“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

Evidence Based Evaluation

Components

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

Static and Dynamic Strength

Pinch & Hand Grip Strength

Extremity Range of Motion

Total Spine Range of Motion

Occupational Tasks and Dexterity

The Only University Recognized Functional Evaluation Protocol

• Historical Review

• Subjective Scales

• Physical Exam

• Physical Capacity

• Physical Abilities

• Interpretation/Summary

Functional Evaluation Issues and Applications

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

Symptom Magnification Crosschecks

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.

Interpreting the Data

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

Report Summary and Conclusions

Picture of

Claimant

provided in

report

Verification of Information

Documentation of Performance

When to Order an Evaluation

Guidelines for Clinicians and Case Managers

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.