Legal MDs Consulting Response:
One of the most impactful services we provide to our attorney clients is the determination of future medical care and associated costs. In our experience, this is an area where cases are frequently undervalued — not because the injuries are minor, but because the attorney lacks the medical foundation to project what care will be needed going forward. The medical literature provides the evidence base for these projections, and physician consultants are uniquely positioned to translate clinical research into a roadmap of anticipated future care.
The importance of evidence-based future care projections cannot be overstated. Leigh et al. in the American Journal of Industrial Medicine (2004, Volume 46, Issue 6, pages 596–609) examined the long-term costs of occupational injuries and found that initial medical costs often represented only a fraction of the total lifetime medical expenditures, particularly for injuries involving the spine, brain, or multiple body systems. This finding has direct implications for settlement negotiations: an attorney who settles based on current medical bills alone may be leaving the majority of the case value on the table.
The methodology for projecting future care typically draws on several types of medical literature. Natural history studies describe the expected course of a condition over time. For example, Deyo et al. in the New England Journal of Medicine (2001, Volume 344, Issue 5, pages 363–370) described the natural history of low back pain and the frequency with which acute episodes transition to chronic conditions requiring ongoing management. Outcomes studies provide data on the expected results of specific treatments, including revision rates for surgical procedures, recurrence rates for conditions, and the likelihood of developing secondary complications. Clinical practice guidelines, such as those published by the American College of Physicians or specialty societies, establish the standard of care for managing specific conditions, which in turn defines the types and frequency of follow-up visits, imaging, medication management, and potential surgical interventions.
From a legal perspective, the presentation of future medical costs requires a proper evidentiary foundation. In Beaudoin v. Texaco, Inc., 653 So.2d 1210 (La. App. 1995), the court emphasized that future medical expense awards must be supported by competent medical testimony establishing that the projected treatment is more probable than not necessary. A physician consultant’s report that connects the client’s current condition to the peer-reviewed literature on natural history and anticipated treatment needs provides exactly this foundation.
In a recent case, we reviewed the records of a 44-year-old warehouse worker who underwent a two-level lumbar fusion following a workplace lifting injury. His attorney was preparing the settlement demand based on the surgical costs and six months of post-operative physical therapy. Our review of the literature on outcomes following lumbar fusion — including the well-documented phenomenon of adjacent segment disease described by Helgeson et al. in The Spine Journal (2013, Volume 13, Issue 10, pages 1339–1349) — led us to project a comprehensive future care plan that included ongoing pain management, potential revision surgery, physical therapy for adjacent segment decompensation, and long-term medication management. The projected future care costs represented a multiple of the initial surgical expenditure.
Our physician consultants can review your client’s medical records, assess the likely trajectory of their condition based on the current medical literature, and prepare a detailed future care analysis that provides the medical foundation for maximizing case value at settlement or trial.
References
Leigh JP, Markowitz SB, Fahs M, et al. “Occupational injury and illness in the United States: estimates of costs, morbidity, and mortality.” American Journal of Industrial Medicine. 2004;46(6):596-609.Deyo RA, Weinstein JN. “Low back pain.” New England Journal of Medicine. 2001;344(5):363-370.Helgeson MD, Bevevino AJ, Hilibrand AS. “Update on the evidence for adjacent segment degeneration and disease.” The Spine Journal. 2013;13(10):1339-1349.Beaudoin v. Texaco, Inc., 653 So.2d 1210 (La. App. 4th Cir. 1995).
This situation is another example of how we can assist you with all the medical issues in your cases. Call (954) 649-5739 or email DrC@legalmds.com to schedule a time to talk about one of your cases.
Let Us Know How We Can Help You
• Medical Summary Reports for Settlement Letters
• IME Observation & IME Rebuttal Reports
• Reports Answering Specific Medical Questions
• Standard of Care Reviews
• Liaison with Treating Doctors
• Help with Strategies to Promote Medical Theories
• Interpretation of Meaning, or Lack Thereof, of Medical Reports & Records
• Independent Record Reviews
• Assessment of Case Validity Regarding Medical Issues
• Referral to Expert Medical Witnesses
• Medical Research
• Facilitation of Communication with Clients, Families, Professionals and Service & Governmental Agencies
• Case Coordination
• Deposition & Trial Question Preparation
• Table-side Deposition & Trial Assistance
As you know, we have purposefully kept our fees exceptionally low allowing you the opportunity to have us review your cases early in your representation while controlling your expenses.
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