Dr. Fowler is both a physician and an attorney, and he is regarded as one of the nation's foremost experts in medical malpractice and occupational medicine law. He currently serves as the Chief Risk Officer, U.S. Public Health Service, Department of Health and Human Services based in Washington, D.C. Previously he served as a legal medicine officer to the Surgeon General of the Army and as a chief physician for Motor Company. He received his Doctor of Jurisprudence with honors from Drake University Law School and is a graduate of the University of Des Moines College of Osteopathic Medicine. He is currently retired from the U.S. Army Reserve Medical Corps. Dr. Fowler is past president of the American Osteopathic College of Occupational and Preventive Medicine. Dr. Fowler is a fellow of the American College of Legal Medicine and American Academy of Family Physicians, the American Osteopathic College of Occupational and Preventive Medicine. He's board certified by the American Osteopathic Board of Family Practice, the American Board of Forensic Examiners, the American Board of Disability Analysts, and the American Osteopathic Board of Preventive Medicine. Dr. Fowler is a member of Florida, Illinois, Kentucky, District of Columbia Bars. He has also been sworn in as a member of the Bar of the United States Supreme Court. Dr. Fowler. So anyway, Murray and I were talking about, you know, we went by Buck Stadium and so on, and speaking of gas prices, I have a used car, so I just was going to check the price of my used car, and you guys know now that on the Kelley Blue Book, they're asking you if your gas tanks are full or empty when they're valuing the price of a new car. So anyway, anyway, anyway, we got to get serious. We got to get serious, OK, because we got an important topic. You know me, we've always got to be serious and I wouldn't tell you anything. So anyway, before we get going, I want to tell you what happened. I was in the courtroom yesterday. And today we're going to talk a little bit about the different disability systems. And this is a true story. I was in the courtroom yesterday. It was a work comp hearing. And you know, what do we do in work comp hearings? We fight over the impairment rate, OK? So the work comp hearing judge, he pounds his gavel down and he says, and I'm there defending the company and Mr. Brown is there defending, and he's representing the plaintiff, the worker. And the judge pounds it down and he says, I'm very disappointed in both of you judges. Both of you have offered me a bribe. And he says, you, Mr. Brown, have offered me $15,000 to decide this case in your favor. And you, Dr. Fowler, have offered me $10,000 as a bribe. So well, you know what the judge does? He takes the judge, he takes a check, he writes it out, and he hands it to Mr. Brown. He says, here's a check for $5,000. We're going to decide this case on its merits. OK, all right, it's tough to get good material. Murray liked that one. That's because my brother is, as you know, a Jewish boy who couldn't pass college chemistry. He's called a lawyer. All right, guys, I hope you did like that. It's tough to come to new material all the time. All right, disability impairment examinations. Jeff, this isn't rolling. Use this one. Hit the which button? You have to do it once on the screen. Then it'll work. Where does this one go? OK, now it'll work. We're good now? Yeah, now it goes. OK, gotcha. So I wish someone would have given me this lecture when I first started in medicine, occupational medicine, and told me all about these disability systems. Because we're going to compare and contrast different disability. And what they are is they're income replacement programs. That's what we're talking about, is replacing your income. All right, we're going to highlight what's your participation as an occupational medicine physician in these programs. How do you contribute, especially in the workers' compensation arena, to this disability process? When should you get an IME? What's a good IME? And if you're involved in doing IMEs, which are independent medical evaluations, what's your role in those? And we'll discuss what's a good IME. All right, we're going to go over these four disability income replacement programs. Like I said, I wish someone would have talked to me about this earlier. We're going to discuss Social Security. We're going to discuss workers' comp, your private disability, which you may have as a personal physician. And last but not least, and we were talking about this with Dean here, is the ever-expanding the VA compensation system. We're going to briefly talk about that subject here in a minute. OK, and in each of these areas, we're going to compare five different things. The authority. What's the definition of disability? Very important, the definition of disability. The administrative process. What's the end point? Do these benefits ever stop? And how do you get these benefits? Where does the money come from for these benefits? OK, Social Security system. We are not talking about the Social Security that you get when you're 62 to 67. You can elect because you worked and you have so