For more than 15 years Mitchell S. Nudelman, MD, JD, FCLM and the Medical Director Solutions, LLC expert panel have been performing a wide scope of peer review services, involving many thousands of cases. Offering professional review at “arms-length”, MDS provides the same independent, credible and reliable medical determinations, whatever medical issue involved and most importantly, whoever is doing the asking. Our areas of expertise include but are not limited to workers compensation, general liability including motor vehicle and trucking industry accidents, disability and ERISA Health Plan determinations. We even can provide your company management outside oversight with a “second opinion” when there is a very important case at stake.
On a case-by-case basis, we accept files and assist attorneys regardless of the party they represent, whether plaintiff or defense. In addition to attorneys, or those who may not have legal representation, we offer these medical review services directly to Employers, Risk Managers, Adjustors, Third Party Administrators, Brokers, Reinsurers, Consulting Firms and Case Management companies - treating each review in the same expert and professional manner.
Like having a doctor on your team who sees things that other doctors or medical directors might not - by wearing his lawyer “glasses” - Dr. Nudelman supervises all cases, “triaging” each one personally. Selecting experts from our panel of well credentialed, board certified and experienced medical experts of almost every specialty that he has developed for MDS over many years (or one of the many other non-physician consultants), when the timing is right and the data necessary to answer the medical issues right the first time is complete… only then he refers them for peer review. If we do not already know of just the right medical expert for your case, where the circumstances allow us to do so, we will seek one out specifically to meet your needs.
When instructed by our client or Dr. Nudelman otherwise makes such a recommendation on a case being triaged and it is approved by the client, we will perform simultaneous or consecutive “tandem” peer reviews involving multiple specialties, and then incorporate the two or more into one single, coherent report, responding to the questions posed. Examples have included: a Physiatrist (Physical Medicine and Rehabilitation) specializing in Pain Management with a Psychiatrist (low impact MVA with diffuse residual pain and claim of post traumatic fibromyalgia); Neurosurgeon or Neurologist and PhD level Neuropsychologist (head trauma); Orthopedic Spine Surgeon and Orthopedic Hand surgeon (double crush injury with CTS and cervical cord compression); Kidney/Pancreas Transplant & Heart and Lung Transplant surgeons. The combinations are of course determined by the specifics or the case.
MDS can also assist you in implementing the changes recommended by your PHARMACY BENEFIT MANAGEMENT or DRUG UTILIZATION REVIEW, including contacting the treating physician in a peer-to-peer contact with one of our medical experts, where permitted by law and the circumstances allows it. See Peer-to-Peer Physician Contact below.
Medical File Peer Review
File Organization and Preparation
Don’t let a poorly organized file result in the wrong outcome for you or your client. Save time, money and maybe even the case itself! Nothing is more frustrating than trying to get your arms around a huge file of out-of-order medical records, with multiple duplicates, non-medical or unrelated documents mixed in, especially in a time sensitive situation. It seems by the time it is done, if it ever is, the opportunity may be lost.
Let Medical Director Solutions conveniently arrange to have your large and unruly files expertly scanned, sorted, organized, and indexed. You get an easily searchable electronic file delivered on a timely basis, complete with Bates Numbering, bookmarks and a table of contents. For particularly large or complex files Hyperlinks can be embedded for instant file navigation. Additionally we can provide transcription of handwritten notes and upon request, we can often identify even missing medical records.
Properly organizing the file BEFORE the Peer Review or Independent Medical Examination takes place will reduce both the number of mistakes and hours of costly medical expert review. No case is TOO COMPLEX or file TOO BIG for us – in fact large, complex cases involving voluminous medical records and a lot of different medical issues are our specialty! Where necessary, a clinical time-line can be constructed for the case by a nurse consultant. When the case calls for it, we may use a Certified Legal Nurse Consultant to assist in this stage. All electronic files are available for you, the medical experts and your clients. Or if you prefer, we will print and tab the organized files and put into binders.
Imagine the savings not only in medical peer review and IME time, but mistakes that may be prevented by knowing what is in the file and where.
See more about the American Association of Legal Nurse Consultants
See more about the National Association of Legal Nurse Consultants.
Medical Director Consultation
Sometimes you don't need a formal peer review; just a little direction. Perhaps you are unsure of what steps to take next, or maybe what specific medical records you need to request to evaluate the medical issue. Where no report is required, fax up to 10 pages and talk a case over for up to 15 minutes with Dr. Nudelman, or one of our many other clinical and administrative medical experts..
