BEING A CAT ON A HOT TIN BEING A CAT ON A HOT TIN ROOF: A LAWYERS ROOF: A LAWYERS

PERSPECTIVEPERSPECTIVE

ROBERT HOOPERROBERT HOOPER

HOOPER LAW OFFICESHOOPER LAW OFFICES

PLAINTIFF’S PERSPECTIVEPLAINTIFF’S PERSPECTIVE

• KNOW THE LEGISLATIONKNOW THE LEGISLATION

• PICK YOUR TEAMPICK YOUR TEAM

• COOPERATE WITH INSURERCOOPERATE WITH INSURER

• KNOW YOUR CLIENTKNOW YOUR CLIENT

• COMMUNICATE WITH ALL PARTIESCOMMUNICATE WITH ALL PARTIES

THE LAWTHE LAW

• PRE 2003PRE 2003

• POST 2003POST 2003

PRE 2003PRE 2003

CATASTROPHIC IMPAIRMENT CAUSED BY AN ACCIDENT THAT CATASTROPHIC IMPAIRMENT CAUSED BY AN ACCIDENT THAT OCCURS BEFORE OCTOBER 1, 2003 IS,OCCURS BEFORE OCTOBER 1, 2003 IS,

(E) BRAIN IMPAIRMENT THAT, IN RESPECT OF AN ACCIDENT (E) BRAIN IMPAIRMENT THAT, IN RESPECT OF AN ACCIDENT RESULTS IN,RESULTS IN,

(i)(i) A SCORE OF 9 OR LESS ON THE GLASGOW COMA SCALE…A SCORE OF 9 OR LESS ON THE GLASGOW COMA SCALE…ACCORDING TO A TEST ADMINISTERED WITHIN A ACCORDING TO A TEST ADMINISTERED WITHIN A REASONABLE PERIOD OF TIME AFTER THE ACCIDENT BY A REASONABLE PERIOD OF TIME AFTER THE ACCIDENT BY A PERSON TRAINED FOR THAT PURPOSEPERSON TRAINED FOR THAT PURPOSE

(ii)(ii) A SCORE OF 2(VEGETATIVE) OR 3 (SEVERE DISABILITY) A SCORE OF 2(VEGETATIVE) OR 3 (SEVERE DISABILITY) ON THE GLASGOW COMA SCALE…ACCORDING TO A TEST ON THE GLASGOW COMA SCALE…ACCORDING TO A TEST ADMINISTERED MORE THAN SIX MONTHS AFTER THE ADMINISTERED MORE THAN SIX MONTHS AFTER THE ACCIDENT BY A PERSON TRAINED FOR THAT PURPOSE;ACCIDENT BY A PERSON TRAINED FOR THAT PURPOSE;

PRE 2003PRE 2003

• (F) SUBJECT TO SECTIONS (2) AND (F) SUBJECT TO SECTIONS (2) AND (3), AN IMPAIRMENT OR (3), AN IMPAIRMENT OR COMBINATION OF IMPAIRMENTS COMBINATION OF IMPAIRMENTS THAT, IN ACCORDANCE WITH THE THAT, IN ACCORDANCE WITH THE AMA GUIDELINES 4AMA GUIDELINES 4THTH EDITION EDITION RESULTS IN 55 PER CENT OR MORE RESULTS IN 55 PER CENT OR MORE IMPAIRMENT OF THE WHOLE PERSON IMPAIRMENT OF THE WHOLE PERSON ; OR; OR

PRE 2003PRE 2003

• (G) SUBJECT TO SUBSECTIONS (2) (G) SUBJECT TO SUBSECTIONS (2) AND (3) AN IMPAIRMENT THAT, IN AND (3) AN IMPAIRMENT THAT, IN ACCORDANCE WITH THE AMA ACCORDANCE WITH THE AMA GUIDELINES 4GUIDELINES 4THTH EDITION RESULTS IN EDITION RESULTS IN A CLASS 4 IMPAIRMENT ( MARKED A CLASS 4 IMPAIRMENT ( MARKED IMPAIRMENT) OR CLASS 5 (EXTREME IMPAIRMENT) OR CLASS 5 (EXTREME IMPAIRMENT) DUE TO MENTAL OR IMPAIRMENT) DUE TO MENTAL OR BEHAVIOURAL DISORDER.BEHAVIOURAL DISORDER.