many quarters. Everybody with me so far? OK, this is Social Security disability. The Social Security administration runs this program. And how many of you heard of SSI? That's one of the programs. Title II, Social Security disability. So let's go into this in a little bit more depth. OK, Title II, payment disability, payments. This is Social Security disability, OK, by virtue of your contributions to Social Security. For SSI, this covers disabled individuals, children, but you've got to have a limited, there's an income test on there, just to have you know those sort of things. But that's Social Security disability. All right, Murray, I'm going to pick on Murray. He's a good buddy of mine. Give me a definition. Don't look at the screen. Give me a definition of disability in general. It is administration. You can't give me one. Can you? No, unless you get more information. OK, yeah, yeah. Right? Because the definition of disability depends on, Murray, right, what system you're under. I'm going to repeat that again, because you may see this somewhere again. I know the subjects I have are very heavily tested, I guess I'm not supposed to be telling you, but they're very heavily tested on the basic exam. Disability depends. The definition of disability depends on what system you're under. So this morning, we talked ad nauseum about ADA, correct? And I had you repeat what the definition of disability, substantially affecting one or more life activities, blah, blah, blah, right? Yes. OK, so let's talk about, for the guides, a general definition, a disability definition would be activity limitations or participation restrictions in an individual with a health condition. Now, you've got to understand the difference between impairment and disability. Two different things. An impairment under the general guides would be a significant deviation, loss, or loss of use of anybody's body structure or body function in an individual with a health condition. Mouthful, all right? We're going to show you examples to help you understand this. All right, so you've got one of your patients applying for social security disability. By the way, you're a regular family practice doctor. How do you know if a patient is on social security disability? How would you know? Anyway, very simple. They're on Medicare, bingo. They're under 65. So the only other possibility would be they had renal failure. OK, right, right. Yes, or Lou Gehrig's also. But so you know any patient that comes into your office and under 65 and shows you a Medicare card, remember, they are on one of those two social security disability systems. Because if you get social security disability, you then are eligible to get Medicare under 65. So that's just a little caveat a lot of people don't realize. All right, so let's go back to applying for social security disability. To get social security disability, you have to have the inability to engage in any substantial activity by reason of any medically determinable physical or mental impairment, which is expected to result in death or which has lasted or can be expected for a continuous period of not less than 12 months. Bottom line, hard or tough test to get disability. Is it hard or tough? Very hard, very extremely tough, very extremely tough. OK, I clerked for a federal judge at a law school. He says, Paul, you're a doctor. He handed me. He says, oh, my gosh, you're the answer to my prayers. He handed me a stack of at least 200 social security appeals from people have been denied. He says, Paul, I don't know what to do with these. You decide and just write down anything you want and we're done. OK, all these appeals, they were stacked to the seal. OK, he says, you know more about this than I do. All right. So, I mean, that's my first exposure to social security disability. So tough test, any substantial gainful activity, that's a tough test. All right. So now let's go back and talk about disability versus impairment. I cannot emphasize this definition and knowing this slide. All right. An individual can be impaired significantly, but he can have no disability. Wait a minute, Dr. Fowler, hold on a minute. So are you also telling me that a person can be disabled and have no, hardly any impairment? That doesn't make sense. All right, let me give you an example. Say we have a paraplegic. He's in a wheelchair, but he's an accountant. So with that paraplegic who's working as a CPA, does he have, let's go over it. Does he have a large impairment or not? When we look at the guys, does he have a big impairment or not? Yes. Huge impairment. He's paralyzed, right? OK. Would he count as being disabled under social security? No. No way he's getting that. No way. Because why? He's employed, he's working. Right. Remember the definition, social security definition, the definition for disability. All right. Now let's go to the complete opposite. Say we got Liberace. Bless his soul. He was playing the piano and he hurt one of his digital nerves. Is his impairment small or little if we went to the guys? Itty bitty. Very little with the guys, right? I mean, less than five percent, but very little, very little. Would