RateFast Podcast: When Surveillance is Necessary

This article is a transcription of an episode of the RateFast podcast, which you can listen to by searching “RateFast” in iTunes or the iOS podcast store.

If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you!

Workers’ compensation helps out employees who sustain an injury while working at their job. Unfortunately, some may try to take advantage of it and lie about their injury. This is just one example of a type of case where a court or stakeholder orders a sub rosa, meaning that an investigator will come out and perform surveillance on the person in question.


The videos are then sent with a written report to a claims examiner at an insurance company. If the report or video show something contradictory to what the patient originally claimed, then it is sent back to the doctor who first saw the patient to see if it lines up with what the patient told them. The combination of video footage and written report are used in court to help establish the employee’s functional limitations and determine whether their workers’ comp claim is legitimate or not.




Sub rosa (noun) – a secret investigation or surveillance, used in workers’ comp to observe employers, employees or doctors to establish that they are telling the truth about their claims. Means “under the rose” in Latin.

Activities of daily living (noun) – routine activities that people do every day without assistance.

Claims examiner (noun) – someone who evaluates insurance claims at an insurance company. They determine if an insurance company should pay a claim, and how much they should pay.

Substantial medical evidence (noun) – a reliable report that a judge can use as evidence in court. This means the doctor did not speculate or guess, they gave adequate medical history and conducted adequate examinations, and relied on objective findings, germane facts and reasonable medical probability.


Interview Transcription


Dr. John Alchemy: Hello, my name is Dr. John Alchemy. Today is March 5th, 2016, and welcome to the California Work Comp Report. Today I have the distinct pleasure of having Mr. Phil Walker, attorney, join us, and we are going to be talking about the sub rosa and what it is in workers’ compensation. Phil, hello.


Phil Walker: Hello, it’s nice to be here, John.


Dr. John Alchemy: So, before we get started, maybe you could tell us your background in workers’ comp and what you do?


Phil Walker: I’m happy to. I started in workers’ compensation in 1982, in California, which means that I have been through five reforms of the system during my career. I started working for U.S. Steel Corporation in California, handling all of their workers’ compensation in the Western United States, literally from Mexico to Canada, and from the Pacific Ocean to the Rocky Mountains. And from then, I worked at a series of law firms, and ultimately, in 2000, I then took three years off. I was so tired of workers’ comp I thought I would blow my brains out. And I moved to New York City and became general counsel of the largest residential real estate firm there, did that for three years, and then I came back to California, and now I have my own workers’ comp law firm. I do a lot of speaking across the country, I teach the AMA Guides, and I write books. And this year, I have two new books coming out. One is called “Causation and Apportionment Made Simple in California Law,” and the second one is “How Employers Can Cut their Workers’ Comp Costs in Half in California.”


Dr. John Alchemy: Excellent. Well, thanks for joining. As you know, I’m a physician, I do California workers’ comp clinical practice. Some of the questions I commonly get from other doctors are around this issue of the sub rosa. So, could you tell us what is a sub rosa?


Phil Walker: Sure. “Sub rosa” is a fancy Latin term. It means “under the rose,” and it essentially means secret investigation, basically. I’ll let you explain the etymology of the word. I was always a little surprised when people would refer to sub rosa, because what it really means in simple terms is surveillance. And it normally boils down to one of two things: Primarily, an investigator is sent out, he arrives at the home of the injured worker around 5 in the morning, he stakes out the house. And he takes movies if the injured worker comes out and goes anywhere, he follows that person, and attempts to observe, usually, what level of physical activity they’re involved in. Sometimes, surveillance can include potential witnesses. I also do, in addition to California workers’ comp, a kind of law called longshore, and surveillance was used when we had a doctor who claimed he was seeing about 200 patients a day, and investigators were hired to establish that that was not true. And essentially they staked out his office and found out, and sometimes surveillance is used, right now, a lot of surveillance is being used when doctors are prescribing unnecessary medications. In California, there’s a big rage now for compounded medications, where doctors crush up ibuprofen and stick it in Nivea skin cream and bill it $6,000 a pop. And so surveillance is being used in that, too.


Dr. John Alchemy: Okay. So surveillance isn’t necessarily just for the injured worker, it can be for any provider in the system, actually.


Phil Walker: That’s exactly right, that’s exactly right. And of course, surveillance can also be done of employers, of work sites, of working conditions, in the movie “Norma Rae,” surveillance was used at the employer, and in “Erin Brockovich,” same thing.