POST 2003POST 2003

• TOTAL AND PERMANENT LOSS OR USE OF BOTH TOTAL AND PERMANENT LOSS OR USE OF BOTH LEGSLEGS

• CHILDREN UNDER 16 MAY BE DEEMED TO BE CHILDREN UNDER 16 MAY BE DEEMED TO BE CATASTROPHICALLY IMPAIRED IF THEIR TREATING CATASTROPHICALLY IMPAIRED IF THEIR TREATING DOCTOR CONFIRMS THAT THE CHILD HAS DOCTOR CONFIRMS THAT THE CHILD HAS SUFFERED AN IMPAIRMENT IN AN ACCIDENT THAT SUFFERED AN IMPAIRMENT IN AN ACCIDENT THAT IS REASONABLY BELIEVED TO BE CATASTROPHIC IS REASONABLY BELIEVED TO BE CATASTROPHIC AFTER TAKEN INTO ACCOUNT THE AFTER TAKEN INTO ACCOUNT THE DEVELOPMENTAL IMPLICATIONS OF THE DEVELOPMENTAL IMPLICATIONS OF THE IMPAIRMENTIMPAIRMENT

• THE 55% TOTAL BODY IMPAIRMENT TIME LINE HAS THE 55% TOTAL BODY IMPAIRMENT TIME LINE HAS BEEN REDUCED TO 2 YEARS FROM 3 YEARSBEEN REDUCED TO 2 YEARS FROM 3 YEARS

• TOTAL AND PERMANENT LOSS OF USE OR ONE OR TOTAL AND PERMANENT LOSS OF USE OR ONE OR BOTH ARMS AND ONE OR BOTH LEGSBOTH ARMS AND ONE OR BOTH LEGS

AMA GUIDELINESAMA GUIDELINES

• IN THIS GUIDE IMPAIRMENTS ARE DEFINED AS IN THIS GUIDE IMPAIRMENTS ARE DEFINED AS CONDITIONS THAT INTERFERE WITH AN CONDITIONS THAT INTERFERE WITH AN INDIVIDUALS ACTIVITIES OF DAILY LIVINGINDIVIDUALS ACTIVITIES OF DAILY LIVING

• ADL’S INCLUDE BUT ARE NOT LIMITED TO SELF ADL’S INCLUDE BUT ARE NOT LIMITED TO SELF CARE AND PERSONAL HYGIENE, EATING AND CARE AND PERSONAL HYGIENE, EATING AND PREPARING FOOD, COMMUNICATION, SPEAKING, PREPARING FOOD, COMMUNICATION, SPEAKING, WRITING, MAINTAING ONES POSTURE, STANDING WRITING, MAINTAING ONES POSTURE, STANDING AND SITTING, CARING FOR THE HOME AND AND SITTING, CARING FOR THE HOME AND PERSONAL FINANCES, WALKING, TRAVELING, AND PERSONAL FINANCES, WALKING, TRAVELING, AND MOVING ABOUT, RECREATIONAL AND SOCIAL MOVING ABOUT, RECREATIONAL AND SOCIAL ACTIVITIES, AND WORK ACTIVITIESACTIVITIES, AND WORK ACTIVITIES

AMA GUIDELINESAMA GUIDELINES

• CHAPTER 14 MENTAL AND CHAPTER 14 MENTAL AND BEHAVIOURAL DISORDERSBEHAVIOURAL DISORDERS

• ACTIVITIES OF DAILY LIVINGACTIVITIES OF DAILY LIVING• SOCIAL FUNCTIONINGSOCIAL FUNCTIONING• CONCENTRATION, PERSISTANCE AND CONCENTRATION, PERSISTANCE AND