he possibly qualify for social security disability or private disability policy? Sure. He can't do his job, right? I thought the question for social security was any gainful impairment. Correct. Let's look at that in two minutes. Hold your time. So it's like, yes, it's any gainful, but they do kind of do a personal thing. I'll show you in a minute. All right. So when they look for impairment under social security, you got a long definition. I'm not going to read this, OK? But the bottom line is social security is not like the VA where they're going to just say, oh, I got this problem. They're going to look at it and say, you got to show under examination that you actually got medical. Doctors got to examine it. You don't even look at your records. They're going to look for medical evidence to establish a physical or mental impairment. With signs, symptoms and laboratory findings, they're just not going to take your word for it. So not only is a tough test, but they're going to really put you through the rigor. OK, so how does the VA make that decision? I mean, not the VA, how does their security administration make that decision? They're going to look at your current work activity. They'll look at the severity of your impairments, and then they're going to try to meet up those impairments. And they got an actual list. So if you've got Lou Gehrig's disease, you automatically meet the listing. You don't have to prove anything. They're going to follow you through. If you've got a cervical, you know what I mean, different things. Schizophrenia, if it's on that listing, but it depends on the severity, they're still going to send you for an exam. They're going to look at your individual residual functional capability. They are going to take a look at your history of past or what, OK? All right. But again, it's any gainful activity is the definition. And then the ability to do other work based on your age, education, and work experience. OK, so those are the factors Social Security. Now, what's the process? You file a claim. You provide your medical documentation. You administrate a review. Of course, there's a medical evaluation. There's a medical review. And then they always deny it. And that's why you're not kidding. And that's why you got. Attorneys on during the day. With everywhere saying, have you been denied Social Security disability or apply for Social Security ability and. And then they file administrative. OK. Social Security disability. Does that if you actually are fortunate to get Social Security disability, does it ever end? Yeah. Age of retirement or return to work. No return to work. I have never in my life, not once. Seen anyone voluntarily inform the Social Security administration that they've returned to work and to cut off their benefits. I have never Charlotte. One person said, I see return to work and some money underneath the table, but I've never seen them inform, inform that when they've gotten a determination of Social Security disability, that you're totally. And I have never once seen any patient call them up and say, stop my payments. No, call them on. Yeah. Some people that return to work or get employed or earn too much money to get the benefits. Yeah, yeah, yeah. Several times. Yeah. But I mean, they didn't call them up and say, stop my benefits. Right. The other way, of course, to stop it is death. All right. Who pays for this? In this room and on there. And how we pay for it. A thing called FICO, FICO. So and I just just this isn't my personal comment. Many people have told us we have never seen so many people. It's never in the history of this country have more people than sitting in the cart and less people pulling that cart of the Social Security. And pretty soon there's not going to be enough people pulling that cart of all the people piled in the cart. Never in the history of this country. All right. Let's talk about workers' compensation. How do you get your money in occupational medicine? How do you get your money? How are you going to put food on your table? There's only there's only really one way. You're not billing Medicare. Not billing Medicaid. You're not billing my federal Blue Cross Blue Shield. It's your workers' compensation, correct? So if you want to pay attention now, because this is your livelihood in occupational medicine, either the company's paying you for doing a physical or you're getting a check from Liberty Mutual or one of those insurance companies. OK, so this whole thing, everything in occupational medicine is workers' comp. Let's talk a little bit about workers' compensation. Let's talk about it's a state program. Everything revolves around how the legislature has defined your particular state program. We're down here in Florida. If we walk across the line into Georgia, two different systems, two different laws. They may even use a different set of guides to turn impairments. OK. Definition of disability. Workers' comp. It is no fault. You have to know that. I'm going to repeat. No fault. I'm going to say it again. No fault system. Why is it a no fault system? Do you have to prove anything when you're injured? That's