Dr. John Alchemy: Okay, interesting. Let’s pull back the focus of the following questions and back to the issue which is common, where the doctor is provided this video, and something is supposed to happen. So let me start with this first question I get, what is it that the stakeholders are really looking for when they order this sub rosa? Give me an idea.


Phil Walker: That’s an excellent question. What they are normally looking for is: Are there physical activities that we can observe with our eyes and film, which the injured worker is able to perform, which are in excess of what he claims he can do? Let me give you the simplest explanation: An injured worker who claims he or she is restricted to a wheelchair, and you go and take films, and you see that after that person comes out of the doctor’s office from the examination, they get out of the wheelchair, throw it in the back of the car, drive away and never use that wheelchair for another month. Same thing with a cane. Or other times, people will say “I can’t lift anything, I can’t bend over, I can’t walk any distance,” and surveillance is used to try and identify activities that the people say they cannot do, and to show they can. It’s even used in psych cases, when people say, for instance, “I’m an agoraphobe, I can’t leave my house, I can’t mingle with anyone.” And you get surveillance to see if they actually are out at the mall, shopping, interacting with everybody. So the fundamental purpose is to attempt to establish either the validity of what the person is claiming as to his or her physical or psychological restriction, or the invalidity of what he or she is claiming.


Dr. John Alchemy: Okay. So it sounds like when there’s a definite claim maybe made by the injured worker of what they can or cannot do, that can be helpful. But what about these situations, where commonly they’ll say “Well I have good days, I have bad days, and in general I can’t lift more than 10 or 15 pounds.” Now, what good is it there?


Phil Walker: This is such a good question. Because early in my career, I had a case where we had somebody said he could not lift more than 2 pounds, okay? And we had him lifting, I think it was a generator, into the back of a truck that weighed about 65 pounds. And we had him doing this for a series of hours, actually, this particular activity. He was making a home move, and we got all of that on tape. So I thought, as a young attorney, “I’ve got it! I’ve got it!” And I went in and showed it to the worker’s comp judge, actually, in court. And I thought I had it. Well, they then put the injured worker on the stand, and he said just what you said. He said “Well, I have good days and bad days, and that was one of my really good days. But boy I paid for that afterwards, and I couldn’t do anything for the next two weeks.” And I lost that case. And because of that, I have learned that when I have surveillance done, I have it done on a series of days that are separated so that if this type of testimony gets given to me, that you know, “I couldn’t do anything for a week afterwards,” then I have the backup video to come up and say “Really? Well, let’s show you what you did two days later.” And showing the same activities.


Dr. John Alchemy: So, sometimes I also get comments from doctors saying “You know, I saw the patient in clinic, they tell me one thing, but my office is kind of by the parking lot, I have a window and I watch them walk out, and I see some inconsistencies between what they’re telling me and I’m seeing in the room, and then what I’m witnessing when they walk.” Now, the question is, should the doctor be putting these after-clinic visit observations into the chart, knowing or not knowing that the patient could have gone in the bathroom and taken a pain pill, applied some ice, et cetera? What’s your advice in that situation?


Phil Walker: My advice is that the physician should, and I take the position must, put that in the chart. I base it on California law, which says in order for a judge to rely on a medical report, it must be what is called substantial medical evidence. And the Marshalls v. Escobedo case gives us an outline of the elements that are necessary for that. But one of them is that the doctor must be aware of “all germane facts.” And in my opinion, if there was a disparity between what the patient reported and what the doctor observed, then the doctor would have to list that as a germane fact. In the same way that, in my experience, good physicians will do the following things: If a patient comes in with a cane, they ask the patient “How long have you had this cane? How long have you used it?” And they will then check two things – the rubber tip on the bottom, to see if it’s worn down, and they check the hand grip, to see if it also shows evidence of wear and tear. They do the same thing if the patient comes in with one of those walker things with tennis balls on the bottom. And usually when doctors do this, they will report the results of their finding in the examination, or they certainly should.


Dr. John Alchemy: So I have a question then. If I have 10 or 15 patients throughout the day, the clinic’s busy, and let’s say half of my patients use durable medical equipment like a cane, like you just used. Is it then a requirement that the provider watch each and every one, or should they just single particular ones out? How do they evenly do this for all the cases, or how do they even choose which ones they should do this on?


Phil Walker: Well, the bottom line is, it is not required for any case.


