Good Business Sense: Part 2

Saturday, April 9, 2005 | 0

This is the second in a series of six by Pamela W. Foust. Earlier installments can be read by clicking on the article title in the side-bar at right.

"A system that's easy to game destroys human character."
- Charles Munger

Part Two - Doctors and Lawyers

The machine operator kept all of his therapy appointments and once a month he was re-examined by either the doctor or his assistant. They'd ask him questions and write the answers down on his chart and tell him to keep going to the therapy and keep taking the medications. He did everything the doctor and lawyer told him to do because they were smart, successful men, much smarter than he was. Yet, underneath it all, there was this vague feeling that he should be looking for work. He even mentioned it to both the nurse and the paralegal. The nurse said she always believed that patients should return to work after an injury as soon as they were able to do so. However, she felt it was only fair to tell him that if he discontinued the treatment too soon, he might get hurt again and his case would probably settle for less money. The paralegal told him that the attorney heartily disapproved of those less than ethical lawyers who told their clients to stay off work just to boost the value of their cases. However, she felt obligated to tell him, confidentially of course, that if he went back to work now, they probably wouldn't be able to get him a very good settlement.

He talked to the other claimants in the doctor's waiting room. Some of them knew people who had gotten $75,000 or $100,000 or even more. He learned that it wasn't necessarily a matter of how badly you were hurt. It all depended on how good your lawyer was and how many mistakes the insurance company made. They had all these complicated rules and if the insurance company made a mistake, the injured worker got more money and sometimes a lot more. If only he could settle his case for a lot of money, it would solve all of his problems. He could pay off his bills and maybe buy a house or even start his own business so he'd never have to take orders from a boss again. He had worked for an hourly wage all his life and even with overtime, there was never any money left over. He and his wife and kids would watch television and wonder what it would be like to be rich and have all the things those rich people took for granted. Now he had a chance to get ahead and he wasn't about to throw it away. Besides, after the way they treated him, he deserved it. He decided that the attorney and the doctor knew what they were doing and he must have a good case or they wouldn't be wasting their valuable time on him.

The machine operator knew that he had been given the opportunity of a lifetime, but he was having a hard time convincing his wife. She didn't understand why he couldn't settle his case now and go back to work. He had to admit he was kind of bored, sitting around watching television and picking up the kids from school. The attorney had warned him that the insurance company might have investigators with video cameras following him around, so he was afraid to go out of the house and do anything of a physical nature. The PTP was talking about sending him to another doctor for injections in his back, and he wasn't sure he wanted to do that, even though he was assured that there was no risk. The forced inactivity was making him increasingly nervous and irritable with his family. Fortunately, his State Disability payments weren't much less than what he had taken home when he was working, but they were going to run out in a couple of months and then they'd only have his wife's income. He picked up the phone, called the attorney and left a message that he wanted to discuss his case.

He was disappointed, but not surprised when it was the paralegal who called him back and not the attorney. She explained that the attorney couldn't do anything until the PTP discharged him from treatment and wrote a report describing his permanent disability. The settlement would have to be approved by a judge and no judge would give the necessary approval until the treating doctor wrote a permanent and stationary report. At the same time, the doctor wouldn't know how much permanent disability he was going to have until he finished his treatment. He called the doctor's office and spoke with the nurse. She told him that it was unethical for a doctor to discharge a patient from active care unless he had tried every available type of treatment and was sure that the patient had received the maximum benefit from that treatment. However, she suggested, why didn't he take it up with the doctor on his next visit? At the time of his next exam, the doctor wasn't in, but the physician's assistant who examined him promised to discuss his concerns with the doctor the next time they had a conference on his case. The machine operator expected someone to call him with the doctor's response to his inquiry, but never heard anything.