PACEPACE• DETERIORATION OR DECOMPOSITION DETERIORATION OR DECOMPOSITION

IN WORK OR WORKLIKE SETTINGSIN WORK OR WORKLIKE SETTINGS

AMA GUIDELINESAMA GUIDELINES

• CLASS 4 MARKED IMPAIRMENT CLASS 4 MARKED IMPAIRMENT =IMPAIRMENT LEVELS =IMPAIRMENT LEVELS SIGNIFICANTLY IMPEDE USEFUL SIGNIFICANTLY IMPEDE USEFUL FUNCTIONINGFUNCTIONING

• CLASS 5 EXTREME IMPAIRMENT= CLASS 5 EXTREME IMPAIRMENT= IMPAIRMENT LEVELS PRECLUDE IMPAIRMENT LEVELS PRECLUDE USEFUL FUNCTIONINGUSEFUL FUNCTIONING

GSC OF 9 OR LESSGSC OF 9 OR LESS

• BEST EYE RESPONSE (4)BEST EYE RESPONSE (4)• BEST VERBAL RESPONSE (5)BEST VERBAL RESPONSE (5)• BEST MOTOR RESPONSE (6)BEST MOTOR RESPONSE (6)• A COMA SCALE OF 13 OR HIGHER A COMA SCALE OF 13 OR HIGHER

CORRELATES WITH A MILD BRAIN CORRELATES WITH A MILD BRAIN INJURYINJURY

• 9 TO 12 IS A MODERATE INJURY9 TO 12 IS A MODERATE INJURY• 8 OR LESS IS A SEVERE BRIAN INJURY8 OR LESS IS A SEVERE BRIAN INJURY

