COMPLEX DISABILITY

Complex Disability

life care planning and disability assessment

Complex Disability Cases can involve issues pertaining to the ability to work as well as to function in terms of daily living, transportation and mobility. To resolve a case, or better define the underlying issues in a case, Kevin Trangle & Associates approaches Complex Disability cases with a variety of experts and specialties.

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KTA has particular expertise in the area of Complex Disability Cases. We understand the ramifications of Complex Disability cases and are well suited to be your partner in determining economic and health implications for patients. Our firm is qualified to develop economic and medical disability evaluation related to:

  • Life Care Planning
  • Workers’ Compensation
  • Non-work-related cases
  • Future employability
  • Extent of impairment & future treatment

Devices and Implant Analysis

expert medical device consulting

Kevin Trangle & Associates can provide medical legal experts with extensive knowledge involving litigation and insurance policy determinations concerning medical devices and implants, such as:

  • Orthopedic implants
  • Medical testing
  • Therapeutic drugs

Diagnostics are becoming more important as people are living longer: they are generally surviving diseases, and much better treatment options are available for previously fatal conditions. KTA has extensive experience as a medical device expert witness - providing consultation, reporting and testimony for cases involving medical devices and implants.

Life Care Planning

life care planning

What is a Life Care Plan?

A Life Care Plan document provides an organized, concise plan of estimated reasonable and necessary (and reasonably certain to be necessary) current and future healthcare needs with the associated costs and frequencies of medications, goods and services and is developed for individuals who have experienced a catastrophic injury or have chronic healthcare issues. It can also be useful for divorce proceedings and contested will cases. The Life Care Plan determines interventions to detect, prevent and manage health problems and risk factors and promotes optimum function, independence and sense of well-being to achieve expected outcomes safely and efficiently. The Life Care Plan is considered a flexible document and is evaluated and updated as needed.

Life Care Planners function within their individual professional scope of practice and, when applicable, incorporate opinions arrived at collaboratively with various healthcare providers including but not limited to healthcare workers (such as a legal nurse consultant), doctors, prosthetists and durable medical equipment providers. Each professional providing input to the plan operates within the specific standards of their practice and discipline to ensure that there is direction, accountability and acceptance with community and professional ethics.

The Purpose of a Life Care Plan

The Life Care Plan of the client is utilized for the person who is the subject of the Life Care Plan.  The purpose is to assist in treatment while developing an appropriate plan of prevention, and to achieve restoration of health by determining interventions to detect, prevent and manage health problems and risk factors. The Life Care Plan promotes optimum function, independence and a sense of well-being to achieve expected outcomes safely and efficiently.

The Life Care Plan should develop accurate, timely cost information, specificity and service details that can be utilized by the client and involved parties.  This will help determine the actual course of events, projected costs and amounts of money that will need to be set aside to care for this individual.

A thorough long-term Life Care Plan includes several aspects. The process includes:

  1. Assessment through a comprehensive review of medical records;
  2. Utilization of clinical judgment, knowledge and research about an individual, family or community response to actual or potential health problems and life processes, providing the basis for selection of interventions to achieve outcomes;
  3. Data analysis to determine expected outcomes and to develop a plan that prescribes strategies and alternatives to attain expected outcomes;
  4. Collaboration as necessary with other healthcare providers and physicians, which may also include physical and occupational assessment, vocational assessment and functional capacity evaluation;
  5. Projected costs of projected future prescribed strategies and alternatives of different services and needs.

Common Injuries that Require a Life Care Plan

For a detailed list of common injuries or chronic healthcare needs that require a Life Care Plan – see our resources page for “When to use a Life Care Plan."

Medical Cost Analysis
Including UCR

medical cost projection and vocational assessments

Medical experts play an important role in the process of a medical bill review for litigation purposes. A bill payment needs to be reviewed by a medical expert in order to be deemed reasonable in a customary fulfillment for that payment. Payable bills that are related to an accident or cause of event, require charges that are necessary, reasonable and accurate. From a financial perspective, the charges need to be identified as usual and customary. There are two parts to a medical bill review: the clinical aspect and the financial review.

The Clinical Aspect:

When conducting a medical audit and bill review, medical experts look at medical records, sometimes examine individuals, determine what diagnoses are related to the particular injury or exposure, look at the treatment the individual received and compare that to how much treatment is reasonable based upon medical opinion. The questions that medical experts are seeking to answer include:

  • Are the particular diagnoses being treated, and is it related to the injury or exposure?
  • How much treatment is reasonable, and how long should it continue?
  • What is the connection between treatment, injury and exposure?

The Financial Review:

The financial review that takes place during a medical bill review involves two separate aspects: looking at what is usual, customary and reasonable charges (UCR) and looking at auditing errors and financial review.

1. UCR Analysis:

The US government healthcare website defines UCR as “the amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service.” By looking at geographic region, specialty, diagnoses, the prevailing and accepted charges and what is actually being done in terms of payment, medical experts are able to determine a UCR during the medical audit and bill review. There are many published standards, reference guides and physician reference guides to help with this process.

2. Auditing Errors and Financial Review:

Auditing errors typically occur in 80-85% of cases. Common errors include double billing for a service, inaccurate billing or giving the wrong quote and unbundling/making multiple charges, duplicate charges, etc. In order to complete a financial analysis of the bill, medical experts look at inpatient and outpatient hospital procedures, information forms, explanation of benefits (EOB) and more.

Learn more about Life Care Planning

Permanent/Total Disability Assessment

disability assessments and medical record reviews

A permanent impairment is defined as one that has reached maximum medical improvement (MMI) and is well stabilized and unlikely to change substantially in the next year with or without medical treatment. Definitions may vary from state to state but are generally consistent with the definition expressed in literature provided by the American Medical Association (AMA).

Kevin Trangle & Associates can be contracted to evaluate medical records, a patient and documentation for a particular case regarding extent of disability & permanency determination. Our disability assessment services for extent of disability & permanency determination are based on objective data and under contract can include:

  • Conduct an extensive medical records review
  • Conduct a thorough medical bill audit and usual, customary and reasonable (UCR) charge analysis
  • Evaluate the patient in person, if necessary
  • Analyze applicable information including test results, imaging studies, etc.
  • Review any relevant literature pertaining to the diagnosis and condition of the individual
  • Provide a deposition, where warranted
  • Provide expert testimony, if necessary
  • Develop a comprehensive written report outlining the projected course of medical treatment and its associated costs

Fitness for Duty Evaluation

fitness for duty evaluation

From pre-placement to injury/illness and return to work, fitness for duty evaluates a patient’s ability to physically or psychologically perform required job tasks. Sometimes, fitness-for-duty evaluations are required when an employee is ready to return to work after taking time off for a serious illness or injury. For example, an employee with a serious back injury might have to take a fitness-for-duty exam before coming back to work, to make sure the employee is capable of meeting the physical requirements of the job. Kevin Trangle & Associates can be contracted to evaluate medical records, a patient and documentation for a particular case.

Our services are based on objective data and under contract include:

  • Conduct a directed medical records review
  • Evaluate the patient in person, if necessary
  • Analyze applicable information including test results, imaging studies, etc.
  • Review any relevant literature pertaining to the diagnosis and condition of the individual
  • Develop a comprehensive written report outlining the projected course of medical treatment and its associated costs and/or a medical certification of fitness for duty including any limitations or restrictions

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