post-traumatic stress disorder claims in auto accident...
TRANSCRIPT
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Presenting a live 90-minute webinar with interactive Q&A
Post-Traumatic Stress Disorder
Claims in Auto Accident Cases Assessing Damages, Proving Claims, Leveraging Experts
Today’s faculty features:
1pm Eastern | 12pm Central | 11am Mountain | 10am Pacific
WEDNESDAY, OCTOBER 4, 2017
Jason Neufeld, Esq., Neufeld Kleinberg & Pinkiert, Miami
Dr. Keyhill Sheorn, M.D., Richmond, Va.
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Program Materials
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Post-Traumatic Stress Disorder Claims in Auto Accident Cases Keyhill Sheorn, MD October 2017
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DSM Criteria for PTSD
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Criteria A - Stressor
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Criteria A - Stressor The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence:
1. Direct exposure.
2. Witnessing, in person.
3. Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.
4. Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect nonprofessional exposure through electronic media, television, movies, or pictures.
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Criteria A - Stressor He was shocked beyond his tolerance and reacted with
abject horror.
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“The more you think, the more you die.”
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Criteria B - Intrusion Presence of one or more of the following intrusion symptoms associated with the traumatic event, beginning after the traumatic event occurred:
1. Recurrent, involuntary, and intrusive memories. 2. Recurrent distressing dreams. 3. Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. 4. Intense or prolonged distress after exposure to traumatic reminders. 5. Marked physiologic reactivity after exposure to trauma-related stimuli.
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Criteria C - Avoidance Persistent effortful avoidance of distressing trauma-related stimuli after the event evidenced by one or both of the following:
1. Trauma-related thoughts or feelings.
2. Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).
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Criteria D - Negative Alterations in Cognitions and Mood
Negative alterations in cognitions and mood that began or worsened after the traumatic event, as evidenced by two or more of the following:
1. Inability to recall key features of the traumatic event 2. Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., "I am bad," "The world is completely dangerous."). 3. Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences. 4. Persistent negative trauma-related emotions (fear, horror, anger, guilt, shame). 5. Markedly diminished interest in (pre-traumatic) significant activities. 6. Feeling alienated from others (e.g., detachment or estrangement). 7. Constricted affect: persistent inability to experience positive emotions. 13
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Criteria E - Alterations in Arousal and Reactivity Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event, as evidenced by two or more of the following:
1. Irritable or aggressive behavior.
2. Self-destructive or reckless behavior.
3. Hypervigilence.
4. Exaggerated startle response.
5. Problems in concentration.
6. Sleep disturbance.
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Criteria F - Duration of the disturbance is more than one month.
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Criteria H - The disturbance is not attributable to the physiological effects of a substance (eg medication, alcohol) or another medical condition.
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Criteria G - The disturbance causes significant distress or impairment in social, occupational, or other important areas of functioning.
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PTSD CHECKLIST
PCL - 5
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PTSD CHECKLIST 1. Repeated, disturbing, and unwanted memories of the stressful experience? Not at all A little bit Moderately Quite a bit Extremely
2. Repeated, disturbing dreams of the stressful experience? 3. Suddenly feeling
or acting as if the stressful experience were actually happening again. 4. Feeling very upset when something reminded you of the stressful experience? 5. Having strong physical reactions when something reminded you of the stressful experience? 6. Avoiding memories, thoughts, or feelings related to the stressful experience? 7. Avoiding external reminders of the stressful? 8. Trouble remembering important parts of the stressful experience? 9. Having strong negative beliefs about yourself, other people, or the world? 10. Blaming yourself or someone else for the stressful experience or what happened after it? 11. Having strong negative feelings such as fear, horror, anger, guilt, or shame? 12. Loss of interest in activities that you used to enjoy? 13. Feeling distant or cut off from other people? 14. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)? 15. Irritable behavior, angry outbursts, or acting aggressively? 16. Taking too many risks or doing things that could cause you harm? 17. Being "superalert" or watchful or on guard? 18. Feeling jumpy, or easily startled? 19. Having difficulty concentrating? 20. Trouble falling or staying asleep? Not at all A little bit Moderately Quite a bit Extremely
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Key Questions to Illuminate Malingering
What are your PTSD symptoms? (Watch out for the list of all twenty!)