The PTP continued to recommend more treatment even after the State Disability benefits ran out. His wife got a second job waitressing on weekends and his two older children got part-time jobs after school. The funny feeling in his back developed into a dull ache that would come and go. The doctor gave him a little machine called a TENS unit that he used for a while. They also sent him to a specialist who administered three injections into his low back after giving him something that made him drowsy. Right after he had the injections, he felt pretty good, but the effects wore off after a while. He was evaluated by a psychiatrist who told him he was depressed and prescribed medication to help him relax during the day and sleep at night. The medication was beneficial because after he started taking it, it didn't bother him so much to just sit around and do nothing. He started meeting with a therapist at the psychiatrist's office once a week and they talked. He had never been a very social person, especially with strangers, and he soon ran out of things to talk about. The therapy sessions got shorter and shorter, but the paralegal told him he still needed to keep his appointments even if he just sat in the therapist's office in silence.

His car was repossessed because he couldn't make the payments and he started taking the bus to his therapy appointments because his wife needed their remaining car to get to work. After he explained the situation to the nurse, a van started coming out to his house to pick him up. This was a help, but he wondered when it would all be over and he'd get his settlement at last. Whenever he brought up the subject with the paralegal, she was sympathetic but told him he'd have to be patient. If the attorney tried to settle his case at this point, she explained, he would be seriously shortchanged because it was a typical insurance company tactic to starve people out and get them to settle for less than what their case was worth. The attorney was confident that he'd get a good settlement if he would wait just a little while longer. Once the PTP discharged him from treatment and issued his final report, they'd be ready to go to court.

The machine operator didn't know who or what to believe. Some of his friends told him it shouldn't be taking that long and maybe he should look for another lawyer. He actually did talk to two other lawyers, but they both told him to stick with his present attorney whom they knew personally and who was doing a good job for him. The second attorney said something about a problem with two attorneys sharing one fee. He had seen a lot of doctors and had gone for a lot of tests. The nurse told him the transportation service was charging the insurance company $75 for each trip to take him to therapy and back home again. The insurance company was also being billed for the interpreters that were present at all of his therapy sessions so that he could communicate in his native language. All of this must be costing a lot of money and as far as he knew, the insurance company had yet to pay a penny. Surely all these doctors and testing facilities and transportation companies and interpreters wouldn't let the bills pile up like that if they weren't certain that he'd win his case. And what about the time the attorney and the paralegal had put in? No, the only logical answer was that he had a good case and in the end, he'd get a settlement that would make all the waiting and the sacrificing worthwhile.

The machine operator sat on the table in the examining room and waited for the physician's assistant to come in and examine him. He was trying to remember the last time he had actually seen the PTP when the door opened and in walked the doctor himself. The PTP told him that it was finally time to discharge him from active care although he would always be welcome to return for more treatment, as needed. Right now, he wanted to ask him some questions so that he could write his final report that would be used to settle his case. The doctor started asking him questions about his pain and where the pain was located and how severe it was and how frequently he felt it. He hesitated because he wasn't exactly feeling pain anywhere at that precise moment but he knew he couldn't say that or the insurance company would use it against him. Wherever the doctor touched him, he said that it hurt and that the pain was pretty bad and that the pain was there almost all the time. When the PTP asked him to bend over and touch his toes, he held back because if he actually touched his toes, you could bet the insurance company would make a big deal out of it in order to cut down on his settlement. If he didn't look out for his own interests, who would?

After he left the examining room, the PTP went straight to his office and started dictating. He knew the machine operator had to be grossly exaggerating, but he didn't tell him to do it and it wasn't his job to decide whether or not his patients were accurately describing their symptoms. He'd let the insurance company and the judge worry about that. He always took what the patients told him at face value and estimated their permanent disability on that basis. This patient's symptoms would warrant some rather stringent restrictions on his activities that would equate to a high level of permanent disability and a substantial monetary award. The attorney would be pleased with his work and would refer more patients. But it wasn't just a matter of money. If all he cared about was money, he'd be working for insurance companies. What really made him feel good was helping some poor working man fight the moneyed establishment that had taken advantage of him. That's why he was more than happy to help the machine operator get what was coming to him.

Next in the series: Referral to Defense Counsel



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