The Critical Role of the Physician Expert Reports Being Called to Court Motor Vehicle Accidents Important Changes to the Law MIG – Minor Injury Guideline Recovering Costs Catastrophic Impairment ODSP, CPP 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

1.Nature of document 1.Nature of the Report - Medical Legal Report - Requested by lawyer 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

1.Nature of document 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 Summary of Qualifications

1.Nature of document Mrs. […] has been a patient of mine since July Brief Summary of the Patient’s History 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 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-rays 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.

including psycho- emotional sequelae […] there has been a rather large psychological impact as well […]

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 DON’T overstep the bounds of your expertise

DON’T DON’T be afraid to contact the lawyer. DON’T DON’T be afraid to provide a report DON’T DON’T advocate unless you can DON’T DON’T regurgitate your chart

Communication is Critical

“I don’t want to go to Court!” “I do not have the time to prepare or attend…” “I am not involved in any of this!” “Do I have to go to court? …. “Is this really going to trial?” “….I have not provided a report!”

-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

$25,000 ($63, current dollars) - August $100, Medical and Rehabilitation benefits

- Changes Effective 1 September 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, for “minor Injuries” 2.$50, 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, to be utilized over 12 weeks and if still suffering $1, thereafter. -What happens if your patient is not better in 12 weeks? -What about psychological impairments? -What about chronic pain?

-You will be fairly compensated - You are entitled to be paid - 3 ways to be paid -OHIP -Insurance -Patients -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)

- ADLs - Social functioning - Concentration, persistence, pace - Adaptation in work or work-like setting s. 2(g) requires assessment of :

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 - Financial Eligibility - Benefits for patients - 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 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