it. Right. Right. But what happened before we had the workers' comp system? What did you have to do before we had workers' comp? Sue them for what, Murray? Negligence. Negligence. Is that a tough test? You'd have to prove that their employee, I mean, the employer deviated from the standard of care. So why was the whole system of workers' compensation started? To keep the courts from being clogged up? It's a no fault. All the workers would have to go and then they wouldn't be getting the medical care at the time. No one was paying their bills because you're waiting and waiting and clogging up the court systems. So that's why most states. There is a federal program. I'm under FECA. If no one, no attorney will take a FECA federal employee case. All right. What does that tell you about the system? No attorney takes it. That's all I have to say. All right. With workers' comp, it's got to be a work related injury or illness. What's it meant to be? Income replacement when you can't work. And supposed to pay your medical expenses. All right. What's the administrative process? We got to have a work related injury or illness. You got to notify your employer. To be honest with you, I really think and we can have a debate on this, but I wouldn't be seeing any person comes in unless you really know the company and they don't have the employer, haven't even notified your employer unless it's an emergency. You got to make sure you're not going to get paid later. You got to make sure that the employer knows the workers here from that company or, you know, they can deny. Yeah, Liz. So what do you tell them? They come in and say, well, I was injured at work, but I want to use my personal insurance. That's their discretion. Depends on the state. Depends on the state. It really depends on the state. In the state of Texas, you can do that. In the state of Texas, you can try and use your personal insurance for work. They will hand you the bill. In Pennsylvania, we'll tell them to go ahead, but they're on their own unless they come to us. Yeah. Yeah. Yeah. So it really depends on your state. You got to know the state you're in. If you're I mean, I practice like Matt out in Iowa and we're right on the border. Illinois. Dean's over in Illinois and many people here, Wisconsin, West Virginia. You got to know your state laws up and down. All right. Now, you notify your employer. It's usually accepted. There's administrative review. There may be a fitness or duty evaluation. They may, you know, one of the carriers may decide to deny it. And then there's always a process. OK. When does workers comp system end? When does it end? Well, in Texas, it's two years. Well, no, no. We want to know when would you point any time? Two years, of course, for each maximum medical improvement. But return to work, return to work, or if they never get to the work, we reach a point called maximum MMI, maximum medical improvement. And then that's where us lawyers in our suits get involved. Right. We send them for an impairment rating. We use the guides. By the way, what's the number one selling book at the AMA? I think it's the sixth edition. Sixth edition of the guides, not not the textbook in surgery, not not not any of the other textbooks. It's the guides is the number one selling that keeps the AMA office open in Chicago is selling of the guides. All right. For us lawyers to get a hold of it. So you have an impairment rating. And of course, always when you have an impairment rating, you're involved with the lawyers in litigation. OK, who pays for workers? Employer pays or sometimes in certain states has a subsequent injury trust fund. So most of the time the employer is paying the premiums to cover it or they could be self-insured. But most of the time they're playing through insurance. OK, really important for every doctor here. How many of you have a I'm raising my hand, have a private I'm talking about a private disability process, an insurance policy that you've gotten either yourself or through your employer? Anyone have a private disability? So if we're hit by if you're hit by you had through your school, Murray, I know I know that. Yeah. Yeah. You had it through your school. OK. But once I went back to private practice. Right. Actually, Dean, you and I as fair workers don't have that. We have sick leave annually. We don't actually have we have a long term disability for that, but we don't have any. OK, so what I'm talking about here is a private disability policy. OK, and this will be it'll be authorized by the state and they'll license that the insurance company do business to sell it to you. And the state insurance commissioner will regulate it. So what's the definition of disability for your private? Disability policy, whatever it says in the contract, whatever. Bingo. So you got to look, I've lectured at many CME conferences, I've lectured at legal conferences on this subject. You gotta look at the terms of that contract. You remember Steve Phillips from the beginning? Yeah. Okay, Steve had one, he was a cardiothoracic surgeon and he had taken one out that said that if he could not do his specialty. Right. And when his