Designated Doctor Opinions...•regional differences (attorney strategy) •strategies for later 9. sibs •technically, two years •but rtw option •fewer sibs cases 10. other issues

CUTTING AGAINST THE GRAIN: HOW TO SUCCESSFULLY

CHALLENGE DESIGNATED DOCTOR DECISIONS

ANALYZING, DEFENDING, & ATTACKING

THE BEGINNING

2

HOW BBQ STARTED IN CENTRAL TEXAS

3

WHAT DOES PRESUMPTIVE WEIGHT MEAN?

• STATUTE

• RULE

• APD

• REAL WORLD

4

FIRST, MUST PAY MMI/IR

• TRUMPS ALL PREVIOUS CERTIFICATIONS

• UNLESS 90 DAY

• PROCEDURES IF REALLY, REALLY AWFUL CERTIFICATION

• 5 DAYS

• MEDICAL TOO

5

6

DISABILITY

• GAMESMANSHIP

• MEDICAL DETERMINATION

• NOT A LEGAL DETERMINATION

• BONA FIDE OFFER OF EMPLOYMENT

• TERMINATION FOR CAUSE

• FAILURE TO ATTEND DD

7

RETURN TO WORK

• DIFFERENT FROM DISABILITY

• BONA FIDE OFFER OF EMPLOYMENT

8

EXTENT

• THE DANCE WITH MMI/IR

• REGIONAL DIFFERENCES (ATTORNEY STRATEGY)

• STRATEGIES FOR LATER

9

SIBS

• TECHNICALLY, TWO YEARS

• BUT RTW OPTION

• FEWER SIBS CASES

10

OTHER ISSUES

• COMPENSABILITY

• LIBS

• ???

11

WHAT ABOUT SUBSEQUENT MMI/IR?

• TREATING DOCTOR?

• POST-DD RME?

• LOOK AT

• DATE OF DD’S CERTIFICATION

• DATE OF NEW MMI

12

DWC-32

• WHO COMPLETED?

• MATRIX

• BOX 37

• COMPARE WITH THE DD SELECTED

13

CHALLENGING THE APPOINTMENT

• GAMESMANSHIP

• COMPARE WITH DWC-32

• QUALIFICATIONS

• SUBJECT MATTER

• 3 DAYS

• MOTION TO STAY

• MOTION FOR EXPEDITED CCH

• NEGOTIATE

• ON THE RECORD14

PREPARING FOR DD

• CONSIDER ADDING ISSUES (BEFORE AND

AFTER YOU KNOW THE DD)

• ODG TREATMENT PURSUIT

• DIAGNOSTIC SCAN REVIEW

• INJURY RE-ENACTMENT

• PEER REVIEW

• SURVEILLANCE

• DESIGNATED DOCTOR ANALYSIS LETTER

15

REFERRALS

• INITIAL CONCERNS

• REFERRAL FOR PROFIT

• LET US PREAUTHORIZE

• DOCTORS

• LET US DO OUR JOBS

• HASSEL FACTOR

• DWC COMPROMISE

• NO PREAUTHORIZATION BUT

POSSIBLE AV16

ANALYZING

• DWC-32 COMPARISON

• PEER REVIEW FOR ACCURACY

• AND IF THE IR IS BELOW 15% …

• BONA FIDE OFFER OF EMPLOYMENT

• IF NOT AT MMI, CONSIDER PURSUIT OF

TREATMENT MODALITIES

17

DEFENDING

• PEER V POST-DD RME

• READ CAREFULLY

• READ LIKE A SKILLED CLAIMANT ATTORNEY

• READ DOCTOR SELECTED BY AND ACTING

IN PLACE OF THE TREATING DOCTOR

REPORT LIKE A SKILLED CLAIMANT

ATTORNEY

• CONSIDER LETTER OF CLARIFICATION

18

ATTACK DD WITH HER OWN REPORT

• QUALIFICATION OF DD

• MECHANISM OF INJURY

• LACK OF MEDICAL RECORDS

• ERRORS IN ROM

• ERRORS APPLYING AMA GUIDES

19

ATTACK DD WITH NEW EVIDENCE (OVERVIEW)

• MECHANISM OF INJURY

• RE-ENACTMENT OF INJURY

• DIAGNOSTIC REVIEWS

• NEW DIAGNOSTIC TESTS

• NEW TREATMENT

• ERRORS

• SURVEILLANCE COMPARISON

• POST-DD RME20

MECHANISM OF INJURY

• COMPARE DD REPORT WITH OTHER MOI DESCRIPTIONS

• COMPARE DD REPORT WITH ACTUAL, DOCUMENTED MOI

• WAS THERE SURVEILLANCE OF MOI

• RE-ENACTMENT OF MOI

21

DIAGNOSTIC REVIEWS

• RE-READS

• REREAD TESTIMONY

• AUTHENTIC4D

22

POST-DD RME

• MORE QUALIFIED

• NOT A DR. NO!

• NO ERRORS

• QUALITY REPORT

• EXPLAINS REASONS, NOT JUST

OPINIONS

• BE WILLING TO TESTIFY

23

VIDEO STATEMENTS

• LIKE A DEPO, BUT …

• EXPENSIVE

• HAVE A GOOD REASON

• BETTER THAN A REPORT

• SOME ADVANTAGES

• SOME DISADVANTAGES

24

DEPOSITIONS

• ATTORNEYS INVOLVEMENT AND

AGREEMENT

• QUALIFIED EXPERTS

• POTENTIAL LITIGATION

• AGREEMENT OF THE DOCTOR

25

PERSUASIVE PRESENTATION

• NOT JUST A COMPARISON OF REPORTS

• TESTIMONY OF EXPERT

• LIMIT ARGUMENTS TO MAX OF THREE

ERRORS

• BETTER IF NEW EVIDENCE (DD WAS NOT

“WRONG”, JUST DID NOT HAVE ALL THE

FACTS)

• FOCUS ON THE CORRECT RESULT, NOT DD

ERROR

26

TIME FOR A LESSON FROM THE MASTERON HOW TO SLICE A BRISKET?

27

LETS GET TO HAPPINESS

28