Lawyers PI Program
 
“Building a PI Practice”

 #33

 From the Desk of:

 Mark Studin DC, FASBE (C), DAAPM, DAAMLP


“What to Say and Do When Meeting With Lawyers”

 

Part 2

Medical Legal Scorecard

 
CLICK HERE FOR SAMPLE SCORECARD
 

When you are with the lawyer in their office after they have invited you to review their charts, you need a formula to expedite the process and be thorough at the same time. The “Medical-Legal Scorecard” is the vehicle to make everything understandable for the lay person as well as allow you to quickly review the lawyer’s chart.

 

The “Medical-Legal Scorecard” is divided into 3 sections: historical issues of how the client feels or symptoms, structural findings and then functional findings. These 3 sections and the persistent functional loss coincide with the narrative format that I have explained in previous consultations. When you review the charts and fill in the columns, the lawyer will instantly understand your goals of triaging the paperwork and supporting his goals of clinically correlating history-structure-function and persistent functional loss to have a viable case. This now creates the need for the lawyer’s client to have a “Plaintiff IME,” or second opinion, based upon what part is missing and the ensuing diagnostic dilemma that persists (if present based upon the paperwork reviewed). Your job is to get the lawyer to understand the purpose, format and results of the “Medical-Legal Scorecard.”

 

First, I want you to print a copy of the “Medical-Legal Scorecard” by going to www.lawyerspiprogram.com, clicking on "Communication Materials," and downloading this free template. I created the “Medical-Legal Scorecard” in Microsoft Excel format so you can add your clinic information on the bottom. When you create these for the lawyer, they are going to refer back to this document because they are not doctors and they will need help. I promise they will and when they do, I want them to see your name over and over. Remember, marketing is about Repeating and Reviewing with Regularity.

 

As a note, I have been told that I am the stupidest business person on the planet because I give you all of my forms in an editable format. My mentors have advised me to put them all in a format that can’t be stolen, modified or shared with others who are not part of my program. They are right. However, if I do that, you can’t customize the forms to your practice and it makes it harder for you. So…I believe that everyone does the right thing in life and if you don’t, karma will take care of you, not me. Therefore, I simply ask you not to share with those not in the program. With that said, let’s look at the form and understand each part.

 

On the top, you have the client’s name. Remember, this is from the lawyer’s perspective, not the doctor, so it is the client you are referring to. The date of intake vs. the date of the accident is critical to the lawyer. This is where you are going to get into the business of personal injury law. If you demonstrate to the lawyer that you understand their business as well or sometimes better then they do, it will give them confidence in you and further bolster your relationship.

 

What makes lawyers money in personal injury? The answer is simply to settle or preval in their cases, as soon as possible. If their cases are sitting in their files and languishing for months and years, their money is sitting there, too.

 

Let’s look at the word “languish.”

lan·guish ˈl橯 gwɪʃ –

–verb (used without object)

To undergo neglect or experience prolonged inactivity; suffer hardship and distress: to languish in prison for ten years.

Dictionary.com Unabridged (v 1.1)

 

This word is the kiss of death for most businesses because it affects cash flow. In the business of law, it is a death sentence because of statutes of limitation.

 

When you are filling out the form, make sure you get this information, and if today’s date is greater then 6 months from the date of accident and there is little medical information, then this case has begun to languish in the file. Someone has dropped the ball in the lawyer’s office. Many cases go 1-2 years with little or no information on a case. This will also tell you about the level of organization of the lawyer and how they manage their cases. The more disorganized the lawyer, the more receptive they will be to hear what you have to say because they will want to recruit you to do the gathering of their medical material for them. The mechanism of injury is also important to understanding causality and clinically correlating the injuries to the accident.

 

The first thing to bear in mind is that all of the information is coming from other doctors' reports in the lawyer’s file. Request that the lawyer have all of the reports separated from all other documents to expedite the process. They usually have their files set up in that fashion.

 

Rule 1: When documenting results on the “Medical-Legal Scorecard,” always do it in a RED pen so it stands out on the form. Also, add Recommendations and Second Opinion Requested to the bottom of the page so the lawyer knows waht is needed. This also gives you the opportunity to discuss P-IME's

 

Column 1 has the symptoms. When you go through the medical reports, circle the region on the document and be careful to note left or right. You cannot correlate a left C5 herniation with a right C5 radiculopathy.

 

Column 2 is the structural findings. These are all of the tests that doctors perform that use film to render structural findings. This includes MRI, X-ray, bone scan, triple phase bone scan, CAT scan, Sonogram, tomogram, etc… So any finding that needs a film is placed in this column. When writing the results, be cryptic in completing the form, i.e. HNP C-5 Left or DJD L3.

