I learn something new every day, no matter how big or small. I love what I do and don’t see it as work.
A Day in the Life of Certified Legal Nurse Consultant Lori Sprenger
by Lori Sprenger, PhD, RN, CLNC
For the past year and a half, I have worked at a plaintiff’s law firm, specializing in personal injury, and I absolutely love the work. This is the only job where I feel like I work with my employer rather than for my employer. We synchronize well personally, and we both value communication. He trusts and values my opinion.
This is the first plaintiff’s firm I’ve worked for since I pursued a full-time career as a Certified Legal Nurse Consultant 4 1/2 years ago. My previous experience working in three defense law firms has definitely helped me work on the plaintiff side. I can confidently predict defense arguments and collaborate with the attorney on how to respond to such arguments.
On most of my cases I draft both general and more focused medical chronologies, which include analysis and research on pre-existing conditions and how the incident has impacted the plaintiff’s current condition. A common defense argument is that the plaintiff has a history of back and neck pain prior to a motor vehicle collision (MVC), and thus the opposing side is not going to pay a significant settlement. This is where my skills are crucial. I demonstrate that, while the patient did have pre-existing back pain and cervical pain, the MVC directly caused new injuries to the spinal column. Accessing radiology imaging and reports is vital to proving these facts. We also ensure we have all prior medical records, sometimes going back 25 years.
Besides working on current cases, I’m also responsible for reviewing potential new medical malpractice cases that come through the firm’s intake system. We also receive potential new clients from attorney referrals, and we work with the referring law firm to determine if the case is meritorious. We accept 1-2 cases for every 100 possible medical malpractice cases that come to us. The cases we reject usually don’t meet the criteria for damages and causation. Questions such as “Did the negligence cause the damages?” “What is the degree of damages?” and “Would earlier intervention have made a difference” help us to assess case viability. We also apply a negligence rating to provide a quantitative component to the merit review, aiding the attorney’s decision on whether to pursue the case.
Another part of my CLNC position involves locating consulting experts to review the cases we determine are meritorious. If the consulting expert agrees there was medical malpractice, we then search for a testifying expert. The firm uses a third-party vendor to find qualified experts, saving us significant time.
I enjoy working with the experts and managing all expert-related tasks. The attorney and I interview potential testifying experts virtually, take notes, ask questions and evaluate their qualifications. If they pass, we retain them. Then I send organized medical records and other materials for review. We then arrange a virtual conference call to obtain their verbal opinion. I keep an expert log of all materials produced to an expert, ensuring we have their most current CV, fee schedule and W-9. I correspond with the experts frequently to ensure they remain available to provide testimony.
A challenge of my current position is being pulled away from a case I’m working on when a new potential client comes in. I need to review a potential case immediately, which then pulls my focus away from a medical chronology I’m working on. I have collaborated with the intake team to ask potential clients more questions upfront and to explain issues, such as the statute of limitations. Sometimes, I’ll call potential clients and ask them to document a timeline of events, which is helpful for guiding my review.
Another part of the job is meeting with the attorneys and paralegals to focus on the details needed for mediation. For example, we are currently working on a case and want to highlight a significant increase in the client’s doctor appointments and pain levels since the MVC. I was asked to review the medical records and create two charts (one for pain levels and one for medical visits pre- and post-incident) to demonstrate the aggravation of injuries caused by the MVC. We are working with a litigation graphics company to develop a 2-D line graph to illustrate increased pain levels and increased medical visits pre- and post-incident. I provide the data for the visuals and use statistics (range, average, median, mode) to show overall pain ratings. This visual will be useful during mediation with the insurance company and, if the case goes to trial, with the jury.
We also had a case involving a craniotomy where a surgical complication decreased the client’s cognitive functioning. This was initially an MVC, which evolved into a medical malpractice case from a craniotomy to repair a defect. We collaborated with a litigation graphics company to create a 2-D brain visual, which was effective in demonstrating how the MVC and surgical complication negatively impacted this client’s outcome and long term management of a traumatic brain injury. These cases allow me to bring case facts to life by collaborating with the litigation graphics company.
My schedule is flexible. I can arrive at the law firm office between 8 and 10 am and leave between 4 and 6 pm. As a salaried employee, I can work from home to ensure I achieve 40 hours per week. If I don’t complete eight hours in the office, I finish at home. One of the pros of working on the plaintiff’s side is there are no billable hours. The work is busy, and I must be cognizant of time spent on tasks, so I track my time on cases even though I’m not required to.
I negotiated working from home two days a week and working in the office three days a week. There are pros and cons to both. Working remotely provides a mental break from rushing to get to the office on time. Once I’m in the office, being able to access the attorney immediately is effective for getting work done and getting questions answered. Not being a morning person, I sometimes work between 10 pm and 1 am, but this throws me off schedule and leaves me tired the next day. Thus, I strive to align my schedule with the typical 9-to-5 working world.
Working in a plaintiff’s law firm is highly satisfying for me. I learn something new every day, no matter how big or small. I love what I do and don’t see it as work. There’s always something to do, and new cases are consistently coming in. The clients are our main focus. Keeping clients updated is a high priority, ensuring they understand their case progress and can ask questions. They are why we do what we do. Our goal is to help clients during difficult times when they have been wrongfully injured and left to deal with devastating long-term effects or when they have lost a loved one to a wrongful death.
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