1. The MVA Patient -
Your Favourite!

2. Why Family Doctors?

3. Why Family Doctors?
experts in Family Medicine

4. Why Family Doctors?
experts in Family Medicine
know the patient best

5. Why Family Doctors? experts in Family Medicine know the patient best
jurors have family doctors and tend to relate to them well

6. Why Family Doctors? experts in Family Medicine know the patient best
jurors have family doctors and tend to relate to them well
experience with chronic conditions

7. In What Types of Cases?

8. In What Types of Cases?
“chronic pain” personal injury cases

9. In What Types of Cases? “chronic pain” personal injury cases
“before and after”

10. In What Types of Cases? “chronic pain” personal injury cases
“before and after”
clarify impact of pre-existing impairments

11. In What Types of Cases? “chronic pain” personal injury cases
“before and after”
clarify impact of pre-existing impairments
explain clinical course

12. CAUSATION

13. CAUSATION
did the MVA cause the pt’s symptoms?

14. CAUSATION did the MVA cause the pt’s symptoms?
consideration of pt’s prior hx

15. CAUSATION did the MVA cause the pt’s symptoms?
consideration of pt’s prior hx
line between pre-accident and post-accident hx is blurry

16. CAUSATION did the MVA cause the pt’s symptoms?
consideration of pt’s prior hx
line between pre-accident and post-accident hx is blurry
accident need not be the sole or direct cause of symptoms

17. CAUSATION “material contribution” Supreme Court of Canada says:
‘Where the “but for” test is unworkable, the courts have recognized that causation is established where the defendant’s negligence “materially contributed” to the occurrence of the injury.’

18. CAUSATION
positive scientific proof not required

19. CAUSATION positive scientific proof not required
recognizes multifactorial nature of many conditions

20. “INJURY vs. IMPAIRMENT”

21. “INJURY vs. IMPAIRMENT”
emphasis on impairment, not injury

22. “INJURY vs. IMPAIRMENT”
emphasis on impairment, not injury
no functional impairment = no case

23. “INJURY vs. IMPAIRMENT”
emphasis on impairment, not injury
no functional impairment = no case
injuries heal but impairments remain, e.g. chronic pain

24. “INJURY vs. IMPAIRMENT”
emphasis on impairment, not injury
no functional impairment = no case
injuries heal but impairments remain, e.g. chronic pain
do impairments interfere with daily life tasks?

25. ANATOMY OF A MEDICAL-LEGAL REPORT
ANATOMY OF A MEDICAL-LEGAL REPORT

26. Nature of document

27. requested by legal representative
Nature of document
medical-legal report
requested by legal representative
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

28. Summary of qualifications

29. Summary of qualifications
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 1995.

30. 3. Brief summary of pt’s hx in your care
3. Brief summary of pt’s hx in your care

31. first contact
Mrs. […] has been a patient of mine since July

32. pt’s past hx
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.

33. 4. Details of event as related by pt

34. first meeting 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.

35. own examination and findings
At that time an examination was carried out and x-rays were obtained which did not show a clinical fracture.

36. 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 […]

37. …functional limitations
…functional 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.

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

39. 5. Summarize history post-event
5. Summarize history post-event

40. 5. Summarize history post-event
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.

41. 6. Opinion

42. 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.

43. 7. Current status and management

44. 7. Current status and managementdx

45. 7. Current status and managementdx
further tests & tx

46. 7. Current status and managementdx
further tests & tx
anticipated benefit of further tx

47. 7. Current status and managementdx
further tests & tx
anticipated benefit of further tx
prognosis

48. 8. Answer critical questions

49. 8. Answer critical questions
current level of function?

50. 8. Answer critical questions
current level of function?
level of function pre-event?

51. 8. Answer critical questions
current level of function?
level of function pre-event?
cause of change in level of function?

52. 8. Answer critical questions
current level of function?
level of function pre-event?
cause of change in level of function?
current status likely to change?

53. 8. Answer critical questions
current level of function?
level of function pre-event?
cause of change in level of function?
current status likely to change?
limitations/restrictions on daily activities? On employability?

54. CONCLUSION
Indicate that your opinions are based on:

55. CONCLUSION Indicate that your opinions are based on:
your own knowledge of pt’s hx

56. CONCLUSION Indicate that your opinions are based on:
your own knowledge of pt’s hx
pt’s chart, including consults

57. CONCLUSION Indicate that your opinions are based on:
your own knowledge of pt’s hx
pt’s chart, including consults
subjective complaints of pt

58. CONCLUSION Indicate that your opinions are based on:
your own knowledge of pt’s hx
pt’s chart, including consults
subjective complaints of pt
your own findings based on examinations and observations

59. CONCLUSION
Qualify your opinion

60. CONCLUSION
“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.”

61. DON’Ts

62. DON’T be afraid to contact the legal representative

63. DON’T be afraid to contact the legal representative
DON’T be afraid not to provide a report

64. DON’T be afraid to contact the legal representative
DON’T be afraid not to provide a report
DON’T regurgitate your chart verbatim

65. DON’T be afraid to contact the legal representative
DON’T be afraid not to provide a report
DON’T regurgitate your chart verbatim
DON’T advocate unless you can substantiate

66. and lastly…
DON’T overstep the bounds of your expertise

67. R E S U L T S . www.flashlaw.ca
Personal Injury. Malpractice. Disability. Insurance Claims. E X P E R I E N C E .
I N T E G R I T Y .
R E S U L T S .