Medical Legal Consulting
Kevin Trangle & Associates’ Medical Legal Consulting program, commonly know as a “Second Opinion” program, is a service provided to attorneys, insurance companies, third party administrators, pension fun adjudicators, risk managers and any other person or agency in need of an objective medical review from seasoned practitioners and specialists.
With a national network of experts, KTA provides an in-depth evaluation, comprehensive report and, when appropriate, an Independent Medical Examination.
Our services are based on objective data and under contract include:
- Conduct an extensive medical records review
- Conduct a thorough medical bill audit and UCR 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
These services will cover non-work-related and non-health-plan-related issues such as fitness-for-duty, return-to-work, short-term disability approval, long-term disability absence, ADA issues, FMLA issues and additional duty issues. Tort litigation support including depositions and trial testimony can be arranged.
Medical Records Review
A medical records review or a medical record audit is performed in most medical legal consulting engagements at Kevin Trangle & Associates. When a medical case exists, the medical records review conducted by KTA can help assist individuals, attorneys and insurance professionals in determining the validity of a claim, the seriousness of an injury, the scope of treatment and other numerous objectives.
The medical records review may cover such issues as Workers’ Compensation, motor vehicle accidents, personal injury claims, managed care policies and procedures, vocational assessment, functional capacity assessments, neuropsychometric testing, case management consultation, and environmental and toxicology issues, as well as evaluation for pension and disability purposes.
Any need to assess when an individual has the ability to work, or could stay at work and ergonomically perform a job, may also fall within the scope of a medical record review.
KTA has been praised in multiple client testimonials for offering highly detailed independent medical evaluations of medical records which typically include not only the medical history and assessment of existing medical records but also extensive research in medical journals and other relevant publications when necessary. Unlike those of other IME and medical record review providers, reports from KTA are backed by deposition and trial testimony when requested.
Medical Expert Witness & Testimony
Medical Expertise from several different disciplines is often necessary when analyzing a case. Kevin Trangle & Associates has both internal and external medical expert resources. On a case-by-case basis, when medical experts are needed, there are a variety of medical specialists available who are willing to testify.
Choosing a medical expert witness can be a tiresome – but very important – process. Using an experienced medical expert witness who provides thorough and credible evaluations is only the first step. How the expert witness presents themselves to the public in a deposition, to a judge and to a jury are also considerations.
Independent Medical Examination
Independent Medical Examinations are conducted when an individual has been injured and needs an objective, third-party medical exam to confirm the extent of their injuries. Kevin Trangle & Associates offer highly detailed assessments, a thorough review of the literature and continuing professional support to case managers and attorneys. Below is an abridged list of services relating to our Independent Medical Examinations (IME) that have been beneficial in providing individuals, corporations, case managers or attorneys with a more thorough medical examination.
Workers' Compensation:
- Extent of Impairment
- Maximum Medical Improvement
- Determination of Treatment Status
- Permanent Partial Impairment (AMA Guides to the Evaluation of Permanent Impairment, 4th, 5th, 6th Editions)
- Permanent Total Impairment
- Claims Allowance Issues
- Industrial Commission Examinations
Motor Vehicle Accident:
- Extent of Impairment and Injuries
- Appropriateness of Treatment
- Future Employability and Work Status
Managed Care Organizations:
- Dispute Resolution
- Extent of Impairment
- Return to Work
- Claim Allowance
Vocational Assessment:
- Return-to-Work Likelihood
- Employability Level
Complex Disability Assessments
Kevin Trangle & Associates 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 assessments related to:
· Workers' Compensation
· Non-work-related cases
· Future employability
· Future income assessment
· Extent of treatment
In addition to the above, KTA can provide a Life Care Plan that is often needed for Complex Disability Cases related to catastrophic injury and chronic healthcare needs.
Medical Environmental Exposure
Kevin Trangle & Associates has decades of medical experience in researching and reviewing a wide variety of environmental exposure cases involving issues with indoor air quality, volatile organic compounds, heavy metals, pesticides, PCBs and other exposures.
KTA has a deep understanding of chemical and environmental health implications and has made Environmental Exposure cases an area of specialty. Experts at KTA are well suited to offer opinions and health commissions to non-work-related exposures that require litigation.
Some of the more common practice areas include:
- Chemical exposure
- Multiple chemical sensitivity
- Organic-chemical-induced disease
- Solvent-induced toxicity
- Indoor air quality
- Occupational respiratory illness including Reactive Airway Disease and Occupational Asthma
KTA can provide consultation and medical evaluation of various elements for potential exposures to chemical or physical agents. Medical evaluations can include a medical and work history with special emphasis on symptoms related to the handling of hazardous substances and health hazards, and to fitness for duty.
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, 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:
- Assessment through a comprehensive review of medical records;
- 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;
- Data analysis to determine expected outcomes and to develop a plan that prescribes strategies and alternatives to attain expected outcomes;
- Collaboration as necessary with other healthcare providers and physicians which may also include physical and occupational assessment, vocational assessment and functional capacity evaluation;
- 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."
Components of a Life Care Plan
What is Life Care Plan?
Life Care Plan is a holistic interdisciplinary team approach of specialists, which produces a document that projects future costs of medical goods and services, modality support, medications and other necessary services for a catastrophically injured or ill patient. The experts involved may...
Medical Cost Analysis
Including UCR
Medical experts play an important role in the process of medical billing 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 audit and 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 audit and 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.
