Motor Vehicle Accident
Sample-Personal Injury Case
Report For Defense
I have enclosed a
new sample of a personal injury case – a motor vehicle accident
for the defense with Considerations/Suggestions and Discussion
of Diagnoses. I do Timelines, but a personal injury timeline
sample is not included with this sample. I have done work for
plaintiff and defense attorneys on personal injury, worker’s
comp, and med mal. I can help with any case where medical
issues are in question. I now have 33 years of healthcare
expertise as an RN in most areas of nursing: at the bedside and
in administration to assist in answers to your questions. If I
have medical questions in areas of less experience; I have many
associates whom I can ask, with the utmost confidentiality kept,
to answer any questions.
Areas an attorney
may want addressed in a personal injury case include:
1. What
injuries or conditions, if any, in my opinion, were direct
results
of the
accident?
2. What
injuries or conditions, in my opinion, were pre-existing?
3. Were any pre-existing injuries or
conditions exacerbated by the
accident, in my
opinion?
If yes, to what
extent and for what duration?
4. What,
if any, conditions or injuries caused by the said accident do I
feel are
continuing or
permanent?
5. What
is the current status of each of the injuries or conditions
claimed to be
continuing or
permanent upon which I feel qualified to comment?
6.
What functional effect, if any, does his/her injury continue to
have upon his/her
ability to conduct
activities required of him/her in normal life?
7. Do I believe that an independent
examination of the plaintiff is necessary in
order to definitively
determine what claimed injuries are related to the
accident? If so, why,
and what type of physician is the best? Are there any
additional records that
we need to obtain prior to the plaintiff’s deposition?
8.
What are some of the arguments
the opposing attorney will give?
What are the
answers to those arguments?
Considerations/Suggestions
1.
I would suggest an IME done by a Rehab physician. I would
recommend
_____who practices in ______.
He will be there on July 7, 2007. When I
mentioned that Dr. K. was the only one to find
something truly wrong with the
plaintiff, his comment was “what do you expect”.
He said that Dr. K. finds
something wrong with everyone and is well known
for this in the ____area.
He suggested calling any of the defense firms in
______to check this out. If
you would like an IME, he charges $2000.00 for
review of records and the
exam. He also said a summary would
be helpful (just send the first few pages
of my master summary). He also said if we didn’t want
an IME, you or I could
fax my summary, and he would give his opinions and
recommendations.
Please let me know about this. It would be helpful for you to
request a
Certified Legal Nurse Consultant to accompany the patient on this IME.
2. In my opinion, the only treating physicians that would be
very supportive of her
case and her claims would be Drs. K. and W. If I were the
plaintiff attorney, I
would not want to have the other physicians testify.
3. I may
have included more in the summary than you actually needed, but
I
wanted you to see her multiple and varied complaints and all the
pain
medication she requested and received. There were a few instances
where
she wanted pain medication and the doctor or pharmacist wouldn’t give
it.
There are several instances of bizarre explanations of why she needed
more
medication (blew out the car window on the interstate, someone stole them).
No
wonder she couldn’t return to work, she wouldn’t have time to go to see a
different
doctor everyday or go the ER for her frequent visits. Often times she
went to see
the same doctor 1-3 times/month.
4. In the medication
summary, the total cost includes only those medications that
may be related to her claim, i.e. pain medication,
anti-depressant and anti-
anxiety medications. I included all those categories not
knowing if Nationwide
would assume any liability for an exacerbation of her anxiety
and depression.
5. Ms. P. was paid
$13,138.00 from the worker’s comp insurer to cover until
2/07.
It might be helpful to talk with her previous employer about
her
performance and working relationship prior to the accident, unless the
worker’s comp agreement forbids it. I think it just spoke to giving out
information to possible employers.
6. Dr. K.
referenced information about sacro-iliac joint dysfunction in an
appeal
letter to BC/BS. I called MCV library and searched the Internet
for this and
was not able to locate it. It would be helpful to get a copy to see
what
information it contains and if it was supportive of his position, though I doubt
he would have referenced it. If you cannot request it from Dr. K. at deposition,
let me
know and I will try to locate it.
7. It is
interesting to note that even when Ms. P. was supposed to be
severely
depressed, she is described as neatly groomed, stylish,
nails nicely
manicured, etc. She also had told a physical therapist she
had trouble
getting up from a tanning bed. This does not seem like a depressed
person.
One of the signs of depression is that the patient does not care about
their
appearance. If the plaintiff was having so much pain, it seems that nails and
tanning would be the last thing on her mind.
Discussion of
Diagnoses
Chronic Pain Disorder
– Pain that continues longer than 6 months without an
accompanying injury or illness OR there is a medical problem,
but it does not have a major role in causing the pain. Patients
have often tried numerous medications and a variety of
physicians in seeking a solution. Standard pain treatments
bring only minimal relief. The pain is usually described as
stinging, burning, aching, may come and go vary in intensity,
duration, location and radiating pattern (moving from body part
to another). Chronic pain disorders include: somatoform
disorders, depression, anxiety, substance abuse, and personality
disorders (all of which Ms. P. has).
Many
patients with chronic low back pain have a history of emotional,
physical and sexual abuse in their childhood. All this applies
to her case.
Source: Cailliet, Rene, MD, Soft Tissue Pain and
Disability, 3rd Ed., FA Davis Co., 1996.
Fibromyalgia
or Myofascial Pain Syndrome
– (Muscle pain) Generalized aches and pains or prominent
stiffness, involving 3 or more sites for a period of at least 3
months. This is a common pain phenomenon occurring in a defined
pattern, reproduced by pressure on “trigger points”. Possible
causes are
abnormal posture, loss of
non-REM sleep, stress and trauma.
Associated signs and symptoms: fatigue, morning stiffness,
numbness and tingling, sleep disturbance, headache, anxiety,
pain during menstruation, prior depression, irritable bowel
syndrome, dizziness, trouble with memory and concentration.
In the management of this condition, heat, massage, ice,
stretching, exercise, posture modification can be used.
Statistics regarding recovery aren’t good. In one study,
only 32% of patients are able to return to full time work and
55% to part time work.
Source:
Cailliet, Rene, MD, Soft Tissue Pain and Disability, 3rd
Ed., FA Davis Co., 1996.
Somatization disorder – mental disorder
characterized by a complicated medical history,
with physical
symptoms, but without a detectable cause. This disorder was
previously called hysteria. Common features in the histories of
these patients: neglect, child abuse or sexual abuse, unstable
adult relationships with divorce and physical abuse, family
history of alcoholism, history of substance abuse, multiple
medical problems or c/o, numerous surgeries, past hx. of
psychiatric illness, history of litigious relationship with
authority figures, learning of pain behavior as a way of dealing
with problems and intimate relationships, In order to have
this disorder, a patient must have at least 13 symptoms or
complaints of a long list, of which she qualifies. One
percent of population suffer from this, usually women.
This disorder starts before the age of 30. Ms. P was in
the ER at least every other month with various complaints since
2000. She saw her family doctors at least 1-3 times/month
since that time also. Dr. H. and Dr. L. thought she had
this. Drs K. and W. did not.
Source: Much of this case study was taken from a case
study provided by the Vicki
Milazzo Institute in my study for national certification as a
CLNC.
