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Best Practices For Litigating Chronic Pain and Fibromyalgia Cases

Avatar Of Rajesh Khanna



For many years, plaintiffs suffering from chronic pain and/or fibromyalgia have been subject to ridicule by insurers as well as the Courts. Some of the skepticism towards such plaintiffs was alleviated by the Supreme Court of Canada’s decision in Martin v. Nova Scotia (Workers’ Compensation Board, The Court stated:

“There is no authoritative definition of chronic pain. It is, however, generally considered to be pain that persists beyond the normal healing time for the underlying injury or is disproportionate to such injury, and whose existence is not supported by objective findings at the site of the injury under current medical techniques. Despite this lack of objective findings, there is no doubt that chronic pain patients are suffering and in distress, and that the disability they experience is real… Despite this reality, since chronic pain sufferers are impaired by a condition that cannot be supported by objective findings, they have been subjected to persistent suspicions of malingering on the part of employers, compensation officials and even physicians.”

Personal injury lawyers for plaintiffs who suffer from chronic pain or fibromyalgia have been forced to develop and implement legal strategies to tackle the challenge of representing men and women who experience pain, often extreme pain, when the basis for their pain experience cannot be proven by an objective test such as an x-ray. Whether in the context of a lawsuit involving a third party insurer, or a long term disability (“LTD”) policy with a first party insurer, lawyers depend on the use of experts to assist in demonstrating that their client is suffering from a serious condition, or disability, that is impairing their ability to work and live their lives without constant pain. It is important for lawyers to understand the difference between strategies for proving disability in the LTD context from those cases involving third party insurers. In either context, choosing the best medical experts to evaluate the client and knowing how to use them to most effectively advance the client’s case are essential components of any personal injury law practice. Since every client is unique and because chronic pain and fibromyalgia are essentially subjective medical conditions, each case will require its own strategy based on the unique circumstances of the particular client. In order to provide their clients with superior legal representation, lawyers handling LTD cases must have a firm understanding of the definitions of both chronic pain and fibromyalgia, the knowledge of what it means to be suffering from these conditions and how to treat them, the ability to consult the medical experts best suited to evaluate and report on chronic pain and fibromyalgia and the skill and expertise to successfully represent their client suffering from chronic pain and/or fibromyalgia through the litigation.

The Difference between LTD and Third Party Insurer Cases

It is important to note that a significant difference exists between a lawsuit involving a third party insurer and an LTD case. Where the former involves an action arising out of a specific event such as a motor vehicle collision or a slip and fall accident, an LTD case is less focused on a “before and after” analysis. In non-LTD actions involving pain-associated disorders, lawyers litigating these cases must possess a complete picture of the plaintiff’s pre-accident history. Acontrast must be drawn between the plaintiff’s life prior to the accident and the significant changes that have occurred since the accident in areas such as physical and mental health, employment, recreational and social activities and personal relationships. For the lawyer to gain an understanding of what the plaintiff’s life was like prior to the accident, he or she must obtain and review the client’s pre-accident clinical notes and records from their family doctor(s) and the client’s decoded OHIP summary. In the non-LTD context, some of the most challenging cases to prove causation are those where the plaintiff already had a history of medical complaints prior to the accident giving rise to the lawsuit.

In LTD cases, a claimant’s medical history is much less of an issue, unless of course a policy is being denied due to misrepresentation(s) on the application for LTD benefits. In LTD cases, the issue is often whether or not the claimant meets the definition of “disability” in order to qualify for benefits under the policy. For lawyers, much time and energy can be saved because medical histories do not have to be extensively reviewed in preparation of Discovery, Mediation or Trial. In LTD cases, the emphasis for lawyers is on how, with the right evidence, one can prove that their client should qualify for benefits under the specific policy. The focus is more geared towards the present and future, with less of a concern for the past. This is why lawyers must know which medial experts are most suitable to provide evidence to demonstrate why their client is entitled to benefits under an LTD policy.

Understanding the Medical Terminology

Pain is defined by the International Association of the Study of Pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (Merskey and Bogduk 1994). Chronic pain is a serious health care problem in North America. Chronic pain is often associated with soft tissue musculoskeletal pain disorders such as whiplash, low back pain and repetitive strain injuries that have not and may never subside over a person’s life. Fibromyalgia can be thought of as a form of chronic pain. The majority of fibromyalgia sufferers are permanently injured and many never return to work. Most fibromyalgia sufferers are not able to enjoy the same quality of life as before they began suffering from the condition.

It has long been understood that chronic pain cannot be proven by objective evidence. Therefore, the evidence that has been relied upon by the Courts is subjective evidence, which is a combination of the plaintiffs’ verbal description of their pain and their doctors’ description of the pain. The inability to provide objective evidence to demonstrate chronic pain and fibromyalgia emphasizes the need to retain doctors experienced in diagnosing and treating these conditions to provide the reports for the clients. What distinguishes a condition like cancer from chronic soft tissue pain disorders is the ability to turn to radiographical structural abnormalities accounting for the pain. As technology continues to advance and the search for objective evidence of pain becomes more possible, the use of CAT scans and MRIs in advancing chronic pain cases may become more common. However, the usefulness of these diagnostic tests to prove chronic pain and fibromyalgia at this time is uncertain. Part of the problem is that when scanning the cervical and lumbosacral spine, CAT scans and MRIs frequently demonstrate structural abnormalities in asymptomatic individuals and yield normal results in symptomatic individuals.

Clients diagnosed with fibromyalgia may also develop other conditions such as anxiety disorder, sleep disorder, irritable bowel syndrome, fatigue and/or depression. Psychological disorders are common among individuals suffering from chronic pain and fibromyalgia. Chronic pain sufferers often demonstrate a combination of symptoms including physical, psychiatric and psychological issues. It is important for the lawyer to explore the interaction of these three variables (as well as others) and how each contributes to the particular client’s overall diagnosis as a chronic pain or fibromyalgia sufferer. In chronic pain sufferers there needs to be a determination as to whether a particular psychological feature is in fact causative of the pain or whether it occurs as a consequence. The fact that psychological disorders are frequently encountered in association with chronic pain has not been adequately explained. Therefore, depending on the client, it may be cause, effect or both. As our understanding continues to grow, we have come to appreciate that the relationship is complex but trending more towards chronic pain leading to psychological disorders than psychological problems causing pain. However, there is a widely held belief that has not been refuted, that psychological difficulties may serve to exacerbate chronic pain. The determination of cause and effect with respect to these variables must be explored and reported by the medical experts in each case.

