Showing posts with label adjuster. Show all posts
Showing posts with label adjuster. Show all posts

Thursday, September 23, 2021

A Horror Story For Insurance Companies




     John Jones gets injured. For this horror story, it doesn’t matter if he was at work or shopping in a supermarket. It doesn’t even matter how the claimed injury occurred or even if he was really injured.

John gets a lawyer to represent his interests. For the sake of discussion, let’s assume the lawyer files the claim saying the injury was psychological or psychiatric.  The lawyer then sends John to a psychologist or a psychiatrist for an evaluation and treatment. The doctor writes a report stating that John had an injury. He begins treatment. The insurance company representing the defendant sends John to another doctor for an opinion. That doctor doesn’t completely concur with John’s lawyer’s doctor but agrees that John was psychologically injured.


     At some later time in the claims process the insurance company pays John some money to compensate him for his injury. John, his lawyer, the insurance company, the defense’s lawyer and both doctors are all happy with the settlement. John has been paid for his damages, the doctors and lawyers have been paid for their services, and the insurance company has paid what they believe is a reasonable amount of money.


     Everyone wins! Or do they? Who loses? Just imagine for a second that the insurance company’s doctor made a mistake in their evaluation. Let’s make it a big mistake, although the size hardly matters. Let’s assume John has successfully exaggerated his injury, or worse yet, faked it entirely. Now there is a loser! No, it’s not the insurance company! They don’t lose because they pass the cost of the claim onto their clients. Every time the insurance company pays out an exaggerated or fraudulent claim the policyholders unjustly pay!


     So along comes another law firm who recognizes the unjust consequences of the insurance company’s doctor’s failure to identify what should have been an easily detected exaggerated or faked claim and files a class action lawsuit on behalf of not only John’s claim, but all the claims that were settled based on inadequate defense doctor evaluations. How much will that class action lawsuit cost the insurance company for failure to use due diligence and good faith? How much will that cost the doctor’s malpractice carriers?


     If you are a defense attorney or a claims adjuster and have what you suspect is a flawed report on your hands, but are not a highly skilled psychiatrist or psychologist, you can prevent making a serious error in judgment and exposing yourself to litigation by getting my analysis of that report. If you’re the defendant in a lawsuit, or represent the defendant who is facing a large loss, settlement and/or increase in their insurance premiums, you can avoid additional costly litigation, including a class action lawsuit by all the insured who have had their premiums wrongly increased as a result of a failure to detect a grossly exaggerated or faked claim by getting an evaluation of the suspected flawed report BEFORE settling the case.


     As regular readers of my monthly newsletter know, I am a Professor Emeritus of Psychology at San Diego State University who has been doing psychological evaluations for over thirty years. During that time I have brought rigorous academic standards to the practice of forensic psychology. In addition to evaluating claims for both claimants and the defense I have specialized in evaluating the credibility of psychiatric and psychological reports. Having read and critiqued between 10,000 and 50,000 reports, in the true fashion of a renegade crusader, on multiple occasions I have fearlessly stepped up and testified that the vast majority are demonstrably substantially flawed to the point of lacking the ability to prove the doctors’ conclusions.


     Additionally, I would like to point out that I have been writing what I call Apricots™ for the last 12 years. An Apricot™ is a work-product privileged report that helps an attorney cross-examine and/or write a trial brief by describing the substantial flaws found in a psych doctor’s report in jargon-free, non-technical language with supporting documentation from the peer-reviewed literature. Apricots™ also provide attorneys with a series of specific questions to ask the doctor that results in getting those flaws into the record despite the doctor’s evasive or non-cooperative behavior.


     Finally, I would like to suggest to you that if you have a case that you suspect is substantially flawed you can send me a copy of that report and I’ll tell you what’s wrong in a free telephone consult at 844-444-8898. At that point you can decide if you want me to write an ApricotTM or go it alone based on the information I gave you. If you decide on the later you can go to my website at DrLeckartWETC.com and download a free copy of my book, Psychological Evaluations in Litigation: A Practical Guide for Attorneys and Insurance Adjusters and use some other resources found there to plan out your strategy. Or, you can ask me to write a report that includes a complete analysis of the flaws with supporting data and professional literature citations as well as a full set of questions that will dismantle the doctor’s testimony during cross-examination. Either way, I’m here to help.







