Physical Medicine & Rehabilitation Expert

Chronic Pain & Personal Injury Litigation

It’s all in the Records.

 Pain

  • An unpleasant sensory or emotional experience

  • Associated with actual or potential tissue damage


Chronic Pain Defined

  • Pain that extends beyond the expected period of tissue healing

  • May be defined as pain that lasts 3–6 months

  • Usually accompanied by psychosocial factors

Chronic Pain vs. Secondary Gain

  • Secondary gain is a significant psychosocial factor

  • Chronic pain more common when secondary gain may be present

  • Clinical outcome studies exclude Workers' Comp and patients in litigation

  • Such patients sometimes have poor outcomes

Other Factors Implicated in Chronic Pain

  • More common in those who have experienced physical, emotional and sexual abuse

  • More common in cases of early abandonment during childhood

  • More common with a personal or family history of substance abuse

  • Often used to obtain pain medication


Important Information You and Your Consultant Should Use in Evaluating Chronic Pain Claims

  • The difference between the injured party’s history and the timeline as presented by relevant medical records.

  • The physical examination

  • The diagnostic studies

Use of Medical Records

  • Without an objective review of the unchanging medical records related to the case, there’s no concrete, objective interpretation of the events as they occurred years before.

    • Why?

      • Human testimony can vary over time.

      • Court cases are usually years after an injury.

      • Medical records don’t change.


1. First Medical Record Review

  • Do early records reflect an injury to that "chronic pain" body part?

  • Remember, symptoms are complaints and signs are objective findings

2. Second Medical Record Review

  • Did the claimant seek immediate medical care?

  • Did the examining physician order diagnostic tests?

  • Were there referrals to specialty physicians?

3. Third Medical Record Review

  • Did a physician recommend the claimant not work?

  • Does the claimant tell all of their treating physicians about their severe disabling condition?

  • Does the claimant have timely follow-up doctor visits for their "severe" injury?


Does it Boil Down to Behavior? Not Just The Patient’s Behavior.

  • The physician's behavior reflects their concern for the severity of the injury

  • The claimant's behavior is reflected in their medical care:

    • Timeliness of their first visit

    • Frequency of follow-up visits

    • Consistency of their complaints to all of their medical providers

Which Complaints are Related to the Accident?

  • Those that are documented shortly after the accident

  • New onset of symptoms weeks or months later are usually not related

  • Typically get better with time rather than worse — may reflect new conditions or psychosocial issues

Independent Medical Evaluations (IMEs)

  • Must be thorough, impartial, objective, and well-documented

  • All complaints the claimant attributes to the accident need to be addressed

  • The physician conducting the IME can be accused of causing injury and improper behavior

  • Video and sound recording can detract from the clinical aspects of the IME encounter and turn it into a performance


Diagnostic Tests

  • Radiologists are trained to comment on all findings regardless of their clinical significance

  • Even normal, uninjured spines can show abnormalities. Experts are expected to know the differences between clinically significant findings and normal physiological variance.

    • Imaging

      • MRI

      • CT Scan

      • X-Ray

    • Variances

      • disc bulges

      • disc degeneration

      • disc herniations

      • changes positively correlated to the aging process