Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 661
Infrastructure 154 I

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: many of these issues I bring are small, yet each issue is just that… an issue. If you take care of the small issues, then you will be able to build and focus on the larger issues… a larger, more profitable practice along with more family time. 

“Lawyers Training Manual”

Preparing Your Patient for a IME DME (Defense Medical Examination)
As a result of presenting to both trial lawyers and defense (carriers') lawyers, I have been exposed to not only their tactics but their training manuals. At one large presentation where I was invited to speak, there were training manuals for sale of which I gladly spent a few hundred dollars to get the “inside scoop.” As a side note, the training manual was two volumes and approximately 600 pages and over the next few weeks, I will be sending you excerpts.

The manual instructs the plaintiffs' lawyers on how to prepare their clients for a defense medical exanimation. I am going to include both the lawyers' perspective and my recommendations based upon a significant amount of personal experience in my patients getting “screwed” to help ensure that the truth is exposed and reported. I will be substituting the word “client” to “patient” to make this rhetorically more applicable to you:

“Talk to your patients about the exam. Drive home the importance of honesty and explain just how detrimental exaggerating can be. For example, explain to your client that complaining of pain in areas that don’t really hurt diminishes the credibility of their complaints about areas that do hurt. 

All of your patients and their spouses and/or family members should keep a diary. Diaries tell you things you would never know about your patient and how his or her family is suffering due to the injury. It also forces the family member to pay attention to and document unusual behavior by the injured. More than one cases been won based upon the observations of others close to the patient for example the diary might depict: Irritability, “Sam yelled the F-word at the electronics manager in the store and security escorted us out of the building. It was humiliating”. Depression, “Sarah cries every day. She will cry sometimes for 45 minutes over commercials on television.” Lack of initiation, “Tom won’t go anywhere. I have a hard time getting him up to take the kids to school. I know he has a brain injury and I know the Dr. told me this would happen, but it’s still hard to work all day, then come home and see the breakfast dishes piled in the sink and he is sitting in the same chair he was sitting in when I left home this morning.”

This is the type of ancillary documentation that your patients should bring with them to the defense medical examination and hand to the doctor to have the insurance company doctor memorize for their examination documentation. Although the lawyers’ manual suggests considering hiring a photographer and videographer to join your patient in an examination, I generally disagree because that will create an even more confrontational environment. I do, however, as previously suggested, strongly urge you to have your patient bring with him/her a friend or relative to attend the examination to act as witness.

The lawyers’ manual goes on to say:

“Once you have the report, make sure you and your patient review the material (the IMEs examination report). Ask your patient to make comments on the defense report or attached papers. This can provide tremendous amount of fodder for cross-examination. For example, you may see notes like: “the doctor never did such a test or I never saw this Dr. or he’s a man’s name and I saw a female.”

In addition, what I’m suggesting is that you look for the insurance company Dr. who lied through either omission by not documenting test results or claimed the examination was much more comprehensive than it actually was. This has been the case more times than not in my experience over the last decade.

Should the insurance company Dr. lie for any reason, then consider following the protocols in section #9, IME, Peer Review and Carry Rebuttals in the consultations or go to section #18 and talk to Dr. Manoni who will support you in the process if you choose. I urge you to choose your actions carefully and only make the “fraud” allegation if the insurance company Dr. has clearly lied. By not taking action, you are condoning and perpetuating the fraud and abuse, while making both these doctors and the carriers wealthier at your expense. 


 
Respectfully,



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

Adjunct Assistant Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences 

 
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