Describe your symptoms of PTSD (ie what is a flashback like for you? Tell me about your nightmares.)
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DIAGNOSTIC ALTERNATIVES
Acute Stress Disorder
Adjustment Disorder
Character Disorder
Anxiety Disorder
Pain Disorder
Iatrogenic Disorder/Critogenic Disorder
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iatrogenic
(adj) adverse effect or complication caused by or resulting from medical treatment or advice.
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critogenic
(adj) adverse effect or complication caused by the legal process or the legal system.
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Misdiagnosis of PTSD Claimants
Can lead to improper forensic outcomes.
Can lead to extended work benefits.
Tremendous financial settlements in court.
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Because a Professional Perpetuated an Inaccurate Diagnosis
The true psychological trauma is:
Undiagnosed
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Because a Professional Perpetuated an Inaccurate Diagnosis
The true psychological trauma is:
Undiagnosed
Untreated
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Because a Professional Perpetuated an Inaccurate Diagnosis
The true psychological trauma is:
Undiagnosed
Untreated
Sustained
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An adequate diagnosis gives them a chance to get
better.
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Can He Perform His Usual and Customary
Work?
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Is the Diagnosis Secondary to the Accident?
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Has He Reached Maximum Medical
Improvement?
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If Further Treatment is Necessary, What Would be Appropriate?
Psychotherapy
Medication
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In your opinion, from a psychiatric perspective, is the claimant
permanently and totally disabled from ever returning to any type of
employment on a regular and
continuous basis?
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Even in our sleep
Pain we cannot forget
Falls drop by drop
Upon the heart
Until in our own despair
Against our will
Comes wisdom
Through the awful grace of God
Aeschylus
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Neufeld, Kleinberg & Pinkiert, P.A.
Post-Traumatic Stress Disorder Claims in Auto Accident Cases
NEUFELDLAWFIRM.COM
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My Outline
• Recognizing signs of PTSD during client intake.
• Properly documenting PTSD (what if preexisting?)
• What is the value of your PTSD claim?
• What to look for in a PTSD expert?
• How to work with/prepare the expert?
• Common challenges to your PTSD claim
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Know Your PTSD symptoms
• Need to ask the right questions during intake.
• Lots of people will not volunteer this information (especially men and especially former military personnel).
• Some clients in denial, some find it embarrassing.
• Need to know psych history (prior PTSD and other disorders makes someone more susceptible in the future)*
• *Trauma-Informed Care in Behavioral Health Services Treatment Improvement Protocol (TIP) Series, No. 57
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Documenting PTSD symptoms
• Complaining to your significant other, your sister, your mentor, your spiritual guide, even your lawyer, is mostly meaningless….. (not really, but helps drive the point home)
• If any positive answers during interview, will likely need to first document with non-psych medical professionals (I want it in everyone’s notes).
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Valuating Your PTSD Claim
• BIG QUESTION: Does the PTSD result in social, physical or occupational disability?
• Proof of removal of favorite sports/hobbies/charitable work
• Gym records
• Most important: impact ability to work (or study)?
• If case is big enough, will need a life care planner and economist, in addition to your PTSD expert.
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Your PTSD Expert Wish list
• Once size does not fit all
• Show me clinical experience
• Court experience? (both sides)
• Accessible
• Don’t just tell me what I want to hear
• Use B&A witnesses to bolster expert’s testimony
• CME: always videotaped
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Preparing Your Expert
• Make sure experts actually review prior psych records, if any
• Sometimes your treating psychologist/psychiatrist is not your testifying expert
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Challenges to your PTSD Claim
• 2nd Restatement of Torts, Sec 46, comment b, sec 436A: • “The law has always been wary of claims of emotional distress
because they are so easy to manufacture.”
• Social Media (juries don’t like to see people having fun)
• No posting pictures at the bar.
• No letting oneself be tagged by someone else!
• Client should assume they are under surveillance
• Clients themselves.
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…and more challenges
• Delayed onset: DSM-V says onset typically within first three months, but can take longer.
• Prior psychological issues: your expert needs to be aware and account for prior dx.
• Low PD cases.
• Recovery
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Thank you!
• Any questions?
• Neufeld, Kleinberg & Pinkiert, P.A.
• Miami-Dade: 305.931.6666 | Broward: 954.523.8292
• WWW.NEUFELDLAWFIRM.COM
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