Dr. John Alchemy: Okay.


Phil Walker: But to me as an attorney, when I am selecting doctors and when I’m making recommendations as to who should be used, when I see a doctor who is thorough enough to provide the information that either the cane shows no wear on the tip and nothing on the handle, or the opposite, that the cane clearly has been utilized extensively because it’s quite beaten up, this is hugely valuable information to me either way. Because obviously if the cane is really beaten up, that tends to tell me the claim that’s being made is true. And it will tend to guide me in that direction. So I will say this: It is not required, but doing these things takes about 5 seconds. It literally moves you from just a run-of-the-mill examining physician — I always describe it as the physical examination when you’re getting inducted into the Army, versus a medical legal examination.


Dr. John Alchemy: Okay, excellent. Now, let’s move on to this video. Typically here’s what happens: There’s a single-page letter, it comes into the clinic, it’s got the doctor’s name on it, you open it up, and there’s a DVD. “Doctor, please review this and make opinions on this individual based on this video. Thank you.” So, who actually gets this video? Is it just the doctor, tell us about that.


Phil Walker: Well, this is such a good question. If you think about it, you may really wonder as a doctor, “Why is the video coming to me?” rather than, I’m sure you’d think to yourself, “Well I used to watch Perry Mason, they would show the video in court.” That’s what Paul Drake the investigator did.


Dr. John Alchemy: Right.


Phil Walker: So why is it being sent to me, as a doctor? And I’ll tell you exactly why. And it’s different from what you think. When I first began practicing workers’ comp law, one of my friends was a clerk for a longshore judge. And he told her the first day they met, he said “I want to give you my judicial philosophy.” And she said “What is that?” And he said, “I award benefits.” And she said, “I get that. If the evidence supports it and the medical is there, then you’re going to award benefits.” And he said “No, I award benefits in every case. And the only time I’m not going to do that is when you convince me otherwise.” And that same day, he told her that he had been a plaintiff’s attorney, he hated when surveillance video tape was taken of his clients, particularly when it showed that they were not telling the truth, and because he hated it so much, he would never accept it in his courtroom. And the only time he had ever made a decision based on it was when a man came in and claimed, he was in a wheelchair, that he was paralyzed from the neck down. And they have video tape of him pushing a truck up a hill. And that was the only case in which this judge had ever accepted video tape. Now, people tend not to believe those things, because in elementary school, they were taught that courts are honest and true. I’ve been practicing law for 30 years, and I can tell you that my elementary school teacher had not been to the courts I’ve been in, on both sides. So what happens is, lawyers learn that you have a much better chance of making an impact with video tape by sending it to a doctor, rather than to a judge. And the reason for that is, doctors tend to think they’re God.


Dr. John Alchemy: Mm.


Phil Walker: And they tend to think that they can always tell if somebody’s telling the truth or not. And if they have examined someone and thought they were telling the truth, and then they see video tape which shows they were being lied to, doctors get really angry, okay? And they write a revised report. And suddenly, the amount of disability or impairment the patient has goes way, way down. Because the doctor gets really angry that he has been lied to. And so, lawyers learned that we can make much more impact by sending the video tape to physicians than we can to judges. And since the ultimate judges’ decision has to be based on the medical reports, it’s kind of like we attack the problem at the front of the process rather than at the far end of the process, basically. So that’s why the doctor gets involved. Now, the next question you have is, who should receive a copy of the video tape? And I take the position that if the video tape is going to be used as part of a litigation, if it’s going to form a part of any opinion the doctor is going to make, that you have to provide a copy of that to the other side so that they can see it. Okay? I know people would love not to have to do that, but the bottom line is, I really think they have to. And so I always caution doctors in this way, although I should say something – that applies to California workers’ comp. There are other systems where you are not required to show surveillance ahead of time, because it’s considered cross-examination, okay?


Dr. John Alchemy: Okay.


Phil Walker: Where you’re essentially coming in, you would ask the injured worker “Can you lift? Since your injury, have you been able to lift greater than 10 pounds?” “No, I absolutely have not.” Boom, you bring the surveillance video in, and you cross-examine them by showing that they are a liar, basically. But for all practical purposes, and that’s usually how it’s used in regular civil court, and also in the longshore court it’s often used that way. But, for California workers’ compensation purposes, if you are intending to have the video tape affect the judge’s ultimate determination, either through the judge seeing it or through a doctor writing an opinion based on it, then I take the position that you’ve got to provide a copy to all parties in the case.


