...
they are not disabled from all work and while they may have limitations to their functional abilities, pain is not a primary disability
I tell these patients about SCI, stroke, amputees, TBI, burns as examples of far more disabled individuals

Absolutely, I agree 100 %.

Perhaps I phrased this poorly. In the above scenario I provided, the functional limitiations are pretty much nil ; i.e. the claimant is able to attend school with mild to minimal disability, and her job description is pretty much identical to that of the classroom (i.e. computer work). This is where things get a bit sticky, so to speak.

When faced with the issue of questionable med / legal cases ( sent by the lawyer), I am faced with putting my ethics ahead of the financial interests of the claimant and lawyer.

Has anyone else encountered this dilemma ?

This has seemed to be getting to be more frequent as of late.

 

[lobelsteve]

Absolutely, I agree 100 %.

Perhaps I phrased this poorly. In the above scenario I provided, the functional limitiations are pretty much nil ; i.e. the claimant is able to attend school with mild to minimal disability, and her job description is pretty much identical to that of the classroom (i.e. computer work). This is where things get a bit sticky, so to speak.

When faced with the issue of questionable med / legal cases ( sent by the lawyer), I am faced with putting my ethics ahead of the financial interests of the claimant and lawyer.

Has anyone else encountered this dilemma ?

This has seemed to be getting to be more frequent as of late.

Daily. Exam, imaging. No impairment. No disability. Some impairment some restrictions and limitation.

 

[RUOkie]

Ghost Dog

Do what is right. When a plaintif's attny sends you a patient they are looking for one of two things. Either they want an honest opinion so the plaintif gets out of his/her office (we don't have a case-go away), or they are looking for a big "disability" claim.

Those attorneys learned years ago to never send the latter cases to me unless they had a catastrophic injury. The defense (insurance co) attorneys love me for the same reason.

Do not EVER let a lawyer compromise your ethics, it is not worth the $$ since you need to sleep at night.

 

[Jitter Bug]

Disability determination is easy when you are judging physical or cognitive deficits. Either they can walk, climb steps, make change, answer phones, sit at a desk etc or they can't.

When it comes down to pain, once I have done my due diligence to prove no organic abnormality that needs treatment exists (infection, tumor, nerve compression, ligament sprain, fracture etc) or they have completed exhaustive courses of reasonable treatment with no response, then call it chronic: but pain alone is no reason to restrict activity (including work).

The courts can decide if they deserve money as compensation because their back hurts daily but I will tell them they don't qualify for disability or wage replacement because the best advice for non-organic chronic pain is usual activities including working.

 

[PMR 4 MSK]

A doctor should not be made to determine disability. A doctor should determine impairments and report that to the legal system. Disability is a legal term, not a medical one.

"How long can the patient sit at one time?" How the hell would I know?
"How long can the patient walk total in one 8 hour day?" I don't know, why don't you hire someone to follow him around and time him?
"What impairment is currently preventing the applicant from working?" Umm, monthly disability checks, marijuana and the Oprah Winfrey Network.

 

[Jitter Bug]

A doctor should not be made to determine disability. A doctor should determine impairments and report that to the legal system. Disability is a legal term, not a medical one.

Good point. I usually try to make it clear that medical opinion is different than legal and doesn't follow the same rules.

I try to not burn people by writing letters that say they are not disabled and have a wide variety of jobs they could do. I just tell them that is what I would write, so don't ask me for a letter.

 

[specepic]

A doctor should not be made to determine disability. A doctor should determine impairments and report that to the legal system. Disability is a legal term, not a medical one.

"How long can the patient sit at one time?" How the hell would I know?
"How long can the patient walk total in one 8 hour day?" I don't know, why don't you hire someone to follow him around and time him?
"What impairment is currently preventing the applicant from working?" Umm, monthly disability checks, marijuana and the Oprah Winfrey Network.

Apparently I was not properly 'trained' when it comes to WC/auto/legal stuff b/c I hate these forms and never give them the info they seem to want to hear. I often write things exactly like what you list, "i don't know" or "read my note". I hate doing paperwork twice. There is an office note. f*ing read that first. My fav catch alls: "get an FCE" or "not formally assessed today"

 

[ghost dog]

Ghost Dog

Do what is right. When a plaintif's attny sends you a patient they are looking for one of two things. Either they want an honest opinion so the plaintif gets out of his/her office (we don't have a case-go away), or they are looking for a big "disability" claim.

Those attorneys learned years ago to never send the latter cases to me unless they had a catastrophic injury. The defense (insurance co) attorneys love me for the same reason.

Do not EVER let a lawyer compromise your ethics, it is not worth the $$ since you need to sleep at night.

Of course you are right, and this is how I roll.

I had yet another crap med / legal referral yesterday.

The claimant is 2 years post MVA and did not miss any time off work following the MVA. Not 1 day.

I mean really, why would any lawyer in the right mind take a case like this ??

It gets better: this claimant had not attended their family MD in 4 years. Physio arranged via legal counsel - WTF ?

After hearing this type of story - do I really need to hear anything else ???

I mean really, this sort of **** jamming up the legal system we do not need.