Doctors Best Qualified to Diagnose Chronic Pain and Fibromyalgia Disabilities

When searching for the right doctors to diagnose chronic pain and fibromyalgia, it is important to set up medical and medical/legal assessments with experts who are not only well-respected, but experienced and knowledgeable in the areas of chronic pain and fibromyalgia. As a result of the problems associated with the inability to demonstrate the conditions objectively, there are doctors who will dismiss chronic pain and fibromyalgia as not being “real” problems or conditions at all. If a lawyer is unsure about a particular doctor’s stance on chronic pain, he or she should consider speaking to the doctor prior to an appointment, or inquire with colleagues to determine if the doctor has provided them with useful reports on chronic pain clients in the past. Even a brief conversation with a doctor can provide a lawyer with a good sense of whether it would be useful for the client (and the case) to send the client to that doctor. In LTD cases involving pain-associated disorders such as chronic pain and fibromyalgia, lawyers should hesitate to immediately send their clients to orthopaedic surgeons for medical/legal reports. While their expertise in broken bone cases is invaluable, they will have to overcome the reality that objective findings can be elusive in chronic pain cases. It seems that in a chronic pain case, an orthopaedic surgeon is a doctor who the insurer would want the client to see for an assessment. Another reason to stay clear of orthopaedic surgeons in chronic pain cases is that they rarely treat chronic pain patients in their practice. Most orthopaedic surgeons refer chronic pain sufferers back to their family doctor or other specialists who treat chronic pain.

Clients suffering from chronic pain and/or fibromyalgia should be referred to physiatrists and/or rheumatologists. These types of doctors are best suited to diagnose, evaluate and report on these serious conditions. Their training is geared towards understanding these conditions and their opinions can go a long way to proving the severity of these otherwise ‘invisible’ conditions. A psychologist may assist in tying in the psychological aspect that exists as a result of the chronic pain. A vocational expert should be consulted for his or her opinion on the client’s future employability.

Successful Strategies for Communicating with Medical Experts

It is essential to provide the medical expert with any information which may help them formulate an opinion or diagnosis of a particular client’s disability. While historical medical data of the client may not be necessary to show how a particular accident affected the client, it will certainly give the doctor an important background into the circumstances of the client’s life. Just as a lawyer offering to review a potential case will require as much relevant information as possible in formulating an opinion, a doctor should be equipped with any relevant medical information pertaining to the client, including his or her medical history. No doctor will be able to draft a complete and detailed expert report without being provided with sufficient medical documentation prior to the assessment. The doctor may only spend an hour or two with the client (patient), so providing doctors with the tools to adequately prepare for assessments is vital. Above anything else, a lawyer must make it clear to any medical expert the purpose of the assessment and what the goal of the assessment is. In the third party insurer context, the question is often one of whether the client meets the verbal threshold for a permanent and serious impairment of an important bodily or psychological function. In LTD cases, the doctor should have a clear understanding of what he or she is to report on. Generally, the focus will be on whether the claimant is suffering from a disability and what the impact of that disability is on the claimant’s ability to work.

If a lawyer is sending a client to a vocational expert, the expert should certainly be provided with the client’s complete employment file, including a detailed job description and any other information regarding the work history. As in the case of the medical expert, the vocational expert must be advised of what he or she is to report on for the purpose of the assessment. This may depend on the wording of the particular LTD policy. This is especially important in chronic pain cases.

Duty to Mitigate?

While many LTD policies may be silent with respect to mitigation of damages, Canadian Courts generally impose a common law duty to mitigate for lawsuits involving a breach of contract or tort if the LTD policy is silent in that regard. That is, the aggrieved party must take all reasonable steps to mitigate the loss and cannot claim for avoidable loss. A plaintiff cannot sit back and allow his losses to accumulate and then expect to recover damages for losses he ought to have avoided.

Thus, in a breach of contract claim such as one involving an LTD policy, the damages for breach are reduced by the amount of the loss that should have been avoided if the plaintiff had taken reasonable steps to mitigate. The failure to mitigate is not a bar to recovery, it merely reduces the claim. In the LTD context, a Court may either fix a percentage and reduce the recovery by that percentage or it may rule that payment of benefits should have ceased at the time where the plaintiff was able to mitigate his loss.

The case of Martin v. Mutual of Omaha Ins. Co. presents a similar situation. Here a 46-year old woman labourer was unable to return to work on the production line due to pain and swelling in her legs. She was diagnosed as having soft tissue rheumatism, and she felt that all available treatment was doing her no good. All attempts at rehabilitation had failed, and the prognosis was poor. The Court found the insured to be entitled to continuation of payment of benefits. Although she had a duty to mitigate her damages, the likelihood of success in her rehabilitation was not high and her claim was not reduced by her failure to enter therapy.

A different result occurred in Flewelling v. Blue Cross Life Ins. Co. of Can. where the insured suffered from chronic fatigue syndrome and was found to have been totally disabled as of a certain date. The Court concluded that it was possible that if the claimant had taken the treatment suggested by her physicians, including a course of psychiatric treatment, she would have not become totally disabled. However, the insured did not seek out that form of treatment and allowed herself to be totally disabled. The Court was satisfied that she failed to mitigate her losses by not following the medical recommendations she received. The Court found that she would have been able to return to work approximately three months after her total disability date.

What about the claimant who delays in seeking out medical treatment? Courts have found that claimants who delay or wait years before seeking out medical help have failed to mitigate their damages. And if the claimant’s condition has worsened due to the delay, then the claimant may substantially have reduced his or her claim.

Litigating the Case

While it can be difficult to demonstrate that a client is suffering from chronic pain or fibromyalgia, another challenge is to convince a judge or jury that such pain-associated disorders are disabilities. Before a case goes to trial, the lawyers for both parties know not only the case but also the other side’s position on all the issues. The system is designed to prevent surprises. In the discovery phase, a lawyer will ask questions under oath of the adverse party. This form of oral testimony provides both the plaintiff and defendant with the clearest view of anticipated trial evidence. The views of the deponents become “locked down” and difficult to alter later during trial. Keep in mind that the defence will attempt to use the examination to undermine your client’s credibility by obtaining admissions, which are contrary to your case or commit your client’s evidence so that it can later be contradicted through expert opinions or surveillance. It is vital to any case that the client is fully prepared for the discovery process. A preparation meeting that includes a practice session will give the client an opportunity to experience a simulation of what the actual discovery will be like.

As any case progresses, it is a good strategy for lawyers to develop a theme. The theme is the word or phrase that constantly reappears in the litigation to focus the jury’s attention upon what the case is really about. Possessing a developed theme will not only help a lawyer prepare for trial, but will provide him with a concise overview of the case that can be utilized and referred to at a mediation or pre-trial. Selecting one or more themes is of crucial importance. Themes are like magnets, which constantly attract notice. They must be designed to trigger both rational and emotional responses in jurors. In formulating trial themes, lawyers should focus upon facts, which may be expressed using high impact language, and illustrated by high quality demonstrative evidence. Themes that emphasize “employability” issues would obviously be useful in LTD cases where the burden on plaintiff lawyers is to prove that their client has a disability.

