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By Judy Anderson, J.D.
I work in an applicant/plaintiff medical clinic. Like many people on this side, we are legitimate. Unfortunately, we work under the shadow cast by the few less than honest groups out there. Some attorneys and others have difficulty with the concept of doing this game legitimately. They simply don’t know what to say when they ask us what they get for referring cases to us and we respond “A high quality report that will serve you well in court.”
We have come across some amusing, and some frightening, situations as a result of our firm stance for ethics. Some examples:
- A workers’ compensation paralegal (who likes to let people believe that he’s a lawyer) told us he did not send us all the records on the cases he referred to us because he didn’t want to bias us. This winner also instructed the client not to mention the major car accident he had been involved in just a few weeks prior to our seeing him. The client told us anyway since he didn’t feel right about lying. Perhaps the paralegal thought the doctor wouldn’t notice the large, fresh splenectomy scar.
- I am often asked by the personal injury attorneys to go back and change reports; usually to provide greater detail or to correct dates for patients with faulty memories. One attorney asked that we omit the fact that the patient had hurt his back 20 years ago while playing football in high school and that he had suffered pain ever since. The attorney was most upset when we refused to attribute the patient’s degenerative spine changes to an accident that had occurred only one month before we saw the patient.
- An attorney often asks us if it “was remotely possible” that a patient’s other complaints (not related to the doctor’s specialty) could be industrial. The attorney does this so that he can refer the patient to other specialists. In one case, the attorney was looking for a statement of remote possibility that the patient’s lumbar strain had caused 51% of his psychiatric problems. The patient was 21 and had already been hospitalized twice as a teenager for schizophrenia. I’m afraid the possibility was just a little too remote for me.
- Another attorney said we weren’t charging enough for our workers’ compensation cases. The billing rules for workers’ compensation are fairly tight and we are conservative. A few weeks after this attorney’s recommendation, his favorite doctor was arrested for billing fraud because he was overcharging for his services. Thanks for the advice.
- We routinely have attorneys call to chastise us for returning patients to work, even to modified duty. One office said, “Our clients never go back to work.” Sorry we made him better.
- Another attorney when advised of new compensation laws forbidding giving gifts in exchange for cases indicated that his office could use new computer equipment. Great! So could ours.
- There is one attorney who likes to file workers’ compensation cases primarily so that he can get examinations for Social Security purposes. In one case, he filed a continuing trauma claim for the patient’s back. The patient had a record of 13 drunk driving accidents over the past 30 years, but the attorney wanted us to say that his problems were due to two weeks at one job.
I also have found abuses on the other side. (I used to work for a defense medical firm.)
- A doctor said the patient was exaggerating his pain complaints when he had an 8-mm herniated disc (big by anyone’s standards) and was scheduled for surgery the next day.
- A psychiatrist, who evaluated a patient one week after he suffered asphalt burns over 18 percent of his body, indicated the patient was adjusting well and would never need psychiatric care for the injury. Nine months later, I was talking the patient out of suicide. We couldn’t get him to a psychiatrist because the insurance carrier was denying the injury based on the initial psychiatric report. Post-Traumatic Stress Disorder anyone?
- A compensation doctor trying to justify a higher bill indicated that the patient’s condition was unique and that he had to spend two hours researching it. And just what was the unique condition? A lumbar sprain.
I find one of my biggest problems is with vocational rehabilitation counselors. Under California law, the doctor is supposed to authorize the retraining program plan before the patient starts. I find that counselors routinely start the program first and then ask if it’s okay. (We see many exacerbations that occur this way.) These counselors seem to be geared only to physical work. They have difficulty dealing with patients who have very limited physical ability (Gee, how about training them to work using their minds?) and even more trouble with head injury patients who have cognitive impairment.
- A vocational counselor recommended one patient begin working for a smog tune-up and light automobile repair firm. There was only one problem: the patient was brain damaged. The work fit his physical restrictions; so he couldn’t remember anything that he was taught and couldn’t make judgment calls. Maybe the counselor would allow him to work on her car, but I’m not sure I would. Would you?
- Other counselors when they are told a patient can’t do repetitive upper extremity work refer the patient to train for front office medical work. When they hear this, our front office staff laughs so hard that they are liable to knock over their typewriters and damage their wrist splints.
- Some counselors when they are told the patient can’t do fine manipulative work refer the patient for training in electronic assembly, including soldering circuit boards.
Then, of course, there are the war stories one hears from patients when working on either side of the aisle. There are plenty of patients who create symptoms in order to get drugs for themselves or for their partners. Some patients have heard that a really bad back injury causes numbness; so they complain of numbness over one entire side of their bodies when they are seen for a low back injury. (Sorry, but the nerves just don’t work that way).
- One patient had his wife in the room during his examination.
When the doctor tested this patient for pain, his wife screamed.
- Another patient wanted to be sure we got all of his complaints down on paper: including the fact that his dandruff had increased since his accident.
- Then there was the patient who decided that he wanted as much disability as possible as a result of chemical burns on his hand. He refused to use the hand. When we returned him to work in order to force him to use the hand, he was seen taking off his protective glove and sticking Post-its* to the burned area so that he would have the proof he needed to say that the work was making his hand bleed.
- Another patient claimed her broken left clavicle was due to a seat belt injury. She was the right side passenger. Sorry, wrong side.
For the most part, the people we deal with on either side are legitimate and are doing what they feel is best from their perspective. It’s the ones that cross over the line that provide us with regular amusement or aggravation. Those attorneys mentioned above have either learned to accede to our honesty or they are now sending their patients to someone else.
Judy Anderson, J.D., is a medical legal specialist who has worked 3 years in defense and 3-1/2 years in applicant/plaintiff. She can be reached at (714) 834-1555.
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