     





Tuesday, May 3, 2016

Cross-Examining Psych Doctors-Tip #25-Absence of MMPI Scores


The Minnesota Multiphasic Personality Inventory (MMPI) is an instrument that is widely accepted by psychologists and psychiatrists as being capable of measuring any existing psychopathology and an individual’s test-taking attitudes or credibility.  For some unknown reason, many psych doctors choose to omit MMPI scores from their report.  The absence of those scores means that the reader of their report cannot verify the basis for their summary conclusions.  When you see that a psych doctor has declined to provide the patient’s MMPI scores in their report, you should ask them if there is anything in their report that would allow the reader of that document to confirm the conclusions they drew from the patient’s MMPI.

Friday, April 29, 2016

Cross-Examining Psych Doctors-Tip #24-Incomplete Disorders

When you see that a doctor has diagnosed a Major Depressive Disorder, check to see if the diagnosis is complete.  The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) indicates that in order to diagnose any form of a Major Depressive Disorder correctly it is necessary to specify whether the disorder has been of the Single Episode or the Recurrent variety and also to specify the severity of the disorder.  In fact, the DSM indicates that not only must the doctor verbally describe these factors but they must also provide numerical diagnostic codes to unambiguously identify the specific Major Depressive Disorder they wish to diagnose.  When you see that the doctor has provided an incomplete Major Depressive Disorder, you should ask them where in their report they provided the information about their diagnosis as required by the DSM and of course, you should always make sure that the doctor has provided enough information in their report to indicate that all of the diagnostic criteria were satisfied.

Thursday, April 14, 2016

Missing Data? Get an Apricot™!

Are you an attorney who has gotten an “awful” psych report on a personal injury or workers’ compensation case? Did the doctor simply not find anything wrong with the patient because he or she did not look carefully? Do you know if the data needed for a complete psychological evaluation were absent from the doctor’s report? If so, not all is lost, get an Apricot™ that will provide you with all of the information and questions to ask the doctor that will expose all the report’s flaws during the doctor’s deposition. Essentially, an Apricot™ describes the psych report’s flaws in jargon-free, non-technical language; discusses specific techniques used to Cx the doctors; and provides multiple questions that get those flaws on the record despite what might be the doctor’s non-cooperative behavior.   You can also write your own Apricot™ with the self-help resources at my website, DrLeckartWETC.com. 

Wednesday, April 13, 2016

Did the doctor “give away the store?”

Are you an attorney or an insurance adjuster who has gotten an “awful” psych report on a personal injury or workers’ compensation case? Did the doctor “give away the store?” If so, not all is lost, get an Apricot™ that will provide you with all of the information and questions to ask the doctor that will expose all the report’s flaws during the doctor’s deposition. Essentially, an Apricot™ describes the psych report’s flaws in jargon-free, non-technical language; discusses specific techniques used to Cx the doctors; and provides multiple questions that get those flaws on the record despite what might be the doctor’s non-cooperative behavior.   You can also write your own Apricot™ with the self-help resources at my website, DrLeckartWETC.com. 

Tuesday, April 12, 2016

Clinical Depression

Everybody gets depressed.  However, it is only when that depression is not normal, reasonable, understandable and expectable that it crosses the border and becomes a disorder.  There are many psychological disorders in the DSM-IV-TR that include signs and symptoms of a clinical depression.  Thus, if you are interested in the litigation of psychological claims it is important to know how depression is observable during a psychological evaluation and what to look for in a psych report to see if the author “gave away the store.”