Updated Recent Ontario Case Law

(Below are some brief outlines of recent decisions involving chronic pain and fibromyalgia)

1) Halbot v. Little [2003] O.J. No. 5514

  • 37-year old female plaintiff in a motor vehicle accident in 1998.
  • Chronic Pain – Emotional and Physical.
  • General Damages: $70,000.00 (less applicable deductible of $15,000.00 at the time).
  • Special Damages: $500,000.00 for loss of future income and $12,407.00 for past income loss.

* In this case, the Plaintiff’s credibility was key, and helped the judge reach his decision in light of conflicting evidence from Plaintiff medical experts and defence medical experts.

2) Place v. Ali (2007 CarswellOnt 4134)

  • 23-year old female plaintiff injured in a rear-end motor vehicle accident.
  • Injuries to her neck and upper back, to her low back and hip area, and an inner ear injury. She was left with chronic and permanent pain in her neck, back, shoulder and hip.
  • As a result of her physical injuries and their failure to resolve, plaintiff developed a psychological injury consisting of a major depression/adjustment disorder. Because of the chronic physical pain, plaintiff would be more prone to suffer a recurrence of her depressive mental illness in the future.
  • Plaintiff’s injuries would substantially interfere with her enjoyment of life and with her ability to do the many things required as a young mother and wife. There was a significant possibility that her ability to find and maintain employment would be compromised. She would continue to suffer from chronic physical pain.
  • Borkovich J. awarded the plaintiff general damages in the amount of $125,000.00, as well as $250,000.00 for loss of future earning capacity.

Borkovich J. stated:

“With respect to the plaintiff’s physical injuries, I find soft tissue injuries to her neck, shoulder, low back and hip are chronic and permanent. With respect to the psychological injuries, I find that as a result of her other physical injuries she suffered a major depressive illness. Given the chronic physical pain she suffers from, she has become more prone to a re-occurrence of the depressive mental illness.”

3. Abel v. Hamelin 2007 (CarswellOnt 3108)

  • 48-year old female plaintiff, working as a health care aide.
  • Injured when she was struck by a vehicle while crossing the street.
  • She suffered relatively minor injuries in this incident, yet seven years later, she was substantially disabled from a combination of a chronic pain condition, depression and significant cognitive impairment (the causes of which were contested vigorously).
  • Plaintiff exhibited symptoms of soft tissue injuries. Her knee was swollen and her shoulders exhibited a reduced range of motion. Her condition did not improve over time, and her level of functioning had deteriorated significantly due to musculoskeletal problems caused primarily by the accident, depression over her chronic pain and her poor quality of life and an overarching cognitive impairment.
  • The cognitive impairment was a pre-existing condition which prevented her from effectively remediating her physical complaints or from developing any insights into or effective coping mechanisms to deal with her cognitive limitations.
  • Nevertheless, her cognitive problems had been significantly exacerbated by her accident-related chronic pain syndrome. Her quality of life had been seriously and permanently impaired.
  • Hackland (C.T.) J. awarded plaintiff general damages in the amount of $120,000.00, as well as $123,140.18 for loss of future earning capacity.

4. Garratt v. Orillia Power Distribution Corp. (2006 CarswellOnt 2328)

  • Female plaintiff, a freelance cleaner, was injured as a result of a motor vehicle accident.
  • Prior to the accident, plaintiff suffered back problems, neck problems, type-II diabetes and thyroiditis.
  • These pre-existing conditions did not contribute to her post-accident level of dysfunction.
  • As a result of the accident, plaintiff was left suffering from problems with her neck and back, as well as headaches. She had less energy and had developed chronic pain. This affected her life dramatically and made her a totally different person. Her chronic pain and disability had seriously inconvenienced her.
  • The pain had reached maximal medical recovery and her pain was constant and disabling. Her problems were particularly disabling because her job required much lifting and standing. The consequences of these injuries did and would continue to have an effect on her health and ability to enjoy the normal activities and pleasures of life including recreational, social and work-related activities.
  • Prior to the accident, plaintiff and her husband had an active life. They enjoyed walking and camping, hosting family events and dancing. Their formerly active sex life became non-existent. The accident caused quite a bit of stress in their relationship.
  • J. Ferguson J. awarded plaintiff general damages in the amount of $63,750.00 and the husband damages for loss of care, guidance and companionship in the amount of $17,000.


Things to Know Before Buying A Business – A Buyer’s Perspective

Avatar Of Rajesh Khanna





In the previous chapters, we talked about sellers who are in the process of considering a sale. The focus in this chapter starts instead with the BUYER, and then moves on to look at the big picture aspects of the PRICE.

A critical question worth repeating as we move on to rules for buyers is: Do you really have a willing seller? Or, is the seller so emotionally tied to the business that no buyer will ever actually be good enough to pass muster? Is the seller reluctantly willing to sell — but only if the price/terms are unrealistically high?

Potential sellers should think these things through very carefully before spending a lot of everyone’s time and money on a seemingly desirable deal that is unlikely to actually take place.

Once it becomes apparent to you as a potential buyer that the seller is not really ready to sell, then it’s time to politely walk away. Don’t burn your bridges though; the seller may very well be more ready at some point in the future and you can resurrect the deal at that point. Just don’t waste time and money before the overall timing is right.


The following rules are presented from the buyer’s standpoint, but sellers should be acutely aware of these things too:


The first rule for buyers is: Know what YOU are looking for. Buying a business is risky, expensive, and a LOT of work for the buyer. Do your homework first.

*Not every business is worth the same to you as it is to other potential buyers.

  • What business would fit the best with what you already own?
  • What can YOU bring to the table to enhance its value after the purchase?

In other words, what business can you buy that will result in a 1+1 = 3 scenario? (or even 4?)

  • This is so important, that if the resulting effect of 1+1 is not more than 2, then perhaps you should not buy it at all.


Another rule for buyers is: YOU are for all practical purposes “selling” yourself personally and/or your existing company to the seller at this point as well. That’s because if you really want to buy that target business, someone else probably does also. It’s about a lot more than just price and terms.

So, why should this seller sell to YOU?

*Be ready to sell yourself and/or your company as the most appropriate buyer for that particular business.

  • The seller is almost always looking for a buyer he or she feels comfortable with personally and believes will take proper care of the business, its employees and its customers post-sale.
  • If you fail this unspoken test, you can lose the opportunity before you ever get to issues such as price and terms.


The third rule for buyers: Be ready.

Be ready financially — a strong balance sheet, good banking relationships, and enough uncommitted cash flow with which to do the transaction are essential. Be ready with your own time — if your time is already fully committed, how are you going to handle the additional management burdens?


Another rule for buyers: Consider the basic steps in a business sale.

