Never heard of a "med-legal" conference? Neither had I. I learned when I did a chair side visit to a major third party administrator in Windsor, CT. I asked the adjuster who was hosting me, "What is the next step in the indemnity claim?" – my standard question when an adjuster walks me through a client's claims, when I seek to learn how the adjusters in that office approach claims. The adjuster said that the "med-legal" conference was coming up soon. Huh? The WHAT kind of conference? Ah, med legal… I had never heard of it and neither had the employer's risk management team. Tell me more.
Medical care for an injured employee can be complicated. When the injured employee is represented by an attorney, the plaintiff’s attorney often tries to make the injury appear more serious than it is. Defense attorneys who have handled many similar claims often have a fairly good understanding of the medical terminology and what is meant by various medical reports and are not fooled by the plaintiff attorney overstating the nature and extent of the injury.
However, there are situations where the injury to the employee is unique, and the seriousness and/or complexity of the injury is not fully understood by either the workers comp claims adjuster or by the defense attorney. It is in situations of this nature that a conference between the defense attorney and the doctor is needed. These medical-legal conferences are normally held during the discovery phase of a workers comp claim in litigation, but can be held at any time and are often held in person at the doctor's office attended by the claimant's doctor and the employer's attorney. (WCxKit)
Med-legal conferences can occur by telephone, but more often the defense attorney will reserve an appointment with the medical provider to review and discuss the medical treatment an injured employee is incurring. The med-legal conference allows the defense attorney to better understand the injured employee’s medical care. The defense attorney will have the opportunity to ask questions about the medical reports and will hence be able to decipher and understand the medical reports better.
The med-legal conference puts the nature of the injury, the extent of the injury and the future medical treatment needed into plain English that the defense attorney will be able to understand and convey, if necessary, at a Board hearing or in a full-blown trial. This makes the negotiation of any settlement on the workers comp claim more accurate and feasible.
The med-legal conference also will assist the defense attorney to understand the chronological sequence of the injury, the medical treatment and the recovery. The defense attorney will also better understand the reasonableness of the previously provided care and of the proposed future medical care.
To better understand the use of a med-legal conference, consider the following real claim.
The employee was removing a motor from a dump truck. The employee fastened a chain around it and lifted it with a fork of the forklift (no safety program at this employer!). When the forklift moved, the motor dangling on a chain, swung around and struck the employee in the top of the back, breaking the right clavicle with a compound fracture.
After four months of treatment, the medical provider placed the employee at MMI. The workers comp adjuster paid the PPD rating and thought the claim was done. Two months later the claimant calls the doctor and is in severe pain. The doctor does an x-ray and the clavicle, which had been healed in the prior x-ray before the employee was placed at MMI had developed a non-union along the fracture lines. The plaintiff attorney filed for a “worsening of condition” with a request for additional medical treatment, additional temporary total disability and was pursuing a higher PPD rating.
The defense attorney met with the doctor following the resumption of medical care to discuss the cause of the non-union and how it could have developed after the employee was released from care. The doctor explained that within a reasonable degree of medical certainty the failure of the previous union of the bones had to be caused by the employee suffering an aggravation at his new employer. The doctor explained there was diagnostic evidence of an aggravation. The aggravation breaks the chain of causation resulting in the employer at the time of the initial injury no longer being responsible for the claimant’s medical condition.
To prepare for the med-legal, the employer's medical director can have a conversation about the injury with the defense attorney (their defense attorney). The better understanding the defense attorney has, the more effective the discussion with the claimant's doctor will be. Get the Injury 101- version of the injury from your own doctor, then be prepared to gather advanced information from the claimant's doctor.
Attorney Theodore Ronca suggests for the employer's attorney ask the claimant's doctor, "What is your timeframe for return to work?"
The cost of a med-legal conference is the cost of the doctor’s time and the cost of the defense attorney’s time. The med-legal conference will often answer the questions the defense attorney has in regards to the medical treatment and the status of the injured employee, eliminating the need for a formal deposition and the associated cost.
It is often worthwhile to pay for the time the doctor and the defense lawyer spend reviewing the medical care, the causes of medical issues and the proper resolution of the medical issues. Med-legal conferences should be used any time the medical issues are complex and the understanding of the employee’s medical condition is not clear.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: [email protected].
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