Peer-to-Peer Physician Contact
When you need a helping hand getting through to the treating physician, who like many of their colleagues are simply more comfortable speaking with another doctor, let MDS help you. Whatever the reason, our team of board certified physicians stands ready, willing and able to make that contact for you - and memorialize in writing what occurred.
By direct contact with the treating physician, let us investigate and establish:
Whether the mechanism of injury is consistent with condition, or reasonably related to the work activity
If a prior condition was aggravated or exacerbated, and if so, what was the pre-injury baseline
A treatment plan based upon recognized guidelines
Whether the proposed diagnostic test requested (e.g., MRI, myelogram, EMG, etc.) is medically necessary at this time and/or related to the injury or condition
When the claimant can be expected to be at MMI (maximal medical improvement) or RTW (return to work – light work duty or own occupation)
An impairment rating, if any is appropriate
After this is accomplished we will provide a report. Where appropriate and if we are able to do so, we will have the attending treating physician sign off on our mutually agreed findings.
This is also an effective way of implementing recommended changes in PHARMACY BENEFIT MANAGEMENT. Whether you provide the pharmacy benefit management report or we arrange to have it done for you, our doctor will contact the treating physician to discuss the results and get the plan into action – or establish justifiable medical reasons as to why not.
Note: This service is of course subject to applicable state law (for example, in some states contact with the authorized treating physician is prohibited on WC cases).
IME: Independent Medical Evaluation, FCE or Psychological Evaluation
Except on rare occasions, these services are available exclusively on files on which we are already performing reviews, or may otherwise be involved in the case. If the circumstances are right and it is recommended by Dr. Nudelman or one of the experts performing peer review, or otherwise requested by our client, MDS will arrange face-to-face patient contact by way of Independent Medical Evaluation, Second Opinion, Psychological and Neuropsychological testing, or some other in-person service needed, matching the clinical evaluator to the situation. We will assist in crafting questions to pose, or in seeking clarification where necessary in the course of our QA, even after a report is generated, where appropriate.
However, we are available for assistance in overseeing your own IME vendor, including choosing the most appropriate specialty and reviewing the credentials of the proposed IME expert. Dr. Nudelman has had experience with almost every major peer review and IME vendor in the course of his career. An expert in credentialing, he will not only review the credentials of the IME physician or other evaluator - he will even assist in the crafting of questions, making sure that the right ones for the case are posed, and offer strategies to be sure your money is being well spent. Dr. Nudelman or one of our medical expert panel can speak with the IME evaluators to clarify any discrepancies or delve further than the IME report may have.
URGENT RESPONSE UNIT
You are short on time, maybe even the newly hired adjustor or legal counsel on the file, and the deadline for some important procedural matter is coming up on your case…fast. Just this morning multiple large boxes of medicals have been delivered to your front office, going back a dozen or so years, from who knows how many doctors and medical facilities. Maybe some of the records don't even belong to this patient. Notwithstanding the enormous volume, some of the essential pages may be missing – you couldn’t possibly know. Your cursory review of the most recent medical information seems to suggest that three physicians somehow are managing to hold five different opinions, your client is stressed and quite frankly, you don't know what to do.
Before you settle the case - let our URGENT RESPONSE UNIT evaluate the medical legal situation. Don't be held hostage by your opponent. Level the playing field by engaging Dr. Nudelman and his team to do some of the heavy lifting on the medicals, and the medical expert tactics.
No case is TOO COMPLEX or file TOO BIG for us – in fact large, complex cases involving a lot of different medical issues are our specialty! Send us that disorderly mess, and we will scan, organize and prepare a table of contents with hyperlinks to critical documents. Where necessary, a clinical time-line can be constructed for the case by a nurse consultant and supervised by Dr. Nudelman. When the case calls for it, we may use a Certified Legal Nurse Consultant to assist in this stage. Copies are then available electronically for you, the medical experts and your clients.
While your file is being organized, but only after attorney-to-attorney discussion with Dr. Nudelman (who is also a lawyer), a search begins to identify credible, reliable medical board certified experts that meet the Daubert standard to review, opine and then appear or otherwise testify as required. Based upon the parameters that you give us, we seek out medical and other related specialists - ones that can help you make your best case.
As fast as possible you will have a firm handle on the file and be in the position to declare your experts, should you decide not to settle. If you do decide to settle, you will do so with the benefit of far more knowledge, be in a better position to evaluate the litigation risk, and negotiate more favorable settlement terms. We will go shoulder to shoulder with you the whole way.