  • Is there a business broker involved, and if so, on which side does their allegiance lie? Which party pays the commission? If I as the seller sign a listing agreement, can I get out of it, and how long does it last? What if I bring the buyer to the table myself, do I still owe a commission to my broker under an “exclusive right to sell” agreement?
  • Can or should both sides use the same attorney or C.P.A. in order to save professional fees?
  • Should you sign a confidentiality agreement up-front? At what point?
  • Will this deal be seller-financed in whole or in part, or do I need to get a banker on-board early and see if financing is available beyond what cash I have for the down payment?
  • Am I willing to personally guarantee all or part of my company’s promissory Note to the seller for the balance of the purchase price, or to pledge additional collateral?
  • How much cash will I need for working capital until the cash flow situation in the new business settles down following closing?
  • Do I need a business valuation, and if so should it be a full-blown appraisal or just an opinion letter? Will my banker require an appraisal in order to loan me the down payment or all of the purchase price as the case may be?
  • What role does a letter of intent (an “LOI” or “terms sheet”) play? What kind of LOI should you create? Should it be binding on both parties or non-binding, or should only portions of it be binding?
  • Will the seller request a good-faith cash deposit up-front, perhaps paid into escrow? Refundable or non-refundable?
  • What due diligence is needed, and when, and should the other party pay part of the cost if they back out prematurely for no good reason?
  • What contracts are likely to be needed, and which side should have the subtle advantage of drafting first and controlling the documents (customarily the buyer, since it has the most risk in how the transaction is structured and written up)?
  • What should you expect at closing?
  • Will an independent third-party professional escrow be necessary for the eventual closing?


The fifth rule for buyers: Know the legal basics.

  • What are the crucial legal distinctions between an “asset sale” and a “stock sale” that will determine the overall structure of the entire deal?
  • What additional risks do I effectively assume if I buy the stock of the seller’s corporation, as opposed to buying the assets out of that corporation and thereby shedding most of those risks?
  • What to do with the employees?
  • What about a non-compete agreement with the seller entity as well as the individual owner(s) thereof, or with key employees of the target business who might leave following closing and go right into competition with the very business you just paid a lot of money for; or
  • Does the target company already have those crucial non-competes in place with key employees, and if so are they enforceable and transferable?
  • You need to know the basics, but you will definitely need professional help to get this right.


Another critical rule: Know the tax basics!

  • If I personally buy the company’s stock from the seller, I’ll have no tax deductibility on the purchase price. Does that matter to me, or would I rather have that higher tax basis and thereby pay less tax when I re-sell the company sometime in the future?
  • Or, should I have my own company buy that same stock instead? Can my corporation or LLC buy stock in another without causing serious tax consequences?
  • Am I comfortable with the hidden or unknown risks in this industry or this particular company that come along with a stock purchase format, including the risk of prior taxes unpaid or under-paid by the target corporation; or do I want to insist on an asset purchase format instead and thereby try to “shed” most of those potential liabilities? Can I mitigate that risk by having the selling stockholder indemnify me for all or part of those taxes, interest and penalties, or even other unknown and/or unexpected exposures?

Never forget, there are three parties to every business sale — the seller, the buyer and the IRS. A sale can be a lose/lose/win (guess who the losers are… ); or, the same sale can be re-structured to constitute a win/win/lose. If there is a “loser” in this deal, you want it to be the IRS.

  • The taxes on sale of a business can exceed 50% of the total sale proceeds if the sale is structured wrong!
  • The seller can even end up owing more to the IRS at the front end than he receives as the down payment from the buyer… a particularly unfortunate (and generally avoidable) result of poor tax planning.
  • You don’t need to be a tax expert; but you do need to know there are ways to mitigate this kind of tax disaster and also be able to point the seller in the right direction for professional help.
  • You need to be willing to work with the seller to resolve what may be critical issues to the success of the sale.
  • You need to know the basics, but you will need professional help to get this right.


The seventh rule for buyers: Know how to use your own professional advisors, and when to bring them into the picture (earlier is better, even up to a year or more under some circumstances).

  • CONTROL your professionals in order to keep expenses down and prevent them from killing your deal. It’s YOUR transaction, not theirs. Get advice from them, but do not let them renegotiate the sale.
  • Keep relationships cordial. You will almost certainly need help of some kind from the seller after the sale closes, so don’t let your professional advisors poison that well.

MOST IMPORTANTLY: The most important rule for buyers (and for sellers too for that matter): The sale must be perceived as a “win” on both sides. In most cases, neither side is compelled to do the transaction. If either side concludes that the sale is a “lose” for them, then the deal is likely off at that point.

Special Situations

Some special situations will be covered in more detail in later chapters but deserve a brief mention now:

Internal Sales

Many business owners would love to sell their company to their key employees, but they don’t think it’s possible. The most frequently cited reason is “but they don’t have any money.”

You work with these key employees every day. You probably already know they have the basic talent to run the business, or you would not even consider selling to them. They may already have been running it for many years already from a practical standpoint. Only money seemingly stands in the way.

The fact is, the money issue can almost always be handled to everyone’s satisfaction. The REAL key issue is instead, “Do they have the fire in the belly, and the risk tolerance, to be an entrepreneur?”

The heart of an entrepreneur is an intangible that can’t really be measured or pinned down; but if your key employees have what it takes to be one, then you can probably arrange win/win terms that work financially for them and give you a better long-term after-tax price than you could receive from an outside third-party sale.

As always, YOUR expectations need to be reasonable. Just as with a third-party sale, the price and terms must “pencil-out” for the buyers in any internal succession. The down payment is likely to be less, and the seller financing will probably run for more years. Terms are likely to include a way to split the fruits of future success.

We’ll discuss this more in subsequent chapters, but suffice it to say that if your key employees have what it takes to succeed after you are out of there, then internal succession can be your best exit strategy financially. It can also be an excellent way to attract and retain top-notch employees with an expectation of participating in the buying group and a way to ensure a satisfactory sale of your business when the time is just right in the future.

Family Sales

Family sales are a particularly difficult kind of internal sale. All the usual considerations of internal succession apply, plus uniquely complex tax considerations.

The IRS is deathly afraid parents will do something nice for their children. So an entire chapter of the tax code is devoted to making sure the IRS gets its “fair” share (they consider about half the total value of the business to be “fair”). Needless to say, this adds to complexity.

Intra-family dynamics can be even more complex. Just because a child has the talent, does not mean that he or she has the experience to run the business. And talent + experience still do not mean the child has the intangible heart of an entrepreneur. Even establishing the price can be more difficult than in an arms-length sale since a child can find negotiating with a parent over price and terms to be essentially impossible.


What about “Price”?

Ultimately, the “Price” must be justified by (i) the future cash flow the buyer can reasonably expect from the acquired business, and (ii) the risk the buyer must take in order to receive that cash flow.