back went out and he could no longer do his specialty, that went into effect. And because he was paying the thing on his own, it was tax-free money. You gotta check, number one, the term, it may not start for three or six months. It may only have benefits payable. So if you're hit out, if Murray and I are going outside Buck Stadium and one of the cars crashes into us and we're in the hospital, we can't do our job. That policy we took out, I mean, it may only pay for two years. Some of them actually require you to actually apply for social security disability and then there'll be an offset. Do you realize that? Okay, there'll be an offset on that. So whatever is defined by the terms of the contract, again, it may be, it's very important that you look at it and get a policy that says specific if you're a surgeon or so on, because if it's not, they may make you work in urgent care. You're a cardiothoracic surgeon. You may have to work in urgent care. Yeah, you can be a doctor, sure. We're not gonna pay unless you do that. Correct. Yeah, yeah, yeah. That's why I said it's sent very specific results. So what's the administrative process for this? All right, so Murray and I are hit by a car. We can't go to work. We call up our product. We call up UNUM. By the way, there was a big lawsuit against UNUM for they were doing mass denials. Okay, there was a big class action. So we call up and say, we can't work. We got hit by a car. We file our notes from our doctor, our orthopedic surgeon. There's a review process. Of course, they're gonna deny us initially, and independent IMEs, they'll deny us, and then we'll appeal it to our own private attorneys. All right, when does it end? Bingo, depends on our contract. Whatever the contract is, yeah. Exactly, exactly. So when it ends, you'd be only in two. It may go on. You read social security. It may be whatever your contract says. So read your contract before you sign. You have these group policies through AMA, DOs, AOA. Some of these group policies are, just because it catch all doesn't mean it may be cheaper. Cheaper always isn't the best, okay? So who pays for it? You. Or if you got a group policy through your employer, the employer may be paid. So I'm a part of it. So individual contributions for that. Okay. So this is a great summary sheet. Remember social security, it's any job, it's a tough test. Workers' Comp, that's our livelihood and occupational medicine. It's a no fault system. And with private disability, make sure you're reviewing your disability contract. That's the whole bowl of wax in that system. Okay, I've added this with the VA, Veterans Disability Compensation. This has become huge lately. And why is it huge? What's the first, what's the most important two words on that first line? Tax-free, right? Take it away from your retirement, unless it's not you. You're 50%, right? No, you're not even into the CRSC. Now, I actually serve as a, I do pro bono. I serve as a veteran service officer. And so I have a little familiarity with this of helping people get it. And so what is this? For people who don't have any idea. So for us veterans, it's if you had a service-connected disability or injury that was incurred or aggravated during service, then you're eligible to apply for VA compensation. We're not talking about VA pension. We're talking about VA compensation. All right. Okay. And you can be rated from zero. Zero is actually a rating to 100%. And they use a combined rating table. We won't get into that detail, but VA math, 10 plus 10 plus 10 is not equal 30 under the VA new math. And basically they're paid for, again, disabilities, and you have to prove service connection, which means the injury, again, resulted in a disability and it had to be linked to your military service. But we're seeing more of this. And the reason I'm bringing this up is you may see someone comes up to you and you're doing a, he's applying for civilian. He's got out of the military and you may write on his sheet that he's 50% VA disability, or he's 100% VA disability, that you're going, if you're not familiar with this system, you're going, oh my gosh, that's almost like social security disability. Can this guy, you're going to like, but just because he's 100% disabled, that does not mean he can't work. So that's the reason why I brought this up. I have seen, unfortunately from Iraq, paraplegics not get 100%. And I've seen people running marathons get 100%. So the VA system is a whole different story and a whole different system in its own right. But just for workers' compensation purposes, I mean, for you in occupational medicine, don't get freaked out when someone walks in with a VA rating, it doesn't mean hardly anything in regards to whether they can do their work or not. Yeah, the only caveat on that is you have what they call a TNP for total and permanent. Right, right. Yeah. That still doesn't mean anything. Yeah, you said that. Yeah, but it says you can't work. In certain states, we're giving breaks, we're giving employment. Correct, right. So that gets five people that are 100% not getting quite the benefits of this. But also what Murray also says about