Monday, April 4, 2016

Cross-Examining Psych Doctors, Tip #18-Check Out The Doctor's History


One of the first steps in reviewing a psych report is seeing if the doctor took a complete history of the patient’s symptoms or complaints to indicate that their diagnosis is correct. The history section is only complete once the doctor has sufficient data about each symptom's qualitative nature, including its frequency, intensity, duration, onset and course over time.

Friday, March 25, 2016

Tip #16 - Cross-Examining Psych Doctors-The Diagnosis is Crucial

In writing an Apricot™ for use in cross-examining a psych doctor the focus is most often on the diagnosis, which is the major problem found in most psych reports. Doing this is conceptually very simple.  Just match up the diagnostic criteria found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) with the data found in the doctor’s report to see if the report lacks sufficient data to support the diagnosis.  Once it has been demonstrated that the diagnosis is unsupported, there is absolutely no support for the conclusion that the patient has a psychiatric injury, a psychiatric disability or a need for treatment.

Tuesday, March 22, 2016

Cross Examining Psych Doctors - Tip #15-How to Decide If That Psych Report Is Really As Bad As You Think


Ask yourself?  Does the doctor’s description of the patient describe enough symptoms to conform to the diagnostic manual’s definition of the disorder?  Did the doctor describe enough Mental Status Examination to support their diagnosis?  Do the psychological testing scores demonstrate the patient was both truthful and disordered?  Asking the right questions is the first step to understanding that psych report.

Wednesday, March 16, 2016

Sub Rosa Videos and Psychological Evaluations



During the slightly more than 30 years I have been conducting workers’ compensation and personal injury evaluations in the State of California I have participated in the examination of between 5,000 and 10,000 patients. In the last decade the majority of those examinations have been Agreed Medical Evaluations for workers’ compensation purposes. In the course of conducting those evaluations I have watched my share of sub rosa video surveillances. How relevant are those recordings?
Overall, the average sub rosa video depicting an individual walking down the street, driving a car, going shopping, gardening, talking to a friend, smoking a cigarette etc., has little value in providing information relevant to drawing conclusions about their psychological status.

Thursday, February 18, 2016

California Exclusive


   For some seven years I have been writing a newsletter that for the most part was dedicated to discussing psychological issues in the medical-legal area involving worker's compensation and personal injury litigation. Initially, the distribution of the newsletter was to attorneys and insurance adjusters with whom I had some professional connections with in California.

   As time has progressed, I am happy to say that my newsletter has been picked up by a variety of people in many different areas throughout the United States and in many foreign countries. Many of these readers were initially sent the newsletter by people in California and some connected through my website, where all of the previous newsletters are available. (www.drleckartwetc.com)

[To read more click here or to read all previous newsletters visit the website at www.drleckartwetc.com]

Thursday, February 4, 2016

Cross-Examining Psych Doctors - Tip # 6



Under cross-examination, psych doctors sometimes answer questions with technical jargon or are non-responsive in other ways.  Sometimes that behavior is deliberate and sometimes it is just how the doctors think and express themselves.  Regardless, when that occurs you may not have the foggiest idea of what the doctor is talking about.  One simple solution is to be persistent!  When the doctor is indirect or obscure just go back to your same simple question and repeat it until you get your clear simple answer.

More help for cross-examining psych doctors and preparing briefs for the court can be found at (www.drleckartwetc.com) and in my book Psychological Evaluations in Litigation: A Practical Guide For Attorneys and Insurance Adjusters (http://drleckartwetc.com/wp-content/uploads/2012/10/FINAL-051311.pdf)

Tuesday, February 2, 2016

Free Reference Book




Dr. Leckart's Psychological Evaluations In Litigation: A Guide For Attorneys and Insurance Adjusters
If you are going to take a psych doctor’s deposition or trial testimony you should make yourself as familiar as possible with the nature of psychological evaluations.  Here is a free copy of my book, Psychological Evaluations in Litigation:  A Guide for Attorneys and Insurance Adjusters.  I suggest that you download and save it for the next time you are planning a Cx.