But “Price” is much more than just money to a seller. It can even be seen by him or her as a reflection of their individual worth as a person. A buyer overlooks this only at their great peril.

Starting the conversation with comments designed to push down the price can be fatal to an emotional negotiation like this. You are not haggling over the price of a car here. “It will have to pencil-out, of course, but it’s probably worth quite a bit…” is often a good starting point comment for you as a buyer.

Emphasize creating a “win/win” transaction overall. Remember, the seller most likely does not HAVE to sell, and likewise you do not HAVE to buy. As soon as either party perceives the transaction to be a “lose” for them, the sale will die.

An emphasis on AFTER-TAX cash to the seller is also extremely helpful. Thanks to our overly-complex tax laws, it is often possible to restructure a sale with a lower stated “price”, but more actual after-tax cash for both the seller and the buyer.

An “all-cash” deal is low risk for the seller, but much riskier for the buyer. Therefore, the price is almost always significantly lower in an all-cash transaction in order to compensate for this mismatch in the risk area.

What about payment terms?

Terms are not as emotional, but in a practical sense can be even more important than price. In fact, your authors are fond of saying “The price is not the price… terms are everything!” Terms determine how the sale will “pencil-out” for the buyer. For example, seller financing over a period of 10 years is much easier for the buyer to pay for out of ongoing cash flow from the business, and thus justifies a higher price.

Terms can also dramatically affect taxes for both sides. Since it only counts if you get to keep it, this consideration alone can be more important than price.

Terms affect the risk for both sides. Terms so stiff that the sale cannot possibly pencil-out will obviously raise the risk for the buyer. Less obvious, the seller may incur more risk from draconian terms like this as well. An upside down buyer is much more likely to look for an excuse to rescind a sale or some way to sue the seller for misrepresentation or a breach of the seller’s representations and warranties in the purchase and sale agreement.

Terms can be massaged to share the risk, thus lowering the effective risk for the buyer. Lower risk translates to a higher price. It is fairly common for part of the price to be dependent on future results and retention of business (called a partial “earn-out”), which is a great way to share risk and reward.

Other factors will affect the price as well. For example, do key employees have, or can you create at closing, enforceable non-competes (see our later chapter entitled NON-COMPETES)? What about major customer accounts? Will key vendors terminate their contracts when the “founder” of the business is no longer around?

What about the building occupied by the company? Does the target company’s owner also own that building? Is the Lease transferable, and/or how much longer will it run? Are there any options to extend or to buy the building and not have to incur major expenses in moving the entire business later on? Is the business owner a personal guarantor on that existing Lease, and will the landlord release him or her from that guarantee at closing or simply execute a brand new Lease with the new owner? Is rent likely to be raised post sale?

Finally, it’s not all about “Price” anyway. Price certainly matters; but is rarely the key to a sale.

A seller is likely to have other “hot buttons” that can make or break the deal. Some are obvious, such as how key employees will be treated post-sale in all respects. The seller may want to see to it that a couple of his “pet” long-term employees are retained for a number of years at the buyer’s expense.

Other hot buttons can be quite unusual. Your authors well remember a sale that hinged on providing a parking space on company property for the retiring seller’s yet to be purchased RV. The buyer initially balked, which would have killed the sale. It has been many years now since the closing, and the seller never did quite get around to parking his RV in that spot that seemed so crucial to him at the time.

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The Cyprus Real Estate Market

Avatar Of Rajesh Khanna



On the 12/1/08 Saturday Mr Antonis Loizou has given a lecture at Ayia Napa on behalf of the U.K. Alzheimer’s Society, which was attended by 120 mainly foreign residents in Cyprus. The subject was the Real Estate Market in Cyprus. We provide a shortened version of the speak.

Real Estate Investment, be it a house, land income producing property or development, has been so far a “safe” investment in terms of security of capital. Since 1974 prices have been moving upwards at varying rates p.a. Upto the year 2001, prices moved upwards on average 7% – 10% p.a., but since the Cyprus Stock exchange crash, investors interest turned towards real estate. Cyprus’ inclusion to the E.Union, coupled with the most favourable tax system in the E.U. and the Russia-Cyprus double taxation treaty, has caused Cyprus to attract an increasing influx of European and Russian interest, which has helped real estate investment in Cyprus.

The lifting of restrictions regarding property purchases by E.U. companies and citizens, has widened the scope of real estate investment and now, it is estimated that foreign buyers in Cyprus real estate contribute around CP700 mil. This is just short of the biggest foreign exchange earner, the Tourist Industry and its CP1.200 bill. p.a. and far ahead from the third biggest foreign currency earner i.e. the offshore companies contribution of around CP350 mil. p.a.

This keen foreign demand, coupled with the local interest as well as the added taxation on real estate, such as V.A.T. of 15%, has caused prices to move at a rate between the years 2002 – 2004 of around 15%p.a., whereas the very recent years prices have shot up by almost 20% p.a.

This is particularly so regarding building plots and land and more recently towards agricultural land. With prices of development land being so expensive and with the planning laws allowing the development of a single house just about everywhere, the public’s interest has been diverted with an increasing volume towards agricultural land, where prices have shown increases in excess of 30% – 50% over the last year alone.

This situation of high development land cost, converts now to around 40% of the total development cost of any house/apartment, whereas a couple of years ago, the land cost on a building sales price amounted to 20% – 22% only. This unhealthy state of affairs will get worse with the introduction of VAT on building land from 1st August, 2008.

So, when it will end and more importantly are we heading for a real estate crash? I doubt it. Since so far these substantial increases in property prices, have been absorbed by the public, be it, it has affected the rate of sale mainly for the less competitive projects making in part, the market, rather unpredictable and somewhat uncertain.

To this negative picture one must bear also in mind that various positive/balancing measures that are now in hand. The reducing interest rates [as for 1.1.08 from 4.5% this rate it is reduced to 4.0%] and the longer repayment periods of loans that are now offered have helped.

The new Central Bank measures regarding own contribution in buying or developing real estate which has increased the original contribution of 20% to 40% [for non own users – permanent residents] is expected to affect the “by to let” market, since returns/fields in Cyprus are very low [around 4% p.a.] and it is one of the lowest in the popular holiday home destinations in Europe, whereas high cost of air tickets etc. makes letting not as easy as in other countries [some balance may be gained when low cost air fair airlines are in full operation in Cyprus].

The pending new infrastructure measures such as the pending development of the two airports in the Island, the pending development of the 4 new marinas [expected to come around the year 2012] now under offer, as well as the expected 7-8 new golf courses, will add to the island’s attraction, making Cyprus, perhaps, the most densely area in Europe in terms of golf courses per population. On the other hand if these projects materialise [i.e. golf/marina/Larnaca port projects] they will place in the housing market [mainly directed towards the foreign people] around 10.000 new housing units in addition to the normal number which are now produced [approx. 5.000 p.a.] With the existing demand of around this number [5.000 units] and even considering an increase in demand due to the above infrastructure properties, the supply will surpass demand in the year 2010 -2015 with possible negative affects on the holiday home market prices.

