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“Evidence Based Evaluation…Don’t Leave Home Without it.”
The Arcon / VerNova FCE
in Action
Alan Blitzblau
Arcon / VerNova
1. Trend of Disabling Injuries
• All Classes- 19,300,000: 52,900 /day
• Home- 6,800,000: 1 every 5 seconds
• Public- 6,500,000: 1 every 5 seconds
• Work- 3,800,000: 1 every 8 seconds
• Motor Vehicle- 2,300,000:
1 every 14 seconds
Source- National Safety Council 98
2. Difficult Nature of Claims
Back-30.1%
Upper Extremity-16.6%
Trunk-11.4%
Knees-7.4%
Ankles-4.3%
Feet-3.2%
Head-2.1%
Eyes-1.2%
3. Non-Scientific Evaluations
Evaluator produces report that has little or no value
No interpretation
No scientific basis to support results
WYSIWYG report
4. Fraud
Chronic Disability Syndrome
“Individuals who are capable of working but choose to remain disabled.”
Strang 1985
Arcon / VerNova Philosophy:
“The Focus of Evaluation
Should Be One of Identifying
a Candidate’s Abilities Not
Disabilities.”
Critical Evaluation Components
• A) The Tools - Standardization of tools and methodologies yields consistent, reproducible results which, in turn, determine outcome.
• B) The Protocol - Must meet all principles of Functional Evaluation. Should include a relational balance of Peer Reviewed Norms and Criterion Based Data.
• C) Education - The Evaluator is trained to be an objective observer, combining clinical judgment with specific assessment measurements and demonstrated symptoms and behaviors.
A) Testing Tools and Methodologies
Note: The hardware and software technology presented herein has been developed by Arcon / VerNova, and is proprietary to our clients.
• Strength
• Range of Motion
• Dexterity
• Cardiovascular
The Only University Recognized Functional Evaluation Protocol
• Historical Review
• Subjective Scales
• Physical Exam
• Physical Capacity
• Physical Abilities
• Interpretation/Summary
Claims Management Solutions
(Own Occ. vs. Any Occ.)
• Functional Requirement Evaluations, that test the job specific requirements to determine own occupation status
• Functional Capacity Evaluations that test the capabilities of an individual to determine any occupation status
Return-To-Work Evaluations
INJURED WORKER
RETURN TO FULL DUTY
DEMANDS MATCH
CAPABILITIES
ACCOMODATED DUTY
DEMANDS EXCEED
CAPABILITIES
JOB ANALYSIS
WORK TOLERANCE TESTS
JOB DEMANDS VS CAPABILITIES
ACCOMMODATED DUTIESRETURN TO FULL DUTIES
52% Legal Involvement
SOURCE-AMERICAN BAR ASSOCIATION
• More Litigation than Ever
• Better Prepared Counsel
• Need for Objective Data
It is far easier to write a letter supporting a
patient’s claim for disability than it is to explain
why the patient could be working but is not.
Legal Support
Daubert Decision
• Medical Professionals can no longer stand by their credentials only - their opinion needs to be supported by scientific data.
• Arcon / VerNova OBJECTIVE Functional Data meets the required rules of evidence.
Symptom Magnification
• Delayed Recovery
• Disability Behavior
• Illness Behavior
• Non Organic Signs
• Psychological Overlay
• Malingering
Symptom Magnification Facts
Patients on Compensation receive 2times more treatment than those
who are not.
However they show 33% less impairment
and they also show 4 times longer recovery periods.
Diagnostic and Statistical Manual of Mental Disorders 1994
Symptom Magnification Facts
54% of all claimants entering into treatment are considered to be symptom
magnifiers.
Studies indicate that between
5-7% of the non-organic population are malingering.
Posttraumatic Stress Disorder in Litigation 1995
Dealing with Symptom Magnifiers Reliability Checks
• CV’s
• Graph Formation
• Physiology Responses
• Non-Organic Signs
• Designed Protocols
• Cross Validation
Arcon / VerNova ApproachClinician “Carefrontation”
• Don’t passively accept WYSIWYG
• Document “Red Flags”
• Challenge inconsistencies
• Allow client the opportunity to be “honest”
• Stronger documentation if client refuses
• Allows for report of “true” abilities
Bernie Siegel, M.D.
Clinical Review
The Big 3
1. Referral Questions are Answered
2. Data Supports Conclusions
3. Legally Defensible Language
Pro-active Clinician Support and Quality Review
• Pre-evaluation
• During evaluation
• Post-evaluation
Primary Trigger for FCE
Secondary Triggers for FCE
Possible Action Steps with FCE Results
• Lack of progressive improvement with consistent treatment.
• Physician requests FCE as tool for determining clinical direction.
• Fraud suspected; referral to ISD.
• Documented activities contradict expected activities level.
• Days out of work exceeds maximum published days to recover for type of injury.
• To verify physical recovery.
• Subjective complaints do not match physician’s objective findings.
• Treating provider will not determine work capacity.
• RTW restrictions needed for case settlement.
• Claimant is frequently unable to sustain work at specified work restrictions.
• Lost time injury where light or restricted duty placement is difficult.
• Determine functional abilities and levels of effort of suspicious claims.
• Support physician’s finding and facilitate early return to work.
• Objective test to support evidence and / or to dispute other objective findings.
• Use results of FCE in comparison with surveillance.
• Use results as leverage in settlement negotiations.