 

Column 3 is the functional findings. These are the tests that show what works and what doesn’t and never requires film. This includes Range of Motion, muscle testing, EMG/NCV., SSEP, BAER, VEP, V-ENG, etc… Again, when writing in your results, be cryptic in completing the form, i.e. (+) Radic C5 Left or ↓ROM C-Spine.

 

Persistent Functional Loss: On the bottom of the columns you fill in, based upon the documentation in front of you any functional loss that has persisted after a course of care. What the lawyer tells you, or what the doctor documented at the beginning of care, does not count. The only loss that is relevant is what is documented after a reasonable course of treatment and has persisted. This is critically important to me, as a doctor, to certify disability, and it is important to the lawyer to have a case. It is important to know that a herniated disc without any functional loss has virtually no value to a lawyer. There has to be functional loss as a result of bodily injury.

 

After you have completed all of the columns and the persistent functional loss, you now play connect the dots (this is so much fun)! If you have neck pain, HNP C5 Left and decreased ROM in the C-Spine and EMG + for Radiculopathy at C5 on the left, along with loss of use of the left arm, you have clinical correlation of all 3 areas with ensuing functional loss. The lawyer now has a very good case to argue.

 

Here is what it will look like:

 

Symptom Structural Functional

Neck Pain HNP C5 ↓ROM C-Spine

+ Radic C5 Left

Functional Loss: Unable to lift left arm without pain

 

Your goal is not to make the lawyer a very good case to argue. It is to look at this case from a doctor’s perspective and see if there are any diagnostic dilemma’s that have not been resolved. If in the above scenario, there was no imaging study done, there would nothing filled out in the structural column on the “Medical-Legal Scorecard,” and you would add under Recommendations, a cervical MRI. In this case, there is neck pain and a positive radiculopathy with loss of motion of the joint. How come? What is the cause of the radiculopathy? These are all questions that need to be answered by any doctor in a clinical setting, and issues needing to be resolved for the well-being of the client/patient.

 

Will this potentially help the lawyer’s case? Of course it will, if you now get the clinical answer and it gives you the last piece of the diagnostic puzzle to clinically correlate all 3 columns. Are you doing it for the lawyer’s case? NO! You are a doctor and your job is to help those in need from an honest and ethical scenario.

 

The problem you will find as you start reading other doctor’s reports, is that most doctors are clueless in treating the inured. You will be amazed at the poor level of care rendered to the majority of these victims! I have read 1000’s if not 10,000’s of doctor’s reports and I am still amazed at how little the majority of doctors understand when treating the injured. I am including every doctor from almost every discipline.

 

You must have answers to all diagnostic dilemmas and it also must include functional loss. If there is bodily injury as evidenced by the 3 columns, then what is the persistent functional loss? It is within our scope as chiropractors, as well as many other health care disciplines, to include disability status of our patients, as related to the musculo-skeletal system. In trauma, that is the primary area of disability. Therefore, if the functional loss is not documented, that still leaves a diagnostic dilemma. What can this person no longer do?

 

After you complete the form, simply turn to the lawyer, hand them the form and if a diagnostic dilemma exists, tell the lawyer what you found. This is where you will get the referral. Tell the lawyer that you will perform a Plaintiff IME, or second opinion, and will evaluate their client to confirm the clinical necessity of ordering a test. If an MRI is clinically indicated, you will order it. If a range of motion test is clinically indicated, you will order it. If an EMG is clinically indicated, you will order it. You will also determine what functional losses have persisted as a result of the bodily injury. On the bottom, right-hand side of the form in BLUE bold, is a statement: "Second Opinion Indicated." This is where you will write YES or NO.

 

After having all of the results, you will then create a report for their client and become a treating doctor so the lawyer can submit your report into evidence. At this point in time, the lawyer should have already seen your report and will be very excited to have that level of documentation, as it will help their cases if there are clinical finding present.

 

When I have reviewed cases for the lawyers through the years, 50% of the time I have told the lawyer that there is no case based upon the information presented. I usually suggest to the lawyer that nothing documented usually means there is no bodily injury and they should consider dismissing the case.

 

A lawyer will also be equally happy with you to know, as soon as possible, that there is no case, and they will save time, money and their reputation by releasing cases where there are no injuries. It also adds to your credibility as a doctor in not trying to make something out of nothing. Most lawyers want to have ethical relationships with doctors and are actively seeking those types of relationships. You might not get a case in the short term, but will have created a lifelong relationship as a result of your integrity.

 

I have explained in the previous consultation how to charge for these exams. However, it is the P-IME’s that will allow the lawyer to gain the confidence and respect for you as a doctor, and after seeing a few of your reports, they will start to refer you their new cases. It has worked for me every time, as well as for doctors in New York City, Upstate New York, Florida, California, Connecticut, Kentucky, etc. It will work for you, too. All you need to do is take action!