Transcript Opposites attract? - Flaherty Sloan Hatfield

 The Critical Role of the
Physician
 MIG – Minor Injury
Guideline
 Expert Reports
 Recovering Costs
 Being Called to Court
 Catastrophic Impairment
 Motor Vehicle Accidents  ODSP, CPP
Important Changes to
the Law
 Registered Disability
Savings Plans
Providing Expert Reports
“But I’m not an expert”
You are a Specialist in
Family Medicine
Providing Expert Reports
The College of Family Physicians of
Canada – Four Principles
1. skilled clinician
2. a community-based discipline
3. a resource to a defined practice
population
4. the relationship with the patient is
central
Providing Expert Reports
“Family physicians
…have an understanding
and appreciation of the
human condition,
….especially the nature of
suffering and patients’
response to sickness.”
Providing Expert Reports
Unique perspective
•Education
•Training
•Experience
•Familiarity with Patient
Anatomy of a
Medical Legal
Report
Mrs […] is a patient of this medical clinic under
my care. I have been asked to provide some
further information as to her level of
functioning before and after the accident that
she sustained on September 3 1998.
1. Nature of the Report
1. -Nature
document
MedicalofLegal
Report
- Requested by lawyer
I am a qualified medical practitioner, licensed
to practice in the Province of Ontario. I graduated
from the University of Western Ontario Faculty of
Medicine in 1993 and received my certification
as a Family Practitioner from the Canadian
College of Family Physicians in 1995.
1.2.Nature
ofofdocument
Summary
Qualifications
Mrs. […] has been a patient of mine
since July 31 1996.
3. Brief Summary of
the Patient’s History
1. Nature
of
document
in your care
- Initial Care
• patient’s past history
When I met her she was quite a functional lady
with a history of Paget's disease that was under
reasonable control and a previous history of
several abdominal surgeries. In general though,
visits to the office were over minor concerns
such as upper respiratory tract infections.
4. Details of event as related by patient
- first meeting post event
post-event
On September 4 1998 Mrs […] was seen
in the office the day after an accident that
happened to her in a store when a rack of
picture frames fell on her injuring her right
shoulder.

own examination and findings
At that time an examination was carried out and x-ray
were obtained which did not show a clinical fracture.
list complaints
and…
In short any activity that involves the use of her
hands and arms causes pain in the shoulder girdle
area. This presents a problem for simple activities
of daily living […]
functional limitations
limitations
This presents a problem for simple activities of
daily living such as dressing and feeding and
certainly has been a limitation with respect to her
interaction with grandchildren. She has required a
number of modifications to her home such as
ergonomic aids in the kitchen and bathroom.
[…] there has been a rather large psychological
impact as well […]

including psychoemotional
sequelae
5. Summarize history post-event
Mrs […]'s visits to the office as of late have
been for routine issues including another
respiratory tract infection as well as more
recently some dizziness for which a neurologist
was consulted but to my knowledge no serious
diagnosis was entertained and an MRI of the
head was reported as normal.
6. Opinion
Certainly it is clear to me that Mrs […]'s level of
functioning has been quite profoundly affected
by this accident and its resultant chronic pain.
7. Current status and
management
- diagnosis
- further tests & treatment
- anticipated benefit of
further treatment
- prognosis
8. Answer Critical Questions
- current level of function
- Pre Event level of function
- Cause for the change in level
of function
- Current Status, likely to change
- Limitations / Restrictions on
daily activities? On
Employability?
CONCLUSION – Indicate that
your opinions are based on
 your own knowledge of
patient’s history
 Patient’s chart and consults
 Subjective complaints
 your own findings based on
examinations and
observations
CONCLUSION – “Qualify your Opinion”
“This is a final report based on the
information currently available to
me....
...Should more information become
available later, it may substantiate or
modify the opinions I have
expressed...
...In that case, I would be pleased to
provide an updated report should
you so request.”

