The case of Wachiuri versus Torrance Memorial Center deals with a specific issue in case law. The issue centers on the communication to a qualified medical examiner (QME) or a panel of QMEs. Essentially, in an injury case, this governs the communication to a neutral doctor.
These are called advocacy letters. They’re written to the neutral doctor by the defense attorney, insurance company, and also by the attorney for the injured party.
In the case of an injury, the client sees a treating physician. If one of the parties objects to this physician, a neutral doctor would be called upon to examine the patient. The QME or neutral doctor should simply be called upon to examine the patient with regard to the injury.
Typically, the defense attorney and/or the insurance company will send an advocacy letter. Prior to the case law we’re referring to in this blog, that advocacy letter might clearly delineate why they believe that the client should be denied compensation for the injury. These claims denials really have nothing to do with the injury itself, and that’s the only thing that the physician should be concerned with.
Advocacy letters might state that the patient claimed injury after termination or that there is no liability of the defendant in the injury. In truth, these letters do just what they claim, they advocate for their client. However, advocating AGAINST the patient to their physician can cause bias.
Your injury lawyer should also draft an advocacy letter that clearly shows that the non-medical issues surrounding the injury should be left to the judge. These advocacy letters should state that any issues pertaining to the denial of the case are not relevant to the medical opinion of the injury and could unduly influence the physician’s opinion, which can detrimentally impact an injured worker.
It’s not legal for any attorney to send advocacy letters that are written to sway bias from a neutral physician. They’re neutral for a reason. The defendant cannot layout factual issues of why they deny a claim because it’s not proper for the medical physician to know while determining their prognosis and compiling solid medical evidence that is needed for the case.
It is proper for the attorneys to indicate that they have not accepted a claim is a lack of medical evidence. However, the QME does not need to be made aware of legal arguments for and against a legal claim surrounding the injury if it may prejudice their findings.
This case law was written in favor of the injured workers because it stops larger companies, employers, and insurance agencies from using advocacy letters to sway neutral doctors against their best interest.
Advocacy letters need to be straight and factual. They should contain the name of the client, employment length, and type of injury. The physician is there only to provide a professional opinion on the injury itself. Advocacy letters cannot delineate factual disputes and should never attach information on denials that might sway or bias the physician.
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