1	understanding and then Closing Psychological Claims
2	Complete Your CEU Registration at www.psychological.com
3	Overview of this Seminar Why you must obtain a detailed picture of the patient How do all the individual complaints fit together How to use Pre-emptive Moves Decide how you are to put closure on the cases
4	The BioPsychoSocial Model
5	Epidemiology
6	Georgia Case Demographics Most injuries occur in semi-skilled, intensive labor positions, requiring overtime for financial stability with an absence of career or economic plan. Most have no viable future plans, economic support, and do not fully understand injury or treatment options. Most have marginal education and training; many have subaverage intelligence Many have unrealistic expectancies of treatment or case outcome. Most lost time cases have agenda that complicates or obstructs the course of recovery. Many, many have problematic marriages and family including substance abuse and disability, other health problems and past/current bankruptcy
7	Simple Case Management Axiom If you do not have all of the information, and/or do not fully understand the claimant, you will never have control of this case.
8	Facts: A diagnosed Psychological Disorder is not a disability All Claims Have Multiple Psychological Components Failed Resolution Arises from Case Mismanagement
9	The Causes of Claims of Psychological Disorder (A Multiple Choice Exam) Fraud & Deception Algaecide Needed in Gene Pool Inherent Nastiness of Panel Providers Sadomasochistic Trends in Adjustors Attempts to Please the Employer All of the above
10	The Surgeon Synonym List How to Avoid the term “Psychological” Functional Overlay Conscious Embellishment In excess of objective findings Non-physiologic Indicators Symptom Amplification Inconsistent Effort (“positive Waddell”)
11	The “Psychological” Claim In a pure sense (definition), such claims are not permitted in the State of Georgia “Psychological Component” claims Resultant from injury (e.g. post-traumatic stress disorder) or During the course of care (e.g. major depressive disorder) Most often arise due to naiveté and/or as a result of avoidance by providers and insurers.
12	"Mood and Anxiety Disorders naturally..." Mood and Anxiety Disorders naturally arise from serious injury Employer, Insurer, Physician unnaturally trigger anger, confusion, despair and frustration in injured workers Developmental/Longstanding/Pre-existing/Family Disturbance are opportunistic America’s sense of entitlement
13	First Tip: Using Your Primary Provider Seek Authorized Treating Physician assistance Provide Data (IME Supported) to him/her ATP is rarely aware of patient background ATP may sense the existence of Psychological Components ATP almost never wishes to deal with the psychological components
14	Case Example 35 year old plumber, scalded by exploding water heater, treated by Grady burn unit, describes and referred for PTSD symptoms States that it was a near death experience Cannot do plumbing work around the house States he cannot return to work as a plumber States he cannot find other work Multiple (after injury) family matters arise
15	The Missing Information (What the ATP & Adjustor Did Not Know) Loathed working as a plumber and wanted out – “opportunistic injury” Burns were very mild and superficial There was no risk of serious injury Is abrasive and demanding on new job interviews Is discontent with all providers and all care Sees this as potential financial windfall
16	The Overall Psychology of Every Injured Worker
17	Valid Concerns Regarding Psych Will add to the cost of care Will add to the cost of settlement Will add to the PPD rating Is a manipulative ploy Will not be competently diagnosed Will not be competently treated Will address pre-existing/unrelated issues
18	Harsh Realities Delays are even more costly Appropriate care promotes earlier closure Primary physician may be clueless Denial = Depression, Anger, Retaliation More reliable form of self-protection
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20	Myths Patient will return to work because treating physician says he/she is able Pain is a quantifiable measure best tested by an MRI You can coerce a patient back to work by denying or suspending benefits and other acts Honest patients behave rationally Patients have more problems than doctors
21	Overtly vs. Covertly Psychological (what we have just learned) Overtly Psychological Claims of Mood or Anxiety Disorder Claims of Posttraumatic Stress Disorder Claims of Pain Disorder Covertly Psychological Anger & Resentment Suspicion & Distrust Entitlement & Deservedness Emotional Denial of Pre-existing Problems
22	Psychological Red Flags
23	Why Exams are Postponed Can of Worms Increase in Cost Delayed Resolution Afraid of Offending Insurer Physician Employer Lack of Clinical Sophistication The “duh?” factor Perceptual Bias Psychological problems are nonsense or weakness Psychological problems are expensive Psychological problems are tools of the devil
24	Your Hunches Are Not Data Injury is falsely reported Problems seem pre-existing New problems are unrelated to injury Patient is being untruthful Patient is case-building Patient is drug seeking Patient does not want to work Spouse is the problem Problems are more financial than physical The treating doctors are the problem
25	Ten Critical Data You Must Have The Patient’s Developmental History The Patient’s Educational History The Patient’s Criminal History The Patient’s Medical History (including addiction) The Patient’s Work History The Patient’s Recounting of the Accident The Patient’s Understanding of the Injury The Patient’s Perception of Care The Patient’s Needs and Goals The Patient’s Diagnostic Findings
26	To Return Them to Work
27	Tip 2: Psychological Exam is Needed in: Assault Cases Amputation cases Chronic Pain & Depression Surgical or Procedure Candidacy Suspected Medication Misuse Questionable Surgical Outcome Procedural Candidacy When Complaints Exceed Findings When There is a Criminal History When There is a Prior History of Injury Claims When Employment Prior to Injury Has Been Brief When There is a Catastrophic Claim
28	Swiss Army Knife As a means of determining pre-existing condition(s) As test of functional capacity As extended period of observation As a means of summarizing all medical records As a means of coordinating care between providers As a means of determining whether return to work will ever occur As a means of determining if closure can occur
29	Tip 4: Case Settlement Open Psychological Benefits (IME Needed) How long How frequent Alternatives to private care Pre-emptive Contact with Providers Psychological disability (IME Needed) Totally disabled Partially disabled Temporarily disabled
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