total and permanent, really doesn't matter whether you can do the job or not. I am rated, and I said this before, and I'll use myself as an example, 100% service-connected, total and permanent. I already have that rating. Correct. Here I am, working as a physician, working in the Army Reserve. I'm still an active Reservist. Right, so that- Exactly, it has nothing to do with what you said about whether that person can work or not. Right, right. That's what, you know, I didn't realize this when I first got my first doctorate job, and I was at Ford, and this guy walks in, and back then we didn't have the ADA, you know what I mean? And I go, this guy said he's a 50% disabled vet, and I go, oh my gosh, why, I can't make him, oh my gosh. I had no idea of the VA system or whatever. Says battery's running low. Yeah, you might want to plug in your, I think these people would enjoy me leaving, but anyway. So some lawyers bring joy by coming, others by leaving. But anyway, we're going to plug this in. We're going to get going. We're going to breeze through this part, but we got a really important part for occupational medicine. A lot of this stuff's going to be, you're going to see it again. Okay? So keep talking. Do we have a chart? I'm going to keep talking. Just keep talking. I'm dirty. I don't have any trouble talking. All right. Okay. So what is your contribution? We're going to look at five different areas where your contribution as an occupational medicine physician. Okay? Now it says battery's low. Yeah, that's where it was saying that. Plug it back in. Plug it in. Don't, don't electrocute yourself. Get your finger away from there. We don't need electrical, physical either. We're just going to plug it into the wall. There you go. Here, step in. Wait a minute. We're doing technical difficulties here. Make sure our Zoom land does not miss a point of this lawyer's lecture. There we go. All right. Five areas where you're going to be. You may be involved in. And let's talk right now about workers' compensation system. Okay? Let's just talk about workers' compensation. Medical evaluation documentation. What's the patient's functional expectations? Restrictions and limitations. So important in the field of occupational medicine. We're going to talk about that. Communication between you and the worker and the other third parties. We're going to talk about that. And finally, timely return to functional independence and return to work. That's what this whole ballgame of WACS is all about is returning these patients to work. And that's really the difference. Okay? We're going to talk about that. Oh, here we go again. What's going on? Oh, sorry. There's some weird glitch with this slide. There we go. Okay. So when you do a medical evaluation of your workers' comp, they're coming in work comp injuries. Should be cost-effective. Should be evidence-based. Important thing is when you're seeing a work comp patient, you want to look right away at functional expectations. Then you want to make it part of your treatment plan. Focus on restoration of overall function. But participation recovery. I'm going to say this again. The partition and recovery is influenced by who? Is it influenced by their family? No. Like you said, Carl, when you have people, when they're off work, it's very tough for them to get, they may take on family responsibilities. They did child daycare. You mentioned that before. They've done many studies where every day they're out of work and not doing some sort of light duty, less likely to ever return to any, I'm going to repeat, any gainful employment ever again in their lives. All right. So the bonus is on you as an occupational medicine physician to get them work. And I really think this is what sets the world of occupational medicine as a specialty, is your ability, your knowledge of that workplace as Carl just went, your ability to know that workplace, the ability to set, and we're going to talk about how you get them back to work. Okay. Key point. You need as an occupational medicine to know what a restriction or limitation is, and setting being able to apply that to work and non-work activities. So let's look at this restriction. So what is a restriction? Well, it's a protective measure. We want to protect the worker from any further injury and foster that recovery. A limitation. They may have a limitation, any constraints. So the orthopedic surgeon may come back after back surgery and say, hey, he has a limitation. I don't want him really lifting more than 70 pounds for so many weeks. Okay. And we would issue appropriate restrictions to the workplace. We may not have them want to do this particular job or only do so many hours based on those limitations. So do you understand the difference? This I think is the key in occupational medicine is knowing the ability of restrictions and limitations. Okay. They should be appropriate for the condition and adequate. This right here, this slide sets apart, I believe, good occupational medicine physicians. All right. Listen, any nurse practitioner, any family nurse practitioner, any PA. I'm a family practice. Anyone can hand for carpal tunnel syndrome or any musculoskeletal, you can give them an incis or splints, physical therapy. You can, anybody can treat them. It's not hard. Occupational medicine is not hard from the treatment standpoint for musculoskeletal. What sets us apart as occupational medicine physicians is our innate knowledge of the workplace like Carl just went through and our ability to set appropriate and adequate restrictions. Would you agree with me on that? Yes. The only thing I would say is you can fit in restrictions but the workplace doesn't have to. We're going to talk right now. Beautiful. You're coming into my next slide. Okay. So we're going to talk about communication here in a minute. All right. So you want to be able to set those appropriate and adequate restrictions and limitations based on your clinical experience. You may need to do some testing, communication. Liz talking about this. So regular person comes in. We talk with the patient. We have patient confidentiality. What happens in the worker's comp system? Who else is involved? We forgot about the, who's paying us? Is the patient paying us? Who's paying us? The employer, right? Okay. Besides the employer, who's the other party coming in? The third party administrator. Okay. So the line of communications have got to be really open here between all the parties. In pediatrics, at least you got, you know, you have the parent, the patient, and the physician. Here we got all these parties involved. This again sets the field of occupational medicine because you have more people involved. Communication, release of information. We always, of course, want to maintain patient confidentiality. The first thing you need to do, again, state law many times automatically gives you a waiver. You got to check your state law because when they immediately file a claim, a lot of times it's automatically waived to the employer. But if they don't, make sure you're getting them the first day they come in the door of that release of information. And then the patient always has the right to examine and obtain a copy of the medical record. Don't mix up a work comp injury from an ADA physical examination. All right, don't mix up the two of them. Okay, now suppose we got a patient, he's coming in for the work comp injury, and he said it's hurt his back, but you saw him out the other day playing with his softball team and he hit a grand slam home run. Okay, all right. So, and then he went to dive and catch in the outfield after the injury, but he's still, now he comes in and he says he can't work today, but it wasn't due to the dive and catch in the outfield. All right, so when do we order an independent medical examination or otherwise known as an IME? Well, there's something conflicting. Diagnosis, the treatment, the functional ability of the patient just isn't adding up. I'm going to show you a video. So stay tuned, don't go away. This is an ad for my video, all right? Don't hang tight at the end of this lecture. We only got about 10 more minutes. I'm going to show you an example of when we would order an IME on this patient when everything just doesn't add up. All right, so five characteristics of a quality IME. Should be independent, medical, evaluation, what things we should consider, and how do we report? Okay, IME, independent medical evaluation should be no conflict of interest. Why am I laughing? Is there anything independent about an IME? No, there isn't anything independent about an IME. All right, come on. There's nothing, you're going, look, if I'm in an auto accident and I'm hit by someone, another person, and they rear-ended me, and I claim I got back pain. So their carrier is State Farm, and State Farm says, oh, I don't think Dr. Fowler's back injury is as bad as he claims it is. So they send me to, they're paying 10,000 to a neurosurgeon, right? Do you think the neurosurgeon there is going to say, oh yeah, Dr. Fowler's pain is as bad as he really claims it is? If he does that, is he ever gonna get another exam for another $10,000 ever again from State Farm? So what do I gotta do? I gotta go get my own private IME, and then we fight it out in court, all right? So there's nothing independent about this whole fallacy of just telling you right off the bat of IMEs is just a bunch of baloney, all right? Ah, here we go again, all right. Okay, so when you're doing an IME, there's no physician-patient relationship. The medical, you should be looking at the medical records. You wanna apply your scientific basis and the appropriate specialty of training. All right, I'm gonna tell you a real-life story. Patient of mine, a good friend of mine, he's an occupational medicine doctor. He allowed the patient's mother to come in. He was doing an IME examination in the room, okay? He wrote a not-good report. He didn't think they were disabled at all, okay? In other words, they were fake, all right? He didn't say it in those words. Based on the medical evidence, they made up a bunch of hoo-blah about this DO. They reported it to the state board. There was a state board hearing because it wasn't just he said, she said, it was she said, she said versus that, okay? He