Structured settlements are ruining patients’ lives

There are a lot of TV commercials for structured settlement companies these days. You know, the companies that say if you are cash-strapped but have a structured settlement they will be happy to buy your settlement and give you “cash now.” Some of the commercials are quite clever and catchy featuring everything from operettas to boy bands. After seeing so many of these, one has to conclude that there has to be a lot of people in this situation but how is this possible? After all, if these people are getting ” large cash settlements” how come they are in this fix? Two experiences I had may hold provide an answer.

Twenty years ago my daughter was sitting in the side passenger seat in a car involved in a bad car wreck. The driver, her boyfriend, was killed and she had to be life flighted to a trauma center. Her injuries, although severe, were correctable and she made a full physical recovery. However, within 24 hours we got the inevitable deluge of calls from attorneys wanting to represent us. I had already spoken with the auto insurance carrier and stated all I wanted was to have my daughter’s medical bills paid, and in fact, we never saw one.

There was one particular attorney call I will never forget. A girl with a very sweet voice tried to convince me that there could be long-term psychological damage. Almost as a joke, I said: “And you will make sure my daughter gets sent to the best psychiatrists ?” “Oh yes,” the girl said. “We can make sure your daughter gets help even if it takes years !” I was stunned. Even if my daughter got the “help” and she got her “large cash settlement” what about the rest of her life? Would she able to get a job or even go to college with a record of being under psychiatric care for years? I politely said, ” No thanks.” And instead encouraged my daughter to get back as quickly as possible to her life which she did, and it was the best route to take.

For several years while I was in practice, I did independent medical evaluations or IMEs. For those who do not know, an IME is requested when there is a dispute for the legitimacy of a patients’ health complaints usually following an accident, and the defendant has a deep pocket such as workers compensation or auto insurance. I was asked to review the history, examine the patient and make a judgment as to whether or not the claim was legitimate. I was hired by an independent company and asked to be blinded as to whether or not the IME was requested by the plaintiff or defendant side. By this time, it was months or even years after the event, both sides were heavily lawyered up, and the patient was out of work for a long time.

Ninety-five percent of what I did was auto accident related, and the patient was either the driver, passenger, pedestrian or people in other vehicles involved in the accident. So it was not necessarily the driver of the insured vehicle who I saw. After a while, several things became apparent.

  1. The driver of the insured vehicle was clearly at fault.
  2. All of the initial treatments and tests for anyone who was injured were paid for without question, including chiropractic. (Side note: Chiropractic care tended to end once the insurance ran out usually at three months.)
  3. The patients were heavily coached by their lawyers.

The most common example: Driver of the other vehicle — not at fault, hurts low back. Tests including MRI show “degenerative changes.” The patient swears they never had low-back pain before. Medications, PT, injections and three months of chiropractic fail to resolve the problem, all of which is paid for. The patient fails Waddell’s tests. (Tests for the legitimacy of patient complaints of low-back pain.)

I will not go into the details of what happens next. But the main thing here is that at this point, the patient has been put out of work for several months, if not years, and is now claiming they cannot work due to the pain. Fair enough. I give my opinion, and a settlement is reached, then the patient gets their “large cash settlement.” (Minus the attorney fee, of course.) Now what? The settlement (minus the fee) is not enough to live on, and now the patient is unemployable. The lawyer gleefully moves on to the next case. After some time the patient sees one of these commercials and sells their settlement because they are cash-strapped.

I am forced to wonder. If attorneys really had their clients best interests at heart would they not encourage them to try and get back to their old life ASAP? Of course, that would mean less cash in their own pockets. But hey, business is business.

Thomas D. Guastavino is an orthopedic surgeon.

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