When reviewing subpoenaed records in cases with psych and/or internal allegations, there are a few key topics that defense attorneys and adjusters can use to defend their claims.

John P. Kamin

Paying attention to specific categories of information — such as medications, diagnostic readings and diet — can help rebut narratives that opposing parties are speculatively spinning.

While reviewing records, keep an eye on the following bullet points and ask yourself these questions:

• Prescriptions. When did they start? What was the original diagnosis that the prescription was intended to treat? Did the type of prescription change over time? How has the dosage changed over time?
• Medication compliance. In both psych and internal cases, medication noncompliance can have severe consequences. For example, in a psych case, if a bipolar person goes off his meds, that could lead to hospitalization or even a suicide attempt. For diabetics, medication noncompliance can lead to skyrocketing blood sugar levels. For those with hypertension, medication noncompliance can lead to dangerous blood pressure levels that can cause cardiac events.
• Blood pressure. Mapping blood pressure changes over time can play a role if hypertension is at issue in your case. Logging blood pressure readings over the years sometimes leads to the conclusion that a person’s blood pressure is under control. When logging these, try to figure out if the person is on the medications at the time the reading was taken.
• Diet. What did the personal doctors say about the person and dietary restrictions? For instance, my late diabetic grandmother was always complaining about her dietary restrictions, and she would try to cheat with the occasional piece of cheesecake. (I can’t blame her, cheesecake is amazing.) While reviewing records on one claim, I found a report from a diabetic coach stating that the applicant just gave up and stopped taking all medications and ate fast food for years. Why would someone do that? Depression. With that in mind, there’s a reason why my cardiologist jokingly recommends the “un-American diet.” In other words, skip the meat-centered diet, avoid carbs and stay away from sodium. No amount of exercise can replace a healthy diet.
• Did the applicant miss work for non-industrial events? If terminated, does the missed work match up with the timeline for the termination?
• Labs. Often, reviewing labs taken during major health events can provide useful information. For example, lipid panels and blood sugar tests can tell you about the applicant’s diet and whether he is medication-compliant. If a diabetic person’s blood sugar is at 600, then perhaps she isn't taking her metformin and insulin as prescribed.
• References to other doctors. Sometimes, applicants will see their primary doctor for treatment for most of their health conditions but prefer seeing a different doctor for one specialty. If you are defending a case like this, you want to get the records from those additional doctors.
• Weight. Is this a bed weight, where the applicant is being weighed by the hospital bed? Or is this a weight taken by a nurse in an office while the applicant is wearing jeans, shirt, belt, watch, shoes, socks, hat, cellphone and wallet/purse? If it’s the latter, that can lead to a 10-pound difference. How do the weights vary over time?

Paying attention to these topics while reviewing subpoenaed records will help inform you about the questions to ask at depositions.

For example, if an applicant’s blood pressure is always higher when he sees Dr. Nick Riviera from "The Simpsons," then one could ask:

• What time of day are the appointments with Dr. Nick?
• Does the applicant enjoy meals and coffee before seeing Dr. Nick?
• Where is Dr. Nick’s staff taking the blood pressure readings? Are they taking the readings after marching the applicant down a long hallway and asking 20 questions?
• Did they have to sit through rush-hour traffic on the way to Dr. Nick’s appointments?

Conclusion

The next time you are reviewing subpoenaed records in a psych or internal case, pay attention to diagnostics, medications, dietary restrictions and labs. It’s far more likely to lead to the discovery of useful information.

John P. Kamin is a workers’ compensation defense attorney and partner at Bradford & Barthel’s Woodland Hills location. He is WorkCompCentral's former legal editor. This entry from Bradford & Barthel's blog appears with permission.