Buying / building real estate/homes in Cyprus is easy, since it is the most popular business. At this point of time “Property Development” is carried out by just about everybody independently of qualifications, financial status, honesty etc. For this reason we note an increasing percentage of delays uncompleted projects, projects without a permit etc. and as such, care is needed. For this reason I have prepared for your consideration our firms “10 Building commandments” which every potential real estate buyer should follow as much as possible.

Buying in Cyprus is easy, but selling your property is another matter however. One must compete with the aggressive and well connected developers, well organised estate agents [some of which charge in excess of the legal 3% -5% – rates reaching upto 15%] so you must take into account not to be in a particular hurry should you want to sell your property.

As I have said before, real estate prices have recently moved upwards at a rate of 20%. This is partly due to the foreign interest which represents approx. 20% of the total real estate acquisition in Cyprus. This is a very high percentage especially where it is concentrated in certain areas. So care is needed since if you chose to invest in such popular areas of foreign people concentration, you stand a higher risk of price adjustments up and down, since foreign people behave differently than the locals whose demand/supply is inelastic.

The following table is quite an interesting one illustrating foreign peoples concentration [on a % of the total demand of the area]

Pafos Limassol Larnaca Nicosia Famagusta

90% 40% 50% 5% 50%

What are we going to do with the Russians my dear friends? As this country becomes more stable and as oil prices move upwards so the middle/upper middle income, Russian people will become more and more financially able and to turn their attention to the holiday home destinations. The average sale prices per for this type of property that the Europeans usually buy is in the region of CP1.500 – CP2.500 [max.] per sq.mts., the Russian market with a particular interest for Limassol, has even shown prices of CP4.000 – CP6.000/ for beach units.

With a mathematical calculation Cyprus beach and even the near the beach locations will be acquired by the foreign market and this is something which one must consider. Foreign buyers demand affects the local population whose income is not competitive to the foreign market and who is gradually outpriced.

This will create several problems, whole areas/towns will be inhabited by foreign residents, at periodic visits [see Sotira area west of Ayia Napa] and even the complete take-over of small villages and I dare say towns [see Pafos in 10 years’ time]. Ofcouse I am not against the foreign market and I know that Cyprus cannot go back to the restrictive system on foreigners real estate sale, so it is more of a theoretical approach than otherwise.

We live in a global economy and now with the E.U. travelling and settlement abroad will become easier and easier. Cyprus is at a fortunate position regarding the weather, be it with little drinking water, but in closing, I will say that yes, invest in real estate, but take care and do not outstretch yourselves financially. Do not depend on rental income to repay the loan, bearing in mind that you need around 10% of the 12 month income of a residence to cover repairs/void periods and management, in addition to any tax implications, including your tax liability in the event of a resale.

For those who are permanent residents however, my advice is try to learn some Greek words or even better, to speak the local language. I know that trying to learn Greek is most difficult [two types of languages, the written proper Greek and the local Cypriot speaking Greek – quite difficult]. If you manage to master part of the language, it will make your life much easier, although I am aware that even when you attempt to practice your Greek language skills, people will quickly reply to you in English.

If you manage to speak the language I can assure you it will make your life much easier/happier here.

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Pro Se Primer 101 – 3 – Constitutional Irreducible Minimum Requirements of Standing in Foreclosure

Avatar Of Rajesh Khanna




“Why put all of the blame on the attorneys? Hell, most of them don’t know the law.”

If you were to walk into a 2nd grade elementary school class room and see that all of the boys are standing on their desks shaking their butts, laughing and shouting, and throwing things at the girls in the class, who respond by screaming and running, and then you notice that the 2nd grade teacher is setting at his desk doing nothing to stop the chaos, would you really blame, the children?

No, it is the teacher who is charge of the room. If the teacher does not enforce the rules of classroom behavior, then the children will act like wild monkeys. How would they know not to?

It is no different than the judge in the court case who is charged with controlling and enforcing correctness in information and procedure in a court case.

If the judge does not enforce the constitution, which is all that keeps this country great;

If the judge does not make the attorneys prove their claims and/ or does not keep them from claiming transfers of ownership of essential Promissory Notes with assignments of incidental security instruments (mortgage or deed of trust) which do nothing but describe the collateral, then, of course the attorneys are going to forge and fake and lie, worse than wild monkeys;

Then lack of subject matter jurisdiction is the fault of the judge of the court. He or she places the burden of proof of standing on the borrower (very nearly every time), yet it very clearly is the burden of the court.

The judge promised when he took the job that he, or she, would enforce and protect the laws that come from the constitution and that they defend the court ferociously from losing the public trust. Maybe that was too much to ask from a pompous ass.

Why did we all expect more of judges and attorneys anyway?

If I am any part of the public, then I can tell you for sure, the courts have lost some of the public trust.

It is difficult to pull Borrowers back from their searches for Promissory Notes, Assignments of Mortgage, MERS, PSA etc., etc., thinking like Dick Tracy and looking for a way to “prove” that the party trying to foreclose on them does not have the authority, or, STANDING, to do so.

But, if what I say is true and the judges are letting the attorneys run amuck like the 2nd graders in my description, who can blame the attorneys for running amuck. “Amuck” is quickly becoming synonymous with the “actions of the courts”.

If you had seen judges simply ignore proof when it is presented as much as I have, then what I am really trying to say is that this whole thing is only about Standing and in constitutional law only the court (the court is the judge and the judge is the court.) has the initial burden of determining if the foreclosing party is a Plaintiff with Standing.

It is only the Supreme Court that has original jurisdiction over all issues of Constitutional rights. No state judge or local judge should claim that they have superior jurisdiction to the Supreme Court and it’s decisions.

The way it has been practiced for the last 15 to 20 years has been exactly the opposite.

The judges have been sitting up there on their hands on the bench and waiting for the Borrowers to describe what the foreclosing party was up to and forcing the Borrower prove it. These cases nearly always begin with the judge placing the burden on the Borrower to prove what the Foreclosing Party has tried very hard to hide. That is a ridiculous premise. John Adams, Thomas Jefferson and the rest thought so too.

If an act of fraud is working here, then by definition the act was meant to be kept hidden.

How would the Borrower prove or disprove something he was not privy to. It is the foreclosing party who must claim that he has been wronged by the borrower and it is this same foreclosing party that must prove it (not claim it) with evidence which is “concrete and particularized”.