was vindicated on that, but it went through. So don't let anybody, another thing. Another thing, don't, if someone comes in there, they start filming you. Stop that, shut it off, okay? Shut it off right there and right then. Do not let them film you one iota. If they're saying, well, we're gonna film, you call the carrier right then who's paying you, and you say, I'm not gonna do it, and you just end the examination right there. It's not worth it, okay? I'm telling you, it's not worth it. You shut the phone off. Those are your rules you set. There is no patient-physician relationship involved here. You're doing independent examination for the purpose of that company, all right? So when we did the evaluation, you should apply scientific principles. You wanna thoroughly document, I can't help, let's say this physician was a thorough documentation. Validate the facts, and you wanna demonstrate the functional abilities, okay? Things to consider when you're doing this exam, you wanna make sure you got all the records, make sure you got them all. Ordering labs and tests. I would make sure, if you're doing independent IME, make sure you got company approval before you just really do a stubble in lab test, because who's gonna pay for it, all right? Make sure you get them. Billing and payment, make sure all that's arranged to him, okay? Make sure whether you've got actually copies you need. You really should be looking at the actual films and not necessarily just the reports, okay? The reports should thoroughly document the history of exam. You should be organized. Carl does IME examinations. You know, he spends an extra day later just looking at all of the information, making sure there's quality control in his IMEs that he does. You do those with Blacklung, I think, Carl, you were telling us, right? I do regular IMEs. Right, IMEs too, okay? And then make sure you're, and they want them completed in a timely manner, all right? All right. Okay, we're almost done. Hey, isn't that great? What's the following is a no-fault state-sponsored program for workers, everybody? That's how we get paid. All right, Jeff, where's Jeff? Jeff, I'm gonna have a treat. We're gonna show you, I got this case of this lady who claimed she had a workers' comp injury. When you hear those three famous words on The Price is Right... Oh, come on now! ...you do want to know what's going on behind closed doors. It's the price is right. When you hear those three famous words on The Price is Right... Oh, come on now! ...you do want to know what's going on behind closed doors. It's the price is right. When you hear those three famous words on The Price is Right... Oh, come on now! ...you do want to know what's going on behind closed doors. You do what the man tells you, fast. Like this woman, Kathy Cashwell. $1,375. But a fortune in fabulous prizes wasn't the only thing Cashwell was collecting. Cashwell was also cashing in three grand a month in workers' comp, claiming an on-the-job shoulder injury left her totally unable to stand, run, reach, or grasp. Here we go, good luck. But there she is, spinning that big, heavy wheel. Not once, but twice. It turns out The Price is Right double dealer isn't the only one. Bogus injury claims cost taxpayers hundreds of millions a year. Scores of former New York City cops and firefighters indicted for falsely claiming they had PTSD and anxiety as a result of the September 11th terrorist attacks. Like former cop Vincent Lamontia. He's accused of lying about depression and then collecting almost $150,000 in disability. But while he claimed to be too ill to work, prosecutors say he took exotic trips and bragged online about having a new job. Hey, I'm Cecilia Vega from 2020. We wanted to ask Lamontia about his seemingly remarkable recovery. And the prosecutors are saying that essentially you're a cop who scammed the system. That's not, I'm not a cop. You were a cop at one point. Why don't you give me a quick comment and then we'll get out of your hair. I'm scared, I really can't. You claimed to be so mentally ill that you couldn't work. And yet you were still working on the side, basically defrauding the system. Wow, that's really something. You're going to see much more of Cecilia taking him on tonight on 2020. In the meantime, Cecilia, you're reporting more than a hundred indictments in that 9-11 alleged scheme alone? That's right, David. Vincent Lamontia and all of those other former cops and firefighters from New York have all pleaded not guilty to all of those charges. Wow, more to come on that. And in the meantime, let's talk about our Price is Right contestant. Cathy Cashwell, those pictures were something, right? She told us that despite how it looks in that clip, she was quote, her words here, hurting the whole time, David. Hurting the whole time. All right, Cecilia, thank you. All right, Cecilia, thank you. All right, thank you for putting up with this attorney. Any questions?

medical malpractice

occupational medicine

income replacement programs

Social Security Disability

workers' compensation

private disability insurance

VA compensation

independent medical evaluations