CUTTING AGAINST THE GRAIN: HOW TO SUCCESSFULLY
CHALLENGE DESIGNATED DOCTOR DECISIONS
ANALYZING, DEFENDING, & ATTACKING
THE BEGINNING
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HOW BBQ STARTED IN CENTRAL TEXAS
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WHAT DOES PRESUMPTIVE WEIGHT MEAN?
• STATUTE
• RULE
• APD
• REAL WORLD
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FIRST, MUST PAY MMI/IR
• TRUMPS ALL PREVIOUS CERTIFICATIONS
• UNLESS 90 DAY
• PROCEDURES IF REALLY, REALLY AWFUL CERTIFICATION
• 5 DAYS
• MEDICAL TOO
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DISABILITY
• GAMESMANSHIP
• MEDICAL DETERMINATION
• NOT A LEGAL DETERMINATION
• BONA FIDE OFFER OF EMPLOYMENT
• TERMINATION FOR CAUSE
• FAILURE TO ATTEND DD
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RETURN TO WORK
• DIFFERENT FROM DISABILITY
• BONA FIDE OFFER OF EMPLOYMENT
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EXTENT
• THE DANCE WITH MMI/IR
• REGIONAL DIFFERENCES (ATTORNEY STRATEGY)
• STRATEGIES FOR LATER
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SIBS
• TECHNICALLY, TWO YEARS
• BUT RTW OPTION
• FEWER SIBS CASES
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OTHER ISSUES
• COMPENSABILITY
• LIBS
• ???
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WHAT ABOUT SUBSEQUENT MMI/IR?
• TREATING DOCTOR?
• POST-DD RME?
• LOOK AT
• DATE OF DD’S CERTIFICATION
• DATE OF NEW MMI
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DWC-32
• WHO COMPLETED?
• MATRIX
• BOX 37
• COMPARE WITH THE DD SELECTED
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CHALLENGING THE APPOINTMENT
• GAMESMANSHIP
• COMPARE WITH DWC-32
• QUALIFICATIONS
• SUBJECT MATTER
• 3 DAYS
• MOTION TO STAY
• MOTION FOR EXPEDITED CCH
• NEGOTIATE
• ON THE RECORD14
PREPARING FOR DD
• CONSIDER ADDING ISSUES (BEFORE AND
AFTER YOU KNOW THE DD)
• ODG TREATMENT PURSUIT
• DIAGNOSTIC SCAN REVIEW
• INJURY RE-ENACTMENT
• PEER REVIEW
• SURVEILLANCE
• DESIGNATED DOCTOR ANALYSIS LETTER
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REFERRALS
• INITIAL CONCERNS
• REFERRAL FOR PROFIT
• LET US PREAUTHORIZE
• DOCTORS
• LET US DO OUR JOBS
• HASSEL FACTOR
• DWC COMPROMISE
• NO PREAUTHORIZATION BUT
POSSIBLE AV16
ANALYZING
• DWC-32 COMPARISON
• PEER REVIEW FOR ACCURACY
• AND IF THE IR IS BELOW 15% …
• BONA FIDE OFFER OF EMPLOYMENT
• IF NOT AT MMI, CONSIDER PURSUIT OF
TREATMENT MODALITIES
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DEFENDING
• PEER V POST-DD RME
• READ CAREFULLY
• READ LIKE A SKILLED CLAIMANT ATTORNEY
• READ DOCTOR SELECTED BY AND ACTING
IN PLACE OF THE TREATING DOCTOR
REPORT LIKE A SKILLED CLAIMANT
ATTORNEY
• CONSIDER LETTER OF CLARIFICATION
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ATTACK DD WITH HER OWN REPORT
• QUALIFICATION OF DD
• MECHANISM OF INJURY
• LACK OF MEDICAL RECORDS
• ERRORS IN ROM
• ERRORS APPLYING AMA GUIDES
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ATTACK DD WITH NEW EVIDENCE (OVERVIEW)
• MECHANISM OF INJURY
• RE-ENACTMENT OF INJURY
• DIAGNOSTIC REVIEWS
• NEW DIAGNOSTIC TESTS
• NEW TREATMENT
• ERRORS
• SURVEILLANCE COMPARISON
• POST-DD RME20
MECHANISM OF INJURY
• COMPARE DD REPORT WITH OTHER MOI DESCRIPTIONS
• COMPARE DD REPORT WITH ACTUAL, DOCUMENTED MOI
• WAS THERE SURVEILLANCE OF MOI
• RE-ENACTMENT OF MOI
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DIAGNOSTIC REVIEWS
• RE-READS
• REREAD TESTIMONY
• AUTHENTIC4D
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POST-DD RME
• MORE QUALIFIED
• NOT A DR. NO!
• NO ERRORS
• QUALITY REPORT
• EXPLAINS REASONS, NOT JUST
OPINIONS
• BE WILLING TO TESTIFY
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VIDEO STATEMENTS
• LIKE A DEPO, BUT …
• EXPENSIVE
• HAVE A GOOD REASON
• BETTER THAN A REPORT
• SOME ADVANTAGES
• SOME DISADVANTAGES
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DEPOSITIONS
• ATTORNEYS INVOLVEMENT AND
AGREEMENT
• QUALIFIED EXPERTS
• POTENTIAL LITIGATION
• AGREEMENT OF THE DOCTOR
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PERSUASIVE PRESENTATION
• NOT JUST A COMPARISON OF REPORTS
• TESTIMONY OF EXPERT
• LIMIT ARGUMENTS TO MAX OF THREE
ERRORS
• BETTER IF NEW EVIDENCE (DD WAS NOT
“WRONG”, JUST DID NOT HAVE ALL THE
FACTS)
• FOCUS ON THE CORRECT RESULT, NOT DD
ERROR
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TIME FOR A LESSON FROM THE MASTERON HOW TO SLICE A BRISKET?
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LETS GET TO HAPPINESS
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