DON’T
overstep
the bounds of
your expertise
DON’T be afraid to provide a report
DON’T regurgitate
your chart
DON’T advocate
unless you can
DON’T be afraid to
contact the lawyer.
Communication is Critical
“I don’t want to go to Court!”
“I am not involved in any of this!”
“Is this really going to trial?”
“Do I have to go to court? ….
“….I have not provided a report!”
“I do not have the time to prepare or attend…”
-Review your chart
or your expert report
- Talk with your patient
- meet with your patient’s
lawyer
- Consider educating the
Jury
Early notification of trial date, but…
Do not cancel/reschedule any
appointments until as late as
possible
Provide patient’s lawyer with
least inconvenient date(s) to be
called
Medical and Rehabilitation benefits
-1980 - $25,000
($63,858.70 current dollars)
- August 2010 - $100,000.00
- Changes Effective 1 September 2010
- Drastic Reduction in Medical and
Rehabilitation Benefits Available
-Worst case scenario for your
patient’s reducing medical benefits
from $100,000 to $3500
1. $3,500.00 for “minor Injuries”
2. $50,000.00 for all other
non-catastrophic injuries
1. Includes all: Therapy, drugs,
devices and assessments.
What is a Minor Injury?
- One or more sprain and strain, a whiplash
associated disorder, a contusion, abrasion,
laceration or subluxation and any clinically
associated sequelae
- A sprain and strain have been defined as any
Grade I or II level sprain or strain and does not
include complete tears of a ligament or of the
muscle
- Whiplash is identified within the WAD levels
What is not included in a Minor Injury?
- WAD grade III which includes any
demonstrable definable and clinically relevant
neurological sign
- WAD grade IV which does not exhibit a fracture
or dislocation of the spine
- a pre-existing medical condition that would
prevent that person from achieving maximal
recovery.
How does this impact on the patient?
-If you patient falls under the MIG they are
entitled to $2,200.00 to be utilized over 12
weeks and if still suffering $1,300.00
thereafter.
-What happens if your patient is not
better in 12 weeks?
-What about psychological impairments?
-What about chronic pain?
- You are entitled to be paid
- 3 ways to be paid
-OHIP
-Insurance
-Patients
-You will be fairly compensated
-Hamilton Academy of Medicine
Guide for Fees
“Death by Power Point“
The importance of identifying a catastrophic injury
- Short Term: Access to critical
benefits for immediate needs.
(Attendant Care, Case Manager)
- Long Term: Access to a
more benefits for extended
recovery and rehabilitation
The importance of identifying a
catastrophic injury
- Completing the Forms
- OCF – 19 “Application for
Determination of a Catastrophic
Impairment”
OCF 19 - Catastrophic Impairment
(e) brain impairment resulting in,
(i) GCS ≤ 9
(ii) GOS = 2 (vegetative), or
3 (severe disability)
after 6 months
(f) ≥ 55% impairment
of the whole person (WPI)
(g) = class 4 impairment
(marked impairment), or
= class 5 impairment
(extreme impairment due
to mental or behavioural
disorder)
s. 2(g) requires assessment of:
- ADLs
- Social functioning
- Concentration,
persistence, pace
- Adaptation in work or
work-like setting
0 – 14%
mild impairment
15 – 29% moderate impairment
30 – 49% marked impairment
(severe in almost all social and
interpersonal functions)
50 – 70% extreme impairment
(severe limitations in all
daily functions)
Benefits for patients
-Once approved it is
steady Income
-It is an assessment
disability
- Be under 65 and have
contributed to CPP
-Have a “severe and
prolonged” disability
-Prevents the patient
from working at
any job on a regular basis
"Severe" means that a person is regularly incapable of pursuing any
substantially gainful occupation. The CPP bases eligibility on the
applicant’s incapacity to do any type of paid work on a regular basis.
"Prolonged" means that the disability is of indefinite duration and
will continue to prevent your patient from going back to work in the
next 12 months, or is likely to result in death.
“Incapable”: Not able or fit to pursue any substantially gainful
occupation as a result of a disability.
“Regularly”: The capacity to work is sustainable.
- Can Provide: Income Support or Employment Support
- Benefits for patients
- Financial Eligibility
- Disability Eligibility
To qualify for Income Support the patient must:
-have a substantial physical or mental disability that,
- is continuous or recurrent
- is expected to last a year or more, and
-makes it hard for the patient to take care of
themselves or take part in community life or work.
Disability must be Verified by a Health Professional
Verification of Disability Impairment Form
-Primary and Secondary Disability
-Are they continuous or recurrent?
-How long will then continue?
-How they impact employment?
REGISTERED DISABILITY SAVINGS PLANS
•RDSPs available since 2008 - help people with disabilities
and their families save for the future
•Significant and tangible financial benefits:
•Anyone -- the individual, family and/or friends -may contribute
REGISTERED DISABILITY SAVINGS PLANS
Canadian Disability Savings Grant, on sliding scale: starting at $3
for each $1 contributed
Maximum annual CDSG: $3,500
Maximum lifetime CDSG: $70,000
Maximum lifetime contribution: $200,000
Plus, low income person/family may
qualify for Canadian Disability Savings
Bond, a further $1,000, without
contribution
REGISTERED DISABILITY SAVINGS PLANS
Example: 19 year old earning less than $21,816:
Contribution: $1,500
CDSG on first $500 of contribution: $1,500
CDSG on remaining $1,000 of contribution: $2,000
CDSB: $1,000
Total funds invested in RDSP $6,000
REGISTERED DISABILITY SAVINGS PLANS
Example: 19 year old earning less than $21,816:
Contribution: $1,500
CDSG on first $500 of contribution: $1,500
CDSG on remaining $1,000 of contribution: $2,000
CDSB: $1,000
Total funds invested in RDSP $6,000