More tips and free tools for help in cross-examining psych doctors and preparing briefs for the court can be found at Dr. Leckart’s website: www.drleckartwetc.com

Friday, January 29, 2016

Cross-Examining Psych Doctors - Tip #5

Cross Examining Psych Doctors - Tip #5-Mental Status Examinations


Information about a patient's credibility can be found in the doctor's report of their face-to-face Mental Status Examination (MSE). An MSE provides a set of observations of the patient that are made by the doctor employing a relatively standard set of examination techniques and observations. At the very least the data in the MSE should be consistent with the data found in the doctor's history, the psychological testing, and the patient's medical records. The MSE should also contain information about the doctor's observations of the patient' consistency vs. inconsistency and vagueness vs. clarity both of which speak to the patient's credibility. A complete description of MSE's can be found in my book Psychological Evaluations in Litigation: A Guide for Attorneys and Insurance Adjusters that can be read or downloaded for free on my website. You can also find copies of my monthly newsletters further addressing MSE's
     More tips and free tools for help in cross-examining psych doctors and preparing briefs for the court can be found at www.drleckartwetc.com

Tuesday, January 19, 2016

Cross-Examining Psych Doctors: Tip #3

Cross Examining Psych Doctors - Tip #3-Support for the Diagnosis

The most frequent and substantial flaw in psych reports is the doctor’s diagnosis.  Simply put, there must always be data or evidence that supports the diagnosis.  Thus, the first thing to do is to obtain the diagnostic criteria from the DSM-IV-TR or the DSM-5, whichever is applicable in your jurisdiction. Then look at the doctor’s history.  At that point you just ask yourself, “Do the data support the diagnosis”?  If the history is deficient in providing information about the symptoms in terms of their qualitative nature as well as their frequency, intensity, duration, onset or course over time there is no support for the doctor’s diagnosis.

More tips and free tools for help in cross-examining psych doctors and preparing briefs for the court can be found at Dr. Leckart’s website: www.drleckartwetc.com


Monday, January 11, 2016

Cross-Examining Psych Doctors - Tip #2



When cross-examining psych doctors, attorneys should focus their questioning on the weakest part of the doctor’s report, which is their diagnosis. When effectively done this approach will force the doctor to testify that there were insufficient data in his or her report to support their diagnosis. Once this has been done all of the other conclusions about things like causality, disability, prior pathology and the need for treatment fall by the wayside like a collapsing house of cards. 

More tips and free tools for help in cross-examining psych doctors and preparing briefs for the court can be found at Dr. Leckart’s website: www.drleckartwetc.com

Friday, January 8, 2016

Cross-Examining Psych Doctors - Tip #1



Attorneys should only question the doctor about their report and never about the patient. This approach will ensure that no new "evidence" can find its way into the doctor’s testimony and the outcome will most likely be far superior than asking the doctor about the patient. If you ask the doctor about the patient this allows them to provide information of questionable validity that is not their report that could conceivably support their conclusions. 
This tip is based upon outcomes from actual written pre-deposition consults (Apricots™) done by Dr. Bruce Leckart.
More from Dr. Leckart:
www.drleckartwetc.com

Thursday, January 7, 2016

Welcome to The Med-Legal Psych Professor!

Enjoy Dr. Bruce Leckart's blog!



We're kicking off the blog with a free book giveaway! Click here for your free copy now!

Psychological Evaluations in Litigation: A Practical Guide for Attorneys and Insurance Adjusters

This book was written with the intention of helping attorneys and adjusters assess the credibility of psychological and psychiatric reports, to prepare to take trial and deposition testimony from psychologists, psychiatrists and patients, and to decide which doctors to hire...all in an effort to help win psych cases!

The next time you want to know something about a diagnosis, a psych test, or Mental Status Evaluation just look it up! Keep in mind, the weakest part of every psych report is the doctor's diagnosis.

You may also be interested in reading more about the book in our newsletter: The Book of Apricots™

 
Enjoy our future posts and have a great 2016!

www.drleckartwetc.com