Dr. John Alchemy: Excellent. Help me out then, so I’m the doctor, I’m watching this video. What type of systematic approach do I do when I watch it? What am I looking for? And then more importantly, how do I draft my report in a systematic way that’s fair and open, based on the information I see?


Phil Walker: Right.


Dr. John Alchemy: Yep.


Phil Walker: Now, first, let me tell you: Most video tape is so boring to watch that you want to blow your brains out, okay? And there might be, easily, 45 minutes, and there’s really only 30 seconds to 1 minute of significant material on that, okay? In terms of seeing activities that either support or undermine the doctor’s opinion as to the physical limitations.


Dr. John Alchemy: Okay.


Phil Walker: So, I recommend that what physicians do is, they watch the video tape from beginning to end, and they dictate a brief summary of what they are observing. “Number one: I observed an individual getting into his truck. I can say that I do remember what Mr. Roberts looks like – he weighed 500 pounds, he has bright red hair, and he only has a left leg. And this appears to be Mr. Roberts to me. And I observed him getting in his truck.” And you dictate what you see, generally the high points of the video tape. You might also say, which is quite common, “I see an individual get into the truck. The film is so blurry I can’t tell who the individual is,” okay? “I can’t tell if this is the patient I saw or not.” You can also say, “I don’t remember what Mr. Roberts looks like, because I see 200 patients a day. I have no recollection,” okay? And you can even say, “But for purposes of this report, I will accept the representation that has been made to me that this is Mr. Roberts.” I’ve also had a situation, you’ll love this, where the doctor wrote and said “This is not the patient. The patient I saw was African-American. This patient is Caucasian.”


Dr. John Alchemy: Interesting.


Phil Walker: Yeah. And I also had another case, very interestingly, and this is another area people often forget to go into: I had a case where somebody claimed he had severe impairment, and we had a whole bunch of film of him riding on a trick bicycle, doing tricks on a bicycle that he never could have done with the lumbar spine problems he had. It turned out that the person who had been filmed was his cousin, and not that man.


Dr. John Alchemy: Oh wow, okay.


Phil Walker: And ultimately, what they did was, they brought the cousin into court with the bicycle.


Dr. John Alchemy: Mhm.


Phil Walker: And that was not a very happy moment, as you can imagine. So, I think it’s very important that people, that the doctors particularly, state one of three things: “I can clearly tell this is the patient I remember,” “I can clearly tell this is not the patient I remember,” or, “I am unable to tell if this is the patient I saw, but for purposes of this report, I will assume it is.”


Dr. John Alchemy: Okay. One question that comes to mind is, I assume that once the sub rosa is created, someone who ordered it reviews it and determines if it’s useful. Is it fair to say —


Phil Walker: [laughs] No ho ho ho!


Dr. John Alchemy: — Is it fair to say that every time a sub rosa is created, it’s sent to the doctor or someone looks at it and says “You know what, we don’t think there’s anything here,” and the doctor never sees it?


Phil Walker: Oh, this happens all the time.


Dr. John Alchemy: Okay.


Phil Walker: This happens all the time, but I wanna share —


Dr. John Alchemy: Yeah.


Phil Walker: Three things with you on what really happens.


Dr. John Alchemy: Yeah.


Phil Walker: The investigator takes the films, okay? And then he or she dictates a report, a written report, that says “At 5:58 a.m., we arrived at the subject’s home through means that we are not revealing, we ascertained that the subject was at home.” That usually means they placed a phone call and somebody picked up the phone and said “Hello,” and they hung up, okay?


Dr. John Alchemy: Mhm.


Phil Walker: These reports drive me a little crazy, because most of these investigators used to be police officers, so they write in police jargon. But the bottom line is, they write a report, and they say what they observe and what happened. “We followed him in traffic, we lost him,” you know, that kind of stuff. Now what really happens is, after the surveillance video is done, and that report is typed up, it is sent to the claims examiner at the insurance company. In 1 out of 1,000 cases, the claims examiner actually looks at the film. In reality, the claims examiner looks at the written report, okay?


Dr. John Alchemy: Okay.


