Post-Traumatic Stress Disorder Claims in Auto Accident Cases

Transcription

1 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 WEDNESDAY, OCTOBER 4, pm Eastern 12pm Central 11am Mountain 10am Pacific Today s faculty features: Jason Neufeld, Esq., Neufeld Kleinberg & Pinkiert, Miami Dr. Keyhill Sheorn, M.D., Richmond, Va. The audio portion of the conference may be accessed via the telephone or by using your computer's speakers. Please refer to the instructions ed to registrants for additional information. If you have any questions, please contact Customer Service at ext. 10.

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5 Post-Traumatic Stress Disorder Claims in Auto Accident Cases Keyhill Sheorn, MD October 2017

6 DSM Criteria for PTSD 6

7 Criteria A - Stressor 7

8 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. 8

9 Criteria A - Stressor He was shocked beyond his tolerance and reacted with abject horror. 9

10 The more you think, the more you die. 10

11 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. 11

12 Criteria C - Avoidance Persistent effortful avoidance of distressing traumarelated 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). 12

13 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

14 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. 14

15 Criteria F - Duration of the disturbance is more than one month. 15

16 Criteria H - The disturbance is not attributable to the physiological effects of a substance (eg medication, alcohol) or another medical condition. 16

17 Criteria G - The disturbance causes significant distress or impairment in social, occupational, or other important areas of functioning. 17

18 PTSD CHECKLIST PCL

19 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 19

20 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.) 20

21 DIAGNOSTIC ALTERNATIVES Acute Stress Disorder Adjustment Disorder Character Disorder Anxiety Disorder Pain Disorder Iatrogenic Disorder/Critogenic Disorder 21

22 iatrogenic (adj) adverse effect or complication caused by or resulting from medical treatment or advice. 22

23 critogenic (adj) adverse effect or complication caused by the legal process or the legal system. 23

24 Misdiagnosis of PTSD Claimants Can lead to improper forensic outcomes. Can lead to extended work benefits. Tremendous financial settlements in court. 24

25 Because a Professional Perpetuated an Inaccurate Diagnosis The true psychological trauma is: Undiagnosed 25

26 Because a Professional Perpetuated an Inaccurate Diagnosis The true psychological trauma is: Undiagnosed Untreated 26

27 Because a Professional Perpetuated an Inaccurate Diagnosis The true psychological trauma is: Undiagnosed Untreated Sustained 27

28 An adequate diagnosis gives them a chance to get better. 28

29 Can He Perform His Usual and Customary Work? 29

30 Is the Diagnosis Secondary to the Accident? 30

31 Has He Reached Maximum Medical Improvement? 31

32 If Further Treatment is Necessary, What Would be Appropriate? Psychotherapy Medication 32

33 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? 33

34

35 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 35

36 THE END Keyhill Sheorn, MD

37 Neufeld, Kleinberg & NEUFELDLAWFIRM.COM Pinkiert, P.A. Post-Traumatic Stress Disorder Claims in Auto Accident Cases

38 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 38

39 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

40 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). 40

41 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. 41

42 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 42

43 Preparing Your Expert Make sure experts actually review prior psych records, if any Sometimes your treating psychologist/psychiatrist is not your testifying expert 43

44 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. 44

45 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 45

46 Thank you! Any questions? Neufeld, Kleinberg & Pinkiert, P.A. Miami-Dade: Broward: