If you don't want a five figure bill, don't send 5000 pages

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Re: If you don't want a five figure bill, don't send 5000 pages

Postby appliedpsych on Mon Feb 11, 2019 8:02 am

Absolutely right MyTwo! How many long-suffering injured workers have I heard say a similar thing? Why am I here seeing you 5 years after I was injured? Why didn't the insurance just take care of me?

Do they prefer to pay medical-legal bills rather than the injured worker? What other conclusions might be drawn?
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby vampireinthenight on Mon Feb 11, 2019 9:43 am

vampire: I’m not sure I understand your comment. Are you saying that the paramount goal here is to minimize the time spent by the attorneys on both sides and keep the costs down for the insurance company? If so, it’s going to cost the insurance company more to pay the doctor to review a stack of clearly irrelevant records than to pay the defense attorney to vet them for relevance. By the same rationale one could argue that it’s more efficient for both parties to offer all of the products of discovery into evidence at a trial, relevant or not, and let the judge sort it out.


The defense attorney reviews the records regardless. There seems to be some misconception here that a defense attorney can unilaterally decide what is relevant and only send records he/she feels is relevant to the case. CAN the defense do that? Of course they can! And then be prepared for long contorted road of attacks, objections and re-evals when opposing counsel claims the QME did not review records that AA has later determined are relevant. Again, there is a reason this does not happen. It is inefficient in the long run.

This whole problem/complaint was couched in the notion that there is a less costly, more efficient solution out there. After 6 pages of complaints, I still have not read one detailed solution proposed. Simply fantasizing about parties "agreeing" to things is not a solution that lives in reality. I outlined how I thought such a process would realistically go down if it were compelled in all cases.
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby appliedpsych on Mon Feb 11, 2019 8:07 pm

Vampire in the Night Said: "After 6 pages of complaints, I still have not read one detailed solution proposed".

I suspect that this is because as imperfect and unwieldy as the system is at times, it is the best that can be had given the complexities of the system, rules of evidence, and fairness to everyone involved.
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby jobmdpsych on Tue Feb 12, 2019 12:23 pm

"I suspect that this is because as imperfect and unwieldy as the system is at times, it is the best that can be had given the complexities of the system, rules of evidence, and fairness to everyone involved."

Except 49 other states have figured out how to make it less unwieldy.

Not heard a single idea? Can't cull duplicates? Or won't bother?
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby mytwocents on Tue Feb 12, 2019 1:30 pm

There’s no way anyone could propose a detailed solution because so much of this depends on good judgment and common sense. Vampire, I’m willing to bet you know full well what is or isn’t relevant from a legal standpoint and as a result, you don’t send doctors all kinds of irrelevant documents. Probably most attorneys don’t, but apparently there are enough that do that it’s a problem. Jobmdpsych, since you’re the one who brought this up, can you estimate the percentage of referrals you get where you think a significant number of the records are irrelevant? I’d be curious to know.
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby jobmdpsych on Tue Feb 12, 2019 2:05 pm

I'd say about 60% and that includes records with multiple duplicates. In about 15% of the cases, there are insufficient records (meaning an ortho QME done a year ago somehow isn't included).
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby mytwocents on Tue Feb 12, 2019 7:25 pm

Wow! That's a lot more than I was expecting. If you wouldn't mind, could you give some examples of the types of documents/records you were sent that you didn't think were relevant to the particular psychiatric evaluation? Were most of these non-medical records?
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby appliedpsych on Tue Feb 12, 2019 7:26 pm

Relevance is likely a concept seen differently by applicant and defense attorneys. Sure they can agree on what records to send, but likely err on the side of more records rather than less, and let the doctors sort them out using the special knowledge of their speciality, and/or or analytical skills of a neutral observer.

I recall a case many years ago in which there was a psych injury related to medical injury and one of the main allegations was "severe" weight gain secondary to pain limiting activity level, and weight gain secondary to injury contributing to depression.

Buried within the several thousand pages of medical records were annual weight figures from the last 10 years before the injury. Putting together a simple table of the various weigh-ins of the past, Applicant actually weighed the same at time of current case as they had 10 years prior to the injury. No objective weight gain, despite this being a main allegation of the applicant and their attorney. Facts are facts.

While I was the QME in psychology, I did point out the weight figures that were clearly documented if one was willing to look.

So, sometimes simple facts buried within many pages can cast light on issues of the case, for all parties to see.
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby vampireinthenight on Wed Feb 13, 2019 9:57 am

Relevance is likely a concept seen differently by applicant and defense attorneys. Sure they can agree on what records to send, but likely err on the side of more records rather than less, and let the doctors sort them out using the special knowledge of their speciality, and/or or analytical skills of a neutral observer.


Bingo.

I guess this discussion is focusing on duplicates? Sure, I guess it makes sense to avoid sending massive amounts of duplicate records. I'm going to defer to others on this because through the thousands of cases I have handled, the amount of cases that have duplicate records en masse is probably less than 1%. I would suspect this happens when the QME is provided subpoenaed records from both parties, which should happen less with the new copy service fee schedule. Maybe it is something unique to a geographical area because I really just have not seen it.
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Re: If you don't want a five figure bill, don't send 5000 pages

Postby appliedpsych on Wed Feb 13, 2019 10:18 am

In my experience, duplicates, while present sometimes, are the exception rather than the rule.
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