Phil Walker: Now, if the patient, for instance, has claimed “I have a bad back and as a result of that I have to use a cane at all times,” and the surveillance shows that, okay? The surveillance will never be sent to the doctor, the doctor will never know it has occurred. The doctor only sees the surveillance in one of two situations: The easy one, when there’s a significant difference between what the injured worker claims he can do, and what the tape shows he can do. And what I mean is, the injured worker claims he’s very restricted, and the tape shows he’s not. The other time the video gets sent is when the investigator has, oh how shall we say, embellished what he or she saw, and he says things like “The patient is observed repeatedly lifting items into the back of the pickup truck,” okay?


Dr. John Alchemy: Okay.


Phil Walker: And the claims examiner doesn’t view the film, and the claims examiner thinks this means the injured worker is lifting concrete blocks into the back of the pickup truck. But in reality, the injured worker was lifting Popsicle sticks into the back of the pickup truck.


Dr. John Alchemy: Okay, right.


Phil Walker: And so, there will be times where doctors will get surveillance, and they’ll think “Why is this being sent to me?” Because it’s totally consistent with what the injured worker said. And what that means is, is that the claims examiner did not look at the film.


Dr. John Alchemy: Got it, got it. Here’s another quick question: If I’m an injured worker or I’m a doctor, and I just happen to ask the examiner, or the carrier, “Do you have a sub rosa video on this individual,” do they have to tell me yes or no, or can they be silent and don’t have to say anything?


Phil Walker: They do not have to tell the doctor.


Dr. John Alchemy: Okay.


Phil Walker: They do not.


Dr. John Alchemy: Okay.


Phil Walker: Now, I will tell you that I have had many cases over the years —


Dr. John Alchemy: Mhm.


Phil Walker: — I’ve had one or two cases where doctors have said “It might be wise to conduct surveillance in this case.” I’ve had many cases where doctors have called me and said “Phil, I just finished seeing your patient, I think you need to do surveillance on this one.”


Dr. John Alchemy: Okay.


Phil Walker: And so that’s usually, I mean, I’ve done workers’ comp many years, and so I have guidelines for when I believe that surveillance will be of benefit, and I’ll tell you exactly what they are. I am looking for a situation where I have deposed the injured worker, and one of the questions I will ask is: “Are there any activities that you were able to do before your injury that you cannot do at all since the time of your injury?”


Dr. John Alchemy: Right.


Phil Walker: “That you’ve been completely unable to perform?” And then I get them to give me a list.


Dr. John Alchemy: Okay.


Phil Walker: And what I’m looking for is things that they say, “I absolutely cannot do at all.” And if I get a good list, that’s a case that I will send to surveillance. If I have other things that are corroborating my wondering, those would be: People off from work a lot longer than they should normally be for this type of injury; second, a history of lots of workers’ compensation claims, where that has been kind of the pattern; third, no findings on the physical examination that would support this level of restriction and symptomatology; four, complaints that the pain is constant and excruciating, 24 hours a day, 60 minutes an hour, every second of every minute, that there’s no change in the quality of the pain. This is called, amongst lawyers, the nickname is “constant and excruciating.”


Dr. John Alchemy: Okay.


Phil Walker: Because the truth is, when people are telling the truth, they will tell you about your pain, “It goes up and down. I have times that are better, I have times that are worse, there are things that bring it on, there are things that don’t.” The more people you question, the more you find that it is very unusual for them to say “The pain never changes, it never relents, it’s always constant and excruciating.” It just doesn’t happen.


Dr. John Alchemy: Right. Now, if I’m going to be a doctor, and I’m treating a patient, I mean, the understanding is that the doctor’s there to be neutral, helpful, make an honest effort to get the injured worker better, and if a doctor’s going to be going either to the carrier or making a comment about this, would you advise they have a very open and frank discussion with the patient before doing that, saying “Hey look, what you’re telling me and what I’m finding in exams do not add up, can you help me with this here?” Before you go ahead and go forward, because the doctor, speaking for myself, I don’t like to be made to be seen like I’m on one side or the other. I’m there to help.


Phil Walker: Yeah. This is, this is a superb question, and I’ll answer it in terms of how different doctors handle this. One group of doctors, and this is what I recommend, do confront the patient with the discrepancies. In the exact same way that if you had a patient and the patient says to you, “I haven’t had anything to drink in the last year, not a drop.” And as part of your bloodwork, alcohol is done and it comes back showing significant amounts of alcohol, okay?


Dr. John Alchemy: Okay.


Phil Walker: Treating physicians would confront the patient about that. Now, in about 90% of the cases, the patient will lie and claim it’s not true, but the lab is true, okay?


