This is a critical part of our representation and something that is unique about our firm and in my work it is true for all folks who get hurt to get prompt treatment, treatment as directed by their doctor and to follow their treatment recommendations. There are a few things more frustrating in representing people when they do not help themselves on their case. This is a problem when we do not get retained until months or years after the original injury, because by then people may have inadvertently and without knowing any better make a lot of mistakes in how they follow their treatment. The medical system, we have great healthcare in this country, we have the best medicine in the world, the best doctors, the best hospitals and the best healthcare and we have the best of everything.
However, there is no class in high school on how you get through the medical system, there is no class in high school on how to handle your personal injury claim and so folks just do not know. There are new careers now in healthcare management, case coordinators, people who follow patients to make sure that they are accessing care appropriately, following up on doctor recommendations, there are commercials on television for healthcare companies and how their patients follow up with them, call them, make sure they get to their appointments for their prescriptions, because human nature is one where, as soon as we walk out of the doctor’s office or the hospital, we are feeling a little better, our desire to go back and get more treatment wanes and we want to get back to our lives.
We do not want to think about how our back or neck hurts, we do not want to go to the doctor generally and who can blame us? It is not fun having blood drawn, or sitting in a waiting room. So people oftentimes do not get the treatment they need and it really hurts their claim and their recovery. If they do not follow up on treatment recommendations from their physician, they do not go to physical therapy as directed, if they miss appointments, they not get better. Oftentimes the way they are supposed to get better when they follow physician’s orders, but if they do not, it almost always hurts their claim and affects the outcome of their recovery and their claim. This is a big part of what we do. We have to counsel clients that are an important part of our job and how to appropriately and effectively get the treatment they need, access the system properly and coordinate their care.
Ideally, injured folks will have a primary care physician or an attending physician that will coordinate their care and direct them to different specialists and help them follow up or at least coordinate care. However, in an injury context, when there is a claim, again there is no class in medical school and doctors do not get a lot of continued education on what to do when your patients are having an injury claim and how to deal with the insurance company and those issues. It is not really the doctor; the doctor is going to medical school to treat people and make people better. They do not want to deal with lawyers generally and they do not want to deal with paperwork anymore than they have to and I do not blame them.
Parts of what we try to do is make it easier for doctors to respond and address questions and assist our clients in following their doctor’s directions and doing what the doctors tell them. Quite frankly, explain to them oftentimes why we want you to follow these medical orders. Most people do not speak “doctor”, they do not speak “medical system”. We do. I have had an awful lot of training in that regard, both formally and informally. I took a course at the Oregon Health Sciences University called Medical School for Lawyers. That is where my brother attended medical school; it is a good school and it was a weekly course that was to teach lawyers how doctors think about how the system works so that we can work with them and understand medicine interventions.
Understanding the medicine is important in addition to understanding how the system works. My wife is a physical therapist; I enjoyed helping her study when she was in school. In addition to the rest of my family having medical background over the years, whether it be doing personal injury claims or workers’ compensation claims, when my clients are injured, they are in the medical system, they have problems. I have to be able to read their medical records and listen to what they tell me about what the doctors are saying and translate what is going on, so they have a better understanding of what they need to do and what is really going on because that has just not been a primary focus.
In terms of office visits sometimes, doctors do not have enough time with the patients because the way billing practices are done with the insurance companies and insurance companies are constantly driving down physician visit times, no matter what the specialty is, physicians only have so many hours in the day, paperwork cuts into that, administration cuts into that and they have a lot of headaches other than practicing medicine and part of that is they do not have the time with the patients that they would like. It is just not uncommon to have a ten minute office visit with a physician these days. This is what the insurance companies tell them.
If you are in primary care, there are guidelines about how many patients you are supposed to see in a day or how long a patient visit is supposed to take. It is very difficult for physicians and they are oftentimes dictating short notes at night or they work for very long hours and they just do not have as much time as they would like to explain to their patients everything that is going on. Frankly, when patients understand what they are supposed to be doing and why, they do a better job following through. If they know why they have to get an MRI, why they have to do physical therapy exercises, if they know why it is important to call and reschedule and how important that treatment is and how important it is to follow treatment recommendations, then they tend to do a lot better.
People tend to do better when they understand why they are doing what they are doing and part of our job is to help them. We have great healthcare here, but for someone who does not have six years of college, it can be daunting and we help with that, help the patients, our clients tell their doctors what they need to know, follow their instructions, follow up with care and encourage them to get the treatment they need and get to the specialty care they need.
We have case laws on this in Montana, we have our Unfair Claims Practices statute 33-18-201, Montana Code Annotated, which talks about how the expenses should be paid and then the case law including the Ridley case, which talks about how when a liability is reasonably clear, the insurance company has to pay the medical expenses prior to final settlement. Getting those bills paid on an ongoing basis is important and providers expect to be paid and if they are not getting paid, then people cannot get the care they need and that is important. We spend a lot of time and energy on that so that people get the care they need and then get the right outcome, both in terms of a recovery and in terms of their financial settlement.
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