So, the way it works in reality law is that the judge cannot even preside over a case until he reads what the Plaintiff (in judicial states and defendant in non-judicial states) has written in their lawsuit to make the claim that the court should hand them the deed to your home and that they should get to sell it and keep the money. How this has been allowed to happen illegally ten million times is a shameful disgrace for the majority of our judiciary. It is truly unbelievable. Not untrue, just unbelievable. (There have been many beautiful and sane rulings also, but it is nowhere near “fair” yet.)

It would be very difficult for me to show you how Challenging Standing s is supposed to be working, because no one is doing what I am doing, so it is still, in essence, only in my head. There are hundreds of citations concerning case rulings on the subject, but they are mostly contract law cases from other industries. Home Loans funded with a Promissory Note are all contract law, but no one is doing it enforcing them is the correct way as required by United States Constitution, the basis of all American law.

That doesn’t change how it works with your home loan, because contract law is what governs home loans.

So, since it is the judges burden to know that he or she has subject matter jurisdiction, which he needs to even begin the case, he must see the proof of standing the Foreclosing Party wrote in his lawsuit.

Borrowers, before anything else, you must first understand the proof that is required to establish Standing. If prooff has not been presented and the judge rules without Standing and therefore without subject matter jurisdiction, then he has broken the law and this is the only situation where a judge does not have “absolute immunity”.

If he rules against you, right or wrong, without having “subject matter” jurisdiction he has done so as a “civilian” and if has barred you from any of your constitutional civil rights, he is liable to you for any money or property harm that you have suffered. You don’t really sue the judge as a judge, you sue the man or woman who acted as a judge without the requirements needed to create a legitimate court with subject matter jurisdiction.

There was no legitimate court for any foreclosure case that I have ever seen. I have seen as many as anybody.

So, first things first. Review, slowly and carefully what the US Supreme Court has determined is the constitutional minimum requirements for Standing. The words they use is the strategic offense you will use to keep your house safe from anyone that you do not owe the money to.

Let me know if you can see how those words fit your situation. If not, we will go over them again before moving on, as to how and when we would apply them.

Below is an actual paragraph from my own motion to vacate a void judgment of foreclosure.

Plaintiffs have filed to Invoke their Rights to Challenge the Standing of the Defendants at any Time Under Article III of the United States Constitution earlier into this court case, yet this court failed to even mention or give any recognition that the court had even read the Borrower/Plaintiffs’ invocation of this fundamental constitutional civil right, which was foremost the responsibility of this court.

Plaintiffs state as follows and the court ignores at its own peril:

1.) That Article III of the Constitution of the United States and the Supreme Court have established a constitutional irreducible minimum set of requirements for a party in a genuine dispute to establish Standing. Without Standing of the Foreclosing Party, all courts in the land must acknowledge that the court has no jurisdiction to hear any merits of a case and must dismiss the subject action, in this case the void and fraudulent foreclosure of Plaintiffs’ property.

1a.) That only the United States Supreme Court has original jurisdiction over constitutional question issues.

(The decisions of the United States Supreme Court, whether right or wrong, are supreme: they are binding on all courts of this land, Hoover v. Holston Valley Community Hospital, 545 F. Supp. 8, 13 (E. D. Tenn. 1981) (quoting Jordan V. Gilligan, 500 2 F.3d 701, 707(6th Cir. 1974).

(The lower courts are bound by Supreme Court precedent, Adams v. Department of Juvenile Justice of New York City, 143 F.3d, 61, 65(2nd Cir. 1998)

(Walker v. Quality Loan Service Corp. of Washington et al., No. 65975-8-1)

(Washington State Supreme Court, Bain v. Metro. Mortg. Group, Inc., et al.175 Wn.2d 83, 285 P.3d 34 (2012))

2.) That the requirements in a case of Non-Judicial Foreclosure actions are:

1. The foreclosing party must claim and prove with concrete and particularized evidence that it has sustained and Injury in Fact.

2. This Injury must be fairly traceable to the foreclosed party with concrete and substantive evidence.

3. The court must be able to redress the injury with a ruling in favor of the injured party.

3.) That if it is the alleged foreclosed party that is the claimant party then it must also 1. claim and prove an injury in fact. 2. Its’ injury must be fairly traceable to the foreclosing party. 3. Its’ injury must be able to be redressed by the court.

4.) That the United States Supreme Court defines the requirements of Standing as:

3.1.B. The Constitutional and Prudential Requirements of Standing

Inherent in the constitutional limitation of judicial power on cases and controversies is the requirement of “concrete adverseness” between the parties to a lawsuit. The rise of public interest law litigation involving claims of non-economic loss has forced the Supreme Court to craft an analytical framework for determining whether the requisite adversity is present. The Court requires that plaintiffs establish that the challenged conduct caused or threatens to cause them an injury in fact to judicially cognizable interests. By establishing that they personally suffered injury, plaintiffs demonstrate that they are sufficiently associated with the controversy to be permitted to litigate it. The question of injury raises two questions –

(1) what kinds of injuries count for purposes of standing and

(2) how certain the injury must be if it has not yet occurred.

3.1.B.1. Injury in Fact

The Supreme Court has held that, to satisfy the injury in fact requirement, a party seeking to invoke the jurisdiction of a federal court must show three things:

(1) “an invasion of a legally protected interest,”

(2) that is “concrete and particularized,” and f

(3) “actual or imminent, not conjectural or hypothetical. The following section discusses several types of injuries considered by the Supreme Court in determining whether there is a legally protected interest.

3.1.B.1.a. Economic Interests

The Supreme Court has had no difficultly determining that economic interests are legally protected interests. More difficult is determining when economic injury that has yet to occur is sufficiently imminent and likely to confer standing. The Court has been relatively forgiving in this regard. Economic injury need not have already occurred but can result from policies that, for example, are likely to deprive the plaintiff of a competitive advantage or a bargaining chip. In Clinton v. New York, for instance, the Court held that New York had standing to challenge the veto of legislation permitting the state to keep disputed Medicaid funds. The veto left the state’s ability to retain the funds uncertain, subject to the outcome of a request for a waiver. Despite this uncertainty, the Court regarded the “revival of a substantial contingent liability” sufficient to confer standing.

3.1.B.5. Injury Fairly Traceable to the Challenged Conduct

In addition to alleging injury in fact, the plaintiff must demonstrate that the injury is fairly traceable to the defendant’s unlawful conduct. In cases in which the government acts against the plaintiff, causation is simple.

3.1.B.6. Relief Sought to Redress Injury

A corollary to the Supreme Court’s requirement for standing, that the injury alleged be fairly traceable to the challenged conduct is the separate requirement that the relief sought must redress the injury. In the great majority of cases the inquiry into causation and redressability are indistinguishable.

Thus, in Warth, the Court held that there was no reason to suppose that the elimination of exclusionary zoning would enable the plaintiffs to obtain housing in Penfield. In Eastern Kentucky Welfare Rights Organization, the Court held that there was no reason to think that revoking the IRS Revenue Ruling at issue would assure that the next ill or injured poor person would be admitted to a hospital.

Furthermore, in Allen, the Court held it was entirely speculative that revoking tax-exempt status for allegedly discriminatory private schools would serve to foster public school integration. What is peculiar about the Court’s concern for redressability is the elevation of the question of remedial efficacy to constitutional status.

While the scope of equitable relief to redress unlawful governmental action has long been a matter of controversy, not until City of Los Angeles v. Lyons did the Court clearly articulate the requirement of remedial efficacy as a constitutional component of standing. The plaintiff in Lyons sought damages and injunctive relief after being choked by city police officers. He alleged that the city permitted the police department to use unnecessary choke holds indiscriminately. The Court conceded that Lyons had standing to sue for damages. However, the Court held that he lacked standing to seek injunctive relief, as an injunction would not redress his injury because it was unlikely that he would be arrested and choked again.

You really aren’t trying to outsmart attorneys or that joke of an entity the foreclosing party. What you really want to do is to place the judge in as much of a pickle as you are in (jeopardy).

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When Did You Last Put Your Product Or Service to the Public Test?

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This was a great interview about what is so great with the consulting business. When you see parallel situations you can capitalize on, leverage and charge twice as much for, this is a great opportunity. We did the same thing; we came up with the reliability certificate and mailed it out to qualified prospects.

Before that we did some extra work on this one. We came up with a ‘return on investment’ comparison between our steam machine and the top competitors. We learned in the USP project that our steam machine lasted much longer in the field than all the competition. So we put together a little ‘return on investment chart’ that showed how much money our clients were saving by buying our steam machines.

It’s true we did extra work but that was the ‘key’ in helping us integrate this reliability and get the free report together. Now it is being offered on the web and by the distributors. This free report shows how our steam machine makes more money for customers than any other out there.

Now the sales people, four of them; inside sales people, are sending out free reports before they give any bids. They have dealers on the other end working with the end users and use that free report, plus the ROI analysis as part of the bidding process. That was huge integration in step 2. Getting those inside sales people sold on this report.

Then with step 3, the database. We started to get distributors using the report. We did more training around the USP and the ROI report. Alliances were also working with more distributors doing more marketing on their end. We went through the four steps and that finished about a year ago. Later Rich got an email from Jack the owner, and he said, “Richard, I just want you to know that we are having a record year because of our USP and because sales people are qualifying better, not wasting time on bids that shouldn’t be.”

So you see, a good USP is what you want. This helps eliminate prospects you shouldn’t be working with. What was happening here was the Steam people were getting burned out. Their engineering department, drafting, and design department was getting drained by bids that they should not have been submitting because these were all ‘price oriented’ buyers.

They didn’t care about an ROI on a steam machine. Once the ROI reports started being used by the sales people. For example; a guy would call and say; “I want a bid.” The sales person would say, “Before we do that bid, I need you to read this ROI report. Let’s go over it together first and see the advantages our machine has.” Guess what would happen if they didn’t fill out that report?

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How to Make Plastic Surgery Marketing Reach More Patients

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In this article, I’m going to show you how to creatively make plastic surgery marketing reach more patients.

The secret is to be compelling so patients who see it, want to share it with their friends and family. For example:

Facebook Live Cosmetic Treatment Video

This is How to Make Plastic Surgery Marketing Reach More Patients… Have your staff shoot a video performing a simple cosmetic treatment on a real patient. Do something simple like a peel, IPL or micro needling treatment.

Walk the audience through what you are doing and ask the patient how they’re doing so the viewers can see how easy cosmetic rejuvenation is to perform. Invite them into your practice for a complimentary skin analysis and urge them to share this video with their friends and family.

Urge the viewers to “comment below” so you can answer their concerns and questions. The interaction helps build interest and shares.

Word-of-Mouth Referral Program

Another Retention strategy that makes sense is a referral program.

There are many ways to do this but my advice is to KEEP IT SIMPLE. These programs bomb when they are too complicated and confusing to the patients and the staff.

A super easy referral strategy is a Customized Word-of-Mouth Referral Display with take-a-way Referral Cards because your patients would refer more often IF they were reminded AND it was made EASY for them to do so.

This strategy is How to Make Plastic Surgery Marketing Reach More Patients and generates new patients every week and makes it easy for your patients to brag about you to their friends.

So you’re not hoping new patient referrals come in – they just come in automatically because they are part of your plan.

YouTube Q&A with the Surgeon

How to Make Plastic Surgery Marketing Reach More Patients also includes YouTube videos. Start your own YouTube channel and answer questions you get from your patients. Don’t overthink this or over-prepare. Just talk candidly as if you are talking to a prospective patient asking you questions about the procedure they’re interested in.

After uploading each video, send an email out to your patient list with the link to click to watch it on YouTube. Name your video with a compelling question; I.e, How Long is Liposuction Downtime?

Now anyone online looking for the answer to that question will find your video.

The above strategies on How to Make Plastic Surgery Marketing Reach More Patients included internal and external marketing ideas to execute. You can either outsource to an experienced vendor who knows about graphic design and social media advertising or assign this to your most tech-savvy employee. They can “learn on the go” by researching forums and tutorials.

What To Do Next

If you want to focus on the right activities and get results 5X faster than other practices, download my free marketing checklist now!

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Is There Any Free Search Engines For Unlisted Phone Numbers?

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Is there a free search engine for unlisted phone numbers? NO, there is no free search engine for unlisted phone numbers but there are steps you can take to get the details behind any type of phone number with success.

Here are some of this steps :

Search engines : Search engines such as Google, MSN and Yahoo are very good places to do a free unlisted phone number search. This is because businesses and even individuals who do business online leave their unlisted phone numbers on their websites or blogs where the search engines can easily find and display them. This method is often ignored but it is a great way to get the details beholding unlisted phone numbers.

Downside : There is no guarantee that the owner of the number has done any business on the internet.

Answers community : This is not free search engine for unlisted phone numbers but it is a very good way of trace any type of number for free. You can join answers community such as and ask other members to help you get the details behind the number you are trying to look up. The chances of someone having a membership to some of the paid directories is very high

Downside : It can take you several days before you get the information you need and the chances of those who have membership to paid services not helping is also very high and you can’t blame them.

Paid services : Many people avoid using paid services because they wrongly believe it costs too much money to use this services. Fortunately, it is now very possible to find unlisted phone numbers with paid services for as little as $14.95.

The good thing about these paid services is that it is almost certain that you get the details you are looking for. Another great plus is that you will get the details under 5 minutes and you can be sure the information generated is accurate and up to date.

Some of the information you will be given include :

– Full name of the owner

– Their present address and all previous addresses

– Issuing location

– Carrier or telecommunication company’s name

– Date of birth

– Criminal records

– Marital status

– Home value

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