Dr. John Alchemy: Mhm.


Phil Walker: The lab is absolutely true on this. So in the same way that there are times that treating physicians confront patients with discrepancies, I think that that’s what a wise physician does in this situation. The reason for that is because it may actually lead the injured worker, if he’s not telling the truth, to abandon the claim.


Dr. John Alchemy: I see, uh-huh.


Phil Walker: And not pursue it, basically. But I should tell you that that confrontation occurs in about 10% of all evaluations, that I know of. And in about 60% to 70% of evaluations, it depends on what political philosophy the doctor has. If the doctor feels that people should have personal responsibility, then he will often call the insurance company and say “I think you should do surveillance here.” If the doctor feels that the world is a place where it’s the big, evil corporations against the poor, injured worker —


Dr. John Alchemy: Mhm.


Phil Walker: Often that doctor will simply ignore it, okay? And I know that’s not politically correct to say, but that’s simply what I’ve observed.


Dr. John Alchemy: Got it. Okay, let’s wrap this up then, finally, with a big question: I have a video, I believe I have some evidence that there’s a functional disparity, I’m going to say, and I’ve already performed or submitted an impairment report to the parties. I need or I believe I need to make a change in either the functional limitations I’ve assigned, and/or the impairment values I’ve assigned, based on activities of daily living. How do I go about and do that, and how do I support any changes retrospectively, based on this document that I am now watching?


Phil Walker: Sure. So, you’ve issued a report with all of your conclusions, you’ve now seen surveillance tape, and the surveillance tape leads you to believe there — I’ll just use this example — there is half the impairment that you originally thought was present, okay.


Dr. John Alchemy: Mhm.


Phil Walker: Half, or sometimes none that you think, “Hey, this patient can do everything,” okay. What the physician should write is this: “Since the time of my evaluation, I have had an opportunity to review surveillance video tapes of Mr. Smith which have demonstrated him performing the following activities,” and then you just put a list of what the activities are. Lifting a generator into a truck, blah, blah, blah. Okay? And then you write this: “Based on what I have observed in these video tapes, I believe the patient’s capabilities are greater than what I had previously felt. As a result of that, I now wish to amend my opinions as follows,” so you use the line, “The patient’s capabilities are greater than what I previously felt. I now wish to amend my prior report as follows,” and that’s all you have to put in. And then you put in, “Here are the diagnoses, as I see them,” and you might now put, say it was lumbar sprain, you might now change your diagnosis from “Lumbar sprain” to “Lumbar sprain, resolved.”


Dr. John Alchemy: Okay.


Phil Walker: Okay? So you put the diagnoses, then you do your AMA calculations, basically, and then, likely as part of those calculations, you’re gonna be commenting on activities of daily living. And you might well say “The film showed the patient able to engage in extensive walking, which is an activity of daily living, and he claimed he could not do that at all, that he was limited to a wheelchair, and as a result of that I am changing these opinions in light of what I have observed regarding his ability to perform activities of daily living.”


Dr. John Alchemy: Got it. So Phil, in closing, then, what can you tell docs out there who are seeing these things? How do we look at these sub rosas? Just another piece of evidence, use it like we would an X-ray or an MRI? What’s the take-home?


Phil Walker: Here’s what I recommend when you’re looking at sub rosas: Take out your report before you look at the film, okay? And review it. And then view the film with this question: “Does this film reinforce what my prior opinion was? Does it really compel me to change what my prior opinion was? Or is it non-contributory?” And I think the secret to doing this is, and this is where physicians make a mistake: A lot of times, they review the surveillance, and then they go back and look at their report from the past. I think, and, I think it’s much better — what you’re trying to do is compare the mental image you had in your mind from your evaluation of what this patient could do, to what you’re now seeing on screen. And that’s why I think it works much better if you get the initial picture in your mind from your report of what you felt this patient could do when you saw him, and now you can take some pictures and compare it, as opposed to trying to do the reverse.


Dr. John Alchemy: Got it. Well Phil, thank you so much for joining us today and giving us your experience and ideas on the sub rosa.


Phil Walker: Thank you, it was my pleasure, and thanks for having me.


Dr. John Alchemy: And again, this has been Dr. John Alchemy. Today is March 5th, 2016. To learn more about California workers’ comp, come please visit us at rate-fast.com, click on the Blog, and we’ll see you there. Thank you.

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