GCS CASESGCS CASES

• HOLLAND V. PILOTHOLLAND V. PILOT

• 15 YEAR OLD STRUCK BY A CAR15 YEAR OLD STRUCK BY A CAR

• AT SCENE 7AT SCENE 7

• HOSPITAL 7 AND 8HOSPITAL 7 AND 8

• BLOOD ALCHOL LEVEL ABOVE LEGAL BLOOD ALCHOL LEVEL ABOVE LEGAL LIMITLIMIT

• SMOKED DOPESMOKED DOPE

HOLLANDHOLLAND

• DEBATE ABOUT ALCHOL AND DRUGS DEBATE ABOUT ALCHOL AND DRUGS ON GCSON GCS

• KEENAN, J. CONCLUDES HOLLAND IS KEENAN, J. CONCLUDES HOLLAND IS CATCAT

YOUNGYOUNG

• MVA YOUNG TRAPPED IN VEHICLEMVA YOUNG TRAPPED IN VEHICLE

• READINGS @ SCENE 3,4,3READINGS @ SCENE 3,4,3

• READING @ HOSPITAL POST SEIZURE 3READING @ HOSPITAL POST SEIZURE 3

• DEBATE ABOUT VALIDITY OF TESTSDEBATE ABOUT VALIDITY OF TESTS

• DEBATE ABOUT TIMING OF TESTSDEBATE ABOUT TIMING OF TESTS

• HAVE AN ACCIDENT WITH A HEALTH HAVE AN ACCIDENT WITH A HEALTH CARE PROFESSIONALCARE PROFESSIONAL

YOUNGYOUNG

• ARB DECISION UPHELDARB DECISION UPHELD

• YOUNG DEEMED CATYOUNG DEEMED CAT

TOURNAYTOURNAY

• DAUGHTER SAYS MOMS DEAD @ DAUGHTER SAYS MOMS DEAD @ SCENESCENE

• NO READINGS TILL HOSPITALNO READINGS TILL HOSPITAL

• READINGS DONE AFTER B/P DROPREADINGS DONE AFTER B/P DROP

• READINGS AFTER INTUBATIONREADINGS AFTER INTUBATION

• READINGS AFTER PARALYTIC DRUGS READINGS AFTER PARALYTIC DRUGS GIVENGIVEN

TOURNAYTOURNAY

• REVIEW OF WHAT IS VALID SCOREREVIEW OF WHAT IS VALID SCORE

• TOURNAY WAS CATTOURNAY WAS CAT

F = 55%F = 55%

• YOUR INVOLVEMENTYOUR INVOLVEMENT

• OBSERVATIONSOBSERVATIONS

• REPORTSREPORTS

• TREATMENTTREATMENT

• ASSESSMENTSASSESSMENTS

• HELPFUL TO THOSE NOT ON THE HELPFUL TO THOSE NOT ON THE GROUND FLOORGROUND FLOOR

G=MARKED OR EXTREMEG=MARKED OR EXTREME

• ADLSADLS

• SOCIAL FUNCTIONINGSOCIAL FUNCTIONING

• CONCENTRATIONCONCENTRATION

• WORK OR WORK LIKE SETTINGWORK OR WORK LIKE SETTING

YOUR INVOLVEMENTYOUR INVOLVEMENT

• BEST KNOWLEDGEBEST KNOWLEDGE

• REGULAR REPORTINGREGULAR REPORTING

• GOOD NOTE TAKING ON THE AREAS GOOD NOTE TAKING ON THE AREAS ABOVEABOVE

• REGULAR RE-ASSESSMENTREGULAR RE-ASSESSMENT

• ATTENDANT CAREATTENDANT CARE

• WORK VOCATIONWORK VOCATION

WHYWHY

• MEDICAL/ REHABILITATIONMEDICAL/ REHABILITATION

• $100,000 OR 10 YEARS$100,000 OR 10 YEARS

• $1,000,000 OR LIFETIME$1,000,000 OR LIFETIME

WHYWHY

• ATTENDANT CAREATTENDANT CARE

• $3,000/ MONTH $72,000 MAX 2 $3,000/ MONTH $72,000 MAX 2 YEARSYEARS

• $6,000/ MONTH $1,000,000 LIFETIME$6,000/ MONTH $1,000,000 LIFETIME

WHYWHY

• HOUSEKEEPING AND HOME HOUSEKEEPING AND HOME MAINTENANCEMAINTENANCE

• $100/WEEK 2 YEARS$100/WEEK 2 YEARS

• $100/WEEK LIFETIME$100/WEEK LIFETIME

WHYWHY

• CASE MANAGEMENTCASE MANAGEMENT

• NOT AVAILABLENOT AVAILABLE

• AVAILABLE AND IS INSURED’S AVAILABLE AND IS INSURED’S CHOICECHOICE

HELPFUL HINTSHELPFUL HINTS

• REPORTSREPORTS• DOPE ON NIGHT STAND VS. INFO ON ADL’S AND OTHER AREAS FROM AMA DOPE ON NIGHT STAND VS. INFO ON ADL’S AND OTHER AREAS FROM AMA

GUIDELINESGUIDELINES• YOU ARE ONE OF THE ONLY COMMUNITY OBSERVERSYOU ARE ONE OF THE ONLY COMMUNITY OBSERVERS• ASSIST THE FAMILY DOCTORASSIST THE FAMILY DOCTOR• ASSIST THE TEAMASSIST THE TEAM• REASSESS REGULARLYREASSESS REGULARLY• KEEP YOUR PROFESSIONALISMKEEP YOUR PROFESSIONALISM• BE ETHICALBE ETHICAL• REPORT IN YOUR FIELD ONLYREPORT IN YOUR FIELD ONLY• ATTEND TEAM MEETINGSATTEND TEAM MEETINGS• REVIEW RECORDS FOR GCS ISSUESREVIEW RECORDS FOR GCS ISSUES• REMEMBER AMA GUIDELINESREMEMBER AMA GUIDELINES• REMEMBER CASE LAW ABOUT MARKED IMPAIRMENT DESBRIENS AND WORK REMEMBER CASE LAW ABOUT MARKED IMPAIRMENT DESBRIENS AND WORK

EXAMPLEEXAMPLE• COOPERATE ON TIMELINESCOOPERATE ON TIMELINES• KNOW TIMELINES AND ADHEREKNOW TIMELINES AND ADHERE• DO NOT PRESUME ALL LAWYERS DO THIS EVERYDAYDO NOT PRESUME ALL LAWYERS DO THIS EVERYDAY• GETTING TO CAT A GROUP EFFORT, LAWYER, CLIENT, REHAB PEOPLEGETTING TO CAT A GROUP EFFORT, LAWYER, CLIENT, REHAB PEOPLE