Analyzing a
med-legal report
What a complete analysis has to capture. For paralegals and newer attorneys.
The period of temporary disability. Everyone remembers permanent disability. TD gets forgotten, and it is money.
TTD temporary total TPD temporary partial or a combination (common)
In a P&S report, it should be clear on the face of the document. When it isn't, the report often refers back to prior reports, so go pull them. Never record the TD period as unknown because this one report didn't spell it out.
Report type
AME or QME · physician's specialty · initial evaluation, re-evaluation or supplemental · date of report
Diagnoses
Industrial causation determination
Work restrictions
Anything still needed
Diagnostics, testing, consultations, other treatment
Specialties being deferred to
Flag every one. They drive the settlement analysis below, and they hide in a single sentence
WPI per body part
Per body part, not one global figure
Basis for each
AMA Guides 5th Edition, or Almaraz/Guzman
Industrial apportionment per body part
Kite/Vigil analysis
Should PD for certain body parts be added rather than combined, and did the physician explain it
Full rating strings
Each ratable body part, then the final PD per date of injury
The TD period
See above. The one that gets forgotten.
Supplemental letter, deposition, or neither
A depo can be necessary on complicated issues, but it opens the door to the other side. Both routes cause delay, so sometimes the better move is to settle despite imperfect reporting.
Settlement recommendation to the client
PD value + FMC value (usually a conservative estimate, so say so) + any missing TD. When TD is unknown, request authority on PD + FMC and add a line requesting a current benefits printout.
P&S on all issues, for all specialties?
The worker needs to be P&S for every specialty. If that isn't happening, settlement is still available. Consider buying out the pending specialty where the issue is valid, or where there's a risk of it being found non-industrial.
EDD
Check whether EDD is claiming a lien or money owed on your client's settlement. Easy to forget until it's inconvenient.
Prepared by Hey, Lucie for California applicant-side workers' comp firms. General information for training purposes. Not legal advice, and no substitute for the judgment of the handling attorney. heylucie.ai