Our highly credentialed vocational rehabilitation and life care plan experts write about topics that are important and relevant to our areas of practice. If you have a vocational or life care planning topic you would like to learn more about, please contact us to request a blog post on that topic.
Tackling Life Expectancy in Life Care Planning
According to The International Association of Rehabilitation Professionals (IARP), life care planners evaluate individuals with disabilities or chronic health conditions to quantify the needs created by the disability or medical condition. The life care planner then develops an integrated plan that includes items and services required and the specific costs associated with these items and services.
According to the Life Care Planning and Case Management Handbook[1], “to accurately project lifetime daily, medical and rehabilitative care in a life care plan, an accurate prediction of life expectancy is needed.” However, there are no requirements in our standards of practice suggesting life care planners must calculate the actual costs through life expectancy. To calculate lifetime costs, a life expectancy and years of residual life must be selected to sum annual costs. Some life care planners independently provide a modified life expectancy based on the opinions of physicians or make assumptions using other resources. According to the IARP Code of Ethics, assuming invalid representations of fact, or altering the methodology or process without foundation or compelling reason, is unethical and could lead to inadequate funding for future resources.
When asked to comment on life expectancy, one option for life care planners is to use data from published reports such as the National Vital Statistics System. The Centers for Disease Control and Prevention (CDC) typically publishes this data annually. However, it is important to note that the most recent version (2022) is based on data collected from 2019 (each chart generally is two to three years behind due to data collection and research). These charts report life expectancy for the total United States population and life tables for males, females, and different races and ethnicities. Should a physician be unable to comment on the remaining years of life, life care planners can offer the option of using the least restrictive demographic category of male versus female from these charts as a courtesy to referral sources. Then the life care planner can provide the referral source with an estimate of lifetime costs before an economist adjusts the figures to present value.
Choosing a more specific life expectancy based on race, ethnicity, geography, co-morbidities, etc., requires the life care planner to make independent assumptions that could drastically impact the final lifetime costs. Therefore, we believe it is best to offer the least restrictive, binary male versus female life expectancies when this is requested. For example, what if an evaluee is of mixed race, has a history of heart disease, or is a smoker? These additional demographics and specific variables require assumptions that may not reach the more probable than not including criteria for life care planning. Furthermore, these assumptions may require medical opinions outside the scope of many life care planners.
[1] Weed, R. O., & Berens, D. E. (2019). Life Care Planning and Case Management Handbook (4th ed.). Abingdon, UK: Routledge Press.
Life Care Planning for Post-Traumatic Epilepsy
One common sequela of traumatic brain injury is the development of post-traumatic seizures or epilepsy. Post-traumatic seizures can result from secondary effects of head trauma, including cerebral edema, intracranial hemorrhage, cerebral contusion or laceration, alterations in the blood-brain barrier, or other neurochemical changes. The diagnosis and treatment of post-traumatic seizures represent specific challenges for life care planners to document reasonable future medical care.
In planning seizure treatment, the first challenge is confirming that the episodes experienced are actual seizures. The most common diagnostic test is an electroencephalogram (EEG). An EEG records brain activity during the time the test is taken. EEGs present a "snapshot" of brain functioning or epileptiform brain activity. The gold standard for diagnosing seizure disorder or epilepsy is to capture seizure activity on EEG that correlates to seizure-like behaviors. Infrequently occurring seizures may be challenging to capture on an EEG. When a precise diagnosis is elusive, physicians may order extended EEGs that last up to several days and videotape the patient to correlate brain activity with behavioral changes. Patients may have to be hospitalized to be observed as an inpatient in certain instances, especially if their medications are discontinued to increase the likelihood of catching seizure activity on EEG. Some nonepileptic events mimic seizures, including narcolepsy, Tourette's syndrome, convulsive syncope (body jerks after fainting), and pseudo seizures. Attention Deficit Disorder can also produce behavior mistaken for a seizure.
Once seizures are confirmed, the most common treatment is medication management, usually handled by a neurologist. Most neurologists work to titrate antiepileptic medications to a therapeutic level that reduces the occurrence of seizures while managing side effects. Classic side effects from anti-seizure medications can include dizziness, drowsiness, fatigue, aggression, irritability, depression, and loss of appetite. Occasionally, adjuvant medications such as antidepressants must be used to treat the seizure medication side effects. It is important for life care planning to include sufficient physician follow-up visits and laboratory testing to monitor medication levels and allow for trial and error with medications. Once seizures are controlled, patients can often have a good quality of life. However, seizure precautions may continue to be necessary, with activities such as driving, swimming, working around dangerous equipment, and working at heights.
About 30-40% of people who have epilepsy will develop what is known as intractable or refractory epilepsy, in which medications are not effective. The most common treatment for intractable epilepsy is a Vagal Nerve Stimulator (VNS) device. The Vagus nerve is responsible for regulating internal organ functions such as digestion, heart rate, respiratory rate, and certain reflexes like coughing, sneezing, and vomiting. A VNS is an implantable device designed to send electrical stimulation to the Vagus nerve as it travels to the brain. An incision is usually made near the left collarbone, and a thin device the size of a silver dollar is implanted. Electrical leads are run to the Vagus nerve, and the entire device and leads are sewn up under the skin. Periodic device replacement is necessary as the battery life diminishes and the technology is routinely upgraded. The life care planner should consider the costs associated with the implant and replacement of the stimulator (i.e., physician, facility, and technology fees) and include such in the life care plan.
Depending on the age of onset, treatment for trauma-induced seizures can be extensive and costly. Therefore, life care planners should consult with treating neurologists to discuss the ongoing needs of the evaluee and accurately fund for future care.
Actual, Expected, And Wage Earning Capacity
The typical assignment for vocational rehabilitation counselors in litigated personal injury cases includes the questions: “What was the plaintiff’s wage-earning capacity before the injury, and what is their wage-earning capacity after the injury?” Key to answering these questions are the concepts of actual earnings, expected earnings, and earning capacity.
Actual or demonstrated wages are historical earnings established through employment and compensation records such as social security earnings, tax returns, W-2 records, or pay stubs. In cases where there is an established work record, actual earnings can be a good measure of the pre-injury wage-earning capacity. Variables such as full-time versus part-time labor force participation and propensity to work are important in assessing whether actual or demonstrated wages are the most appropriate metrics for describing pre-injury earning capacity.
Expected earnings are estimated wages related to the plaintiff’s vocational profile. Expected earnings are determined based on the typical wages, usually given in a range, paid for occupations and jobs that a person could have worked in the past or can work in the future. For example, if a worker demonstrated the ability to earn $20 per hour in the past, we can expect they would have earned $20 per hour in the future but for an intervening incident. Expected earnings do not consider the worker’s efforts to maximize earnings by working the maximum number of hours at the highest-paid job they can perform.
Wage-earning capacity is the value an individual can expect to earn if they choose to work to their capacity. The estimates are based on the expected wages paid for particular occupations as determined through published statistical wage data and labor market research. However, wage-earning capacity is not always the maximum amount of wages related to an occupation in the labor market. Therefore, individual personal factors need to be brought into the assessment process.
The assessment of wage-earning capacity versus actual earnings should be used if there is not a well-established pattern of work suggestive of a history of working at capacity. For example, while finishing nursing school, an individual chooses to work in a nursing home as a Certified Nursing Assistant (CNA) and is subsequently injured. Their pre-injury earning capacity could be based on their demonstrated or actual wages as a CNA; however, it may be more appropriate to base the pre-injury earning capacity on the statistical wages for nurses.
The determination of pre and post-earning capacity is specific to the individual’s vocational profile, including age, education, training, work history, skills acquired and transferable skills, vocational test results, and physical and/or cognitive capacities. Therefore, vocational rehabilitation counselors need to consider the most appropriate method for communicating earnings in forming opinions regarding residual earning capacity.
Daubert Standard for Admissibility When Assessing Earning Capacity
When offering opinions regarding earning capacity, the vocational rehabilitation counselor’s testimony must be based on a reliable foundation. Specific requirements are outlined in the Daubert standards, which uphold that (a) a witness qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion if the expert’s scientific, technical, or specialized knowledge helps the trier of fact understand the evidence; (b) the testimony is based on sufficient facts or data; (c) the testimony is the product of reliable principles and methods, and (d) the expert has reliably applied the principles and methods of the facts of the case. In addition, under Daubert, the expert’s opinion needs to be based on scientific evidence that has been subjected to peer-review and publication.
A widely accepted method to assess earning capacity is the RAPEL method, subjected to peer-review and publication. RAPEL stands for:
Rehabilitation Plan
The Rehabilitation plan is based on evaluating the injured party’s vocational profile, including age, education, training, vocational test scores, limitations, strengths, and functioning.
Access
Access refers to the transferability of skills and experiences from prior occupations to alternate occupations and jobs in the labor market.
Placeability
Placeability is the likelihood that an injured person would actually be placed into employment in an occupation. Placeability is affected by many factors, such as the economic situation of the geographic area and availability of open jobs in the relevant market, combined with the characteristics of the evaluee determined by vocational rehabilitation evaluation.
Earnings Capacity
Earnings capacity is the actual comparison of what an injured person could earn before and following the onset of impairment.
Labor Force Participation
Labor force participation references work-life expectancy, lost time in the labor market, and any effects of part-time versus full-time work.
When applying the RAPEL model, the vocational rehabilitation counselor can ensure compliance with the Daubert standard for admissibility when assessing earning capacity.
Flexibility in Life Care Planning
Life care planners practicing in a forensic setting face constant challenges that require flexibility in everyday practice. Life care planners are routinely challenged on their methodology, qualifications, expertise, and the foundation to develop their opinions. Life care planning is an ever-evolving field, and growth and change are inevitable.
To establish and maintain credibility in the field of life care planning, life care planners must stay abreast of court decisions that affect the work they perform and constantly re-evaluate their methodology to reflect changes over time. Adhering closely to the Standards of Practice for Life Care Planners provides guidance and clarity to ground our work. According to the Standards, a life care plan is a dynamic document, which reflects a process of change, growth, or activity.
What may have at one time been accepted as an appropriate methodology can change. For example, it is acceptable in many states to consult with treating physicians to obtain future medical recommendations that serve as the foundation of an individual's life care plan. However, California courts have decided it is considered hearsay in the recent past and cannot be used solely to develop the life care plan. According to the ruling, the treating physician's recommendations must be documented in medical records or sworn testimony (People v. Sanchez). As a result, the methodology the life care planner had long relied on must be somewhat modified to hold up in those court systems.
Another example of flexibility occurs when treating physicians change their recommendations for future medical care after the life care plan has been produced based on their recommendations. Whether in a deposition or medical record, the life care planner's responsibility is to amend their report to reflect the most current recommendations accurately. Routinely, life care plans will be updated and amended several times throughout the case, reflecting that it is a dynamic document.
Life care planners must be able to carefully balance following a set methodology while at the same time being open to changes in practice and being ready to explain those changes when questioned.
To schedule a complimentary consultation with one of our experts at Stokes & Associates, don't hesitate to get in touch with one of our Client Development contacts.
David Barrett
Cell 504-259-6557
dbarrett@stokes-associates.com
Kelly Bradley Ebelt (Texas)
Cell 713-205-2205
kebelt@stokes-associates.com
Stokes & Associates Experts:
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
Ashley Lastrapes, Ph.D., CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Elizabeth Peralta, M.Ed., LRC, CRC, CLCP
New Orleans Office:
3501 N. Causeway Blvd. Suite 900
Metairie, LA 70002
Main: 504-454-5009
Fax: 504-455-1081
Houston Office:
1120 NASA Pkwy. Suite 220K
Houston, TX 77058
281-335-5300
Life Care Plan Physician Consultations and Medical Summary Letters
One of the key criteria for including items in a life care plan is a medical foundation. Items included in the life care plan must be more probably than not causally related to the indexed incident (ex. motor vehicle collision, on-the-job injury, etc.). Additionally, all items included must be deemed medically necessary, preventative, and rehabilitative.
One of the Standards of Practice for life care planners is to perform a comprehensive assessment including review of medical records, interview with the evaluee and family, and conferring with treating or consulting healthcare professionals. Occasionally, clearly stated treatment recommendations can be gleaned from a review of medical records or treating physicians’ deposition transcripts. However, the medical records often fail to specify the frequency and duration of specific treatment required. For example, a neurosurgeon may recommend a 2-level anterior cervical fusion in a medical report but not establish follow-up office visits, physical therapy, pre-surgery labs, diagnostics and imaging, post-surgery medication, or equipment/supplies. Life care planning is a collaborative effort amongst various professionals. An experienced life care planner can develop questions to present to treating and consultative health care providers to identify future needs.
It is not uncommon to consult with multiple medical providers in sub-specialty areas (ex. neurologist, spine specialist, pain management, etc.) on the same case to develop a comprehensive life care plan. After each conference, a summary letter is generated by the life care planner documenting the recommended treatment for future care and presented to the physician/health care professional for review. If any changes or additions are needed, this can be noted by the physician/health care professional so that the preciseness of recommendations is well documented. Only items that are considered more probably than not, based on a reasonable degree of medical certainty, are included in the life care plan.
The recommendations made by physicians and healthcare providers during conferences with the life care planner serve as a basis of items included in developing a life care plan. In addition, since a medical foundation is paramount in developing a life care plan, the following can further assist in life care plan development:
• Physicians document in chart notes and reports recommendations for more probable future medical care needs of the patient
• When taking the depositions of physicians, asking them to specify future treatment recommendations with projected time frames of procedures/surgeries and the frequency/duration of all treatment
• Attorneys should also consider reviewing the life care plan with the physician(s) when taking their depositions to further confirm the proper translation of recommendations into life care plan items
To schedule a complimentary consultation with one of our experts at Stokes & Associates, please call one of our Client Development contacts.
David Barrett
Cell 504-259-6557
dbarrett@stokes-associates.com
Kelly Bradley Ebelt (Texas)
Cell 713-205-2205
kebelt@stokes-associates.com
Stokes & Associates Experts:
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
Ashley Lastrapes, Ph.D., CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Elizabeth Peralta, M.Ed., LRC, CRC, CLCP
Why Engage A Vocational Expert?
If you have ever wondered when to hire a vocational expert to assist in personal injury matters here are some issues to consider. Whether you are representing the plaintiff or defense, consider referring the claimant for an evaluation, if the injured individual:
is a younger adult,
has less than high school education, with little or no training or transferable skills,
has a limited work history in physically demanding jobs,
has physical, cognitive, or emotional limitations precluding return to their pre-injury occupation or occupations they held in the past
An analysis of the ability to work and earn wages can help to determine any difference in pre versus post-injury wage-earning capacity.
Our experts at Stokes & Associates frequently field questions regarding whether a case requires our assistance. Given the facts of the case, we may suggest an evaluation of the plaintiff to prepare for expert testimony, or to act as a non-testifying consultant to assist in clarifying lost wages, future medical costs, or other issues related to return to work.
An evaluation may not be necessary if the facts are obvious, but don’t miss an opportunity to present evidence if it can help you to advance your position in the case.
To schedule a complimentary consultation with one of our experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokes-associates.com or visit www.stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
Ashley Lastrapes, Ph.D., CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Elizabeth Peralta, M.Ed., LRC, CRC, CLCP
New Orleans Office:
3501 N. Causeway Blvd. Suite 900
Metairie, LA 70002
Houston Office:
1120 NASA Pkwy. Suite 220K
Houston, TX 77058
281-335-5300
Main: 504-454-5009
Direct: 504-608-6944
Cell: 504-259-6557
dbarrett@stokes-associates.com
www.stokes-associates.com
Why is the Claimant Interview Important in Vocational Rehab and Life Care Planning?
When conducting a life care plan or vocational assessment, the vocational/life care plan expert should have the opportunity to interview the claimant. An interview evaluation of the claimant provides the expert with current information from the claimant’s perspective. For example, a clinical interview covers topics such as Medical Summary (a chronology of medical history since the time of the injury), Current Medical Providers, Current Medications, Claimant’s Report of Pain and Physical Limitations, Independence in Activities of Daily Living, Equipment and Supply Needs, Prior and Subsequent Injuries and Residual Limitations, Heath Habits and Mental Health, Education and Work History, and Vocational Rehabilitation Goals/Plans.
An interview evaluation allows the vocational counselor/life care planner the opportunity to gather additional information regarding the claimant’s medical treatment not identified through a medical record review alone. For instance, during a clinical interview, the vocational counselor/life care planner often learns that the claimant began treatment with additional or new medical providers not identified through the record review. An interview may also determine that the claimant uses specific durable medical equipment and supplies that help improve their independence and provide pain relief. This equipment and supplies often are not known by the treating physician.
The interview evaluation also allows the vocational counselor/life care planner to collect detail regarding the educational attainment and work history. The vocational counselor/life care planner can then explore elements of the job because a job title alone may leave out important information like essential job duties. The interview also includes the tenure of employment in each position. Time in an occupation can assist the vocational counselor/life care planner to determine whether the claimant has met the specific vocational preparation required to gain the transferable skills for alternative work options. Job tenure can also predict the claimant’s wage-earning capacity, both pre-injury as well as post-injury. Vocational testing (available electronically) could also be administered during the evaluation when appropriate to inform rehabilitation potential and employability.
A clinical interview of the claimant allows for a thorough vocational and life care plan assessment. Obtaining detail through this interview process adds to the level of analysis needed for a thorough evaluation. Although we can perform a vocational or life care plan evaluation based on records alone, a meeting and interview with the claimant enhances the assessment process.
To strategize with one of our vocational rehabilitation or life care plan experts at Stokes & Associates, please call Dave Barrett at 504-454-5009, visit our website, www.stokes-associates.com, or e-mail dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
Ashley Lastrapes, Ph.D., CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Elizabeth Peralta, M.Ed., LRC, CRC, CLCP
Incorporating Telehealth into Modern Vocational Rehab and Life Care Planning (Part 2)
Be honest. Think back to January of 2020. Did you know what Zoom was? Maybe you had heard of Skype? Perhaps you had used Facetime? Since the Covid-19 pandemic, Zoom has officially become synonymous with videoconferencing, much like ‘Kleenex’ is used to signify something you sneeze into and ‘Googling’ is used to represent searching on the internet. At Stokes & Associates, we have been advocating the use of secure videoconferencing to conduct vocational assessments and life care plan evaluations since 2010. Since we last wrote about the issue in 2016, the worldwide pandemic has only accelerated the general public’s comfort with videoconferencing as an alternative to in-person meetings. From primary care visits to the in-home schooling of our children, videoconferencing has become ubiquitous.
Once the national state of emergency was declared in March of 2020, the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services issued guidance to make healthcare services easier. For example, these agencies eased HIPAA regulations, waived regulatory changes to ensure expanded reimbursement for services, altered licensing requirements to allow practitioners to provide services over state lines, and authorized providers to prescribe controlled substances via telehealth. In addition, professional organizations like the American Psychological Association (APA) also issued guidance regarding the use of online assessment that allowed psychologists and other behavioral health providers the opportunity to provide remote testing services.
Is telehealth here to stay? Results from a recent massive study of over 36 million adults published in the JAMA Network suggest significant increases in the use of telehealth that support its popularity. Data were analyzed from working-age individuals enrolled in private health plans from March 2019 to June 2020 and yielded impressive results:
Telehealth use increased from .3% of provider visits in 2019 to 23.6% in 2020.
In-person visits decreased by 37%
Behavioral health visits were virtual 46.1% of the time, while medical visits were 22.1%
Medical care costs decreased by 15% per enrollee from 2019 to 2020
The federal courts also followed suit when the Judicial Conference, the administrative policy-making body for the federal courts, found on March 29, 2020, under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), that “emergency conditions due to the national emergency declared by the President concerning COVID-19 will materially affect the functioning of the federal courts….to temporarily authorize the use of video or telephone conferencing…” This authorization spread throughout the federal and state systems, with U.S. Patent and Trademark Office accommodating video hearings, County registrars offering video marriage licenses, and Federal and State Supreme Courts hearing arguments via video conferencing. For detailed information regarding how specific state courts use technology to operate, check out the National Center for State Courts Data Visualizations.
We have appeared at in-person courtroom trials and continue to provide virtual testimony in many states. Although there are some ethical positions articulated by the vocational and life care planning credentialing bodies and professional organizations, development in technology seems to be moving faster than policymakers. Due to the nature of our professional methodology, we can collect vital information from some evaluees via videoconferencing when in-person interviews are not possible or preferred. By continuing to leverage video capabilities, we have been able to provide the full slate of vocational and life care planning services during the pandemic. We intend to encourage the continued use of remote evaluations to keep costs down and retain other efficiencies such as greater choice for evaluation scheduling options and online vocational testing.
To strategize with one of our vocational rehabilitation or life care plan experts at Stokes & Associates, please call Dave Barrett at 504-454-5009, visit our website, www.stokes-associates.com, or e-mail dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
Ashley Lastrapes, Ph.D., CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Elizabeth Peralta, M.Ed., LRC, CRC, CLCP
Loss of Wage Earning Capacity - Consultations with Physicians
Consultations with physicians to discuss the patient's functional ability can provide specific information to assist the rehabilitation counselor in determining potential vocational outcomes. We have developed a form to assist in estimating a person's workability and job accommodation needs. The following is an example of a physician consultation questionnaire used to gather such information. Feel free to use this tool when you are gathering information about a client.
Below is a summary of the questions included in the form. Click HERE for the form.
PHYSICIAN'S CONSULTATION FORM
Patient/Examinee Name:
1. What is the date of injury?
2. What was the date of the last examination
3. What is the diagnosis?
4. Have diagnostic tests been performed?
If so, please identify the tests, the date, and the findings?
5. What is the prognosis?
6. What is the current medical status?
7. Has the patient reached maximum medical improvement? Date?
8. If no, what is the expected date of maximum medical improvement?
9. Is the patient taking medication that impacts his/her ability to work?
Please explain any limitations:
10. Can the patient be released to his/her previous job or regular work?
11. Can the patient return to temporary light work duty? (Explain limitations or restrictions)
12. Can the patient work based on The Department of Labor Definitions of Physical Demands? Select the maximum strength demand.
___Sedentary _____Light _____Medium _____Heavy _____Very Heavy
13. Please give an opinion of work restrictions or complete a physical capacity work restriction form. If you do not have a work restriction or physical capacities form, one can be provided to you.
14. If the patient/examinee is not capable of working in any capacity at this time, when do you anticipate releasing them for work?
15. Are breaks required during the workday? Frequency? Duration?
16. Can the patient operate a motor vehicle?
To strategize with one of our vocational rehabilitation or life care plan experts at Stokes & Associates, please call Dave Barrett at 504-454-5009, visit our website, www.stokes-associates.com, or e-mail dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
Ashley Lastrapes, Ph.D., CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Elizabeth Peralta, M.Ed., LRC, CRC, CLCP
Life Care Planning and the Medical Fees Directory
Life care planners need to obtain appropriate cost information for the recommended treatment in a life care plan while adhering to life care planning tenets and standards. The most common method is to conduct a survey of the recommended treatment and ask for the "billed price" or the cash pay price without discounts. A range of sources is then included in the life care plan. At Stokes & Associates, we present the results of cost research to ensure that the treatment or service is not being under- or over-funded.
Some consultants have begun using the Medical Fees Directory published by the Practice Management Information Corporation (PMIC) to obtain the cost information for medical services. The purpose of the PMIC is for physicians and providers to compare how their fees rank on a national basis. The text also reports the information can be utilized for negotiation with payers and other purposes. The PCIM did not intend this data for pricing life care plans.
Furthermore, the PMIC provides costs at the 50th, 75th, and 90th percentiles, based on national averages, and are generally reflective of payor allowables. The prices in a life care plan should reflect actual costs within the injured persons' geographic area, not national averages. The use of the 50th, 75th, and 90th percentiles by the PMIC omits the top 10% and the bottom 50% of cost information. A limitation of the resource is that by leaving out the bottom 50% and top 10%, the costs range may not include the treating physician's price or the Usual and Customary Rate (UCR) costs in the patient's geographic area.
The PMIC provides "GAF – Geographic Adjustment Factor," used to adjust the UCR by geographic area. For some areas, such as Mississippi, the text provides only one GAF multiplier for the entire state. It is unclear how specific this calculation can be to an individual's geographic area, given that the PMIC only provides one GAF in the whole state. While it is uncertain how reliable the GAFs are if a life care planner utilizes the PMIC, the GAF should be calculated because the costs across geographic regions can vary greatly.
The PMIC cost information is provided per CPT code. Unless the provider gives a specific CPT code(s) of services or the life care planner is exceptionally well-versed in how CPT codes are utilized, errors can quickly occur. This is especially true if the life care planner is researching the cost of surgery, which could have multiple CPT codes, which can also vary by provider. The use of CPT codes could also leave the life care planner vulnerable to being accused of exceeding their scope of practice. For example, a physical therapy evaluation could be one of three CPT codes, each representing a differing level of complexity. Within the description, the level of complexity is determined in part by using a "standardized patient assessment instrument and/or measurable assessment of functional outcome." In choosing one CPT code over another, it could be argued that the life care planner is deciding what should be determined by a physical therapist.
At Stokes & Associates, we take great care to ensure that we are using best practices. For that reason, we advocate against relying entirely on published fee schedules for life care planning, such as the PMIC. Using the PMIC, in our opinion, does not give a comprehensive cost analysis and distorts the information presented to the trier of fact, rending the information invalid and unreliable.
To find out more about our methods or discuss a potential case assignment, we offer complimentary consultations concerning "hypothetical matters."
To strategize with one of our vocational experts or life care plan experts at Stokes & Associates, please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, Ph.D., CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Elizabeth Peralta, M.Ed., LRC, CRC, CLCP
New Orleans Office:
3501 N. Causeway Blvd. Suite 900
Metairie, LA 70002
Houston Office:
1120 NASA Pkwy. Suite 220K
Houston, TX 77058
281-335-5300
Main: 504-454-5009
Direct: 504-608-6944
Cell: 504-259-6557
dbarrett@stokes-associates.com
www.stokes-associates.com
Organ Transplant Life Care Plans
When developing life care plans involving organ transplants, the life care planner is tasked with capturing the costs of complex medical care needs with immediate and lifelong implications.
When obtaining recommendations for future care needs, life care planners typically consult with treating or consulting physicians. This consultation can be difficult to arrange when an organ transplant is involved, as the treating physician may not comment on post-transplant needs. For example, regarding a lung transplant, a pulmonologist would refer the patient for an evaluation by a transplant team to qualify for a transplant. The treating pulmonologist makes the initial referral but is typically unable to comment on post-transplant care needs such as immunosuppressants. While a transplant physician can comment on post-transplant needs, the patient may or may not have been referred and evaluated at the time of the life care plan. Additionally, it can be challenging to schedule consultations with transplant physicians, usually due to extensive hospital group affiliations and a lack of experience and knowledge of the litigation system. In these cases, it may be prudent to engage a consulting physician who can comment on future care needs.
The life care planner also needs to be knowledgeable about the transplant procedure and its implications. Following a transplant, the patient may be at greater risk for infections, cancer, and other complications, which means the life care planner must ask about services related to the monitoring of these complications. Are increased primary care or dental visits required? Are dermatology visits warranted, given the increased risk for skin cancer? Would an annual flu shot be justified given the patient's compromised immune system?
Another consideration is the location of the patient to the nearest transplant center. For example, Patient A and Patient B both need a bilateral lung transplant. Patient A lives in Dallas, Texas, within driving distance to three transplant facilities. Patient B lives in rural West Virginia and will need to fly to receive treatment. Depending on the organ, transplant patients typically need to be near the transplant facility for up to three months postoperatively, followed by annual, multiple-day assessments at the transplant facility. The life care planner must consider costs for flights and extended stay lodging for Patient B to receive treatment. Other considerations for Patient B may include childcare and home and lawn maintenance while away receiving treatment. While Patient A and Patient B require the same surgical procedure, the life care plans will look drastically different when considering location differences.
Life Care Planning for transplant cases is complicated and requires a great deal of planning and forethought in case management. Transplant consultations often involve multiple bodily systems with variable future potential complications. It takes a team of experts to fully develop a Life Care Plan for such patients, whether engaged by the plaintiff or defense.
To strategize with one of our vocational rehabilitation or life care plan experts at Stokes & Associates, please call Dave Barrett at 504-454-5009, visit our website, www.stokes-associates.com, or e-mail dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
Ashley Lastrapes, Ph.D., CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Elizabeth Peralta, M.Ed., LRC, CRC, CLCP
Language Choices in Life Care Planning
When developing life care plans by consulting with physicians and other professionals for future medical care needs, it is essential to consider words carefully to ensure that all parties communicate effectively and are "on the same page."
We use terms like "on a more probable than not basis," "more likely than not," and "more than a 50% chance of being required" when asking about future medical care needs. The Standards of Practice for Life Care Planners states that "the life care planner facilitates understanding of the life care planning process" and "provides information about the life care planning process to involved parties to elicit cooperative participation." The person we are consulting with must understand what we mean by these terms to obtain the appropriate information. It may seem clear to the life care planner what is meant by these terms; however, different professionals may interpret them differently, especially treaters with limited experience consulting with life care planners.
In a recent case, we consulted with an orthopedic surgeon, Dr. Smith, to obtain his recommendations for John Doe's future medical care due to a motor vehicle accident. When we spoke with the surgeon, we needed to clearly communicate that we were inquiring about any care required from the present through life expectancy and only future medical care specifically related to the indexed incident. The care needs to be probable and not just possible. Our review of Dr. Smith's medical records for Mr. Doe noted that Mr. Doe had a spinal fusion due to this incident two years prior. Therefore, we asked if Mr. Doe would require an adjacent level fusion in the future due to adjacent segment disease. Dr. Smith said it was a possibility (not included in a life care plan). We went on to ask if, in Mr. Doe's remaining life expectancy, there was more than a 50% chance that Mr. Doe will require an adjacent level fusion due to the indexed incident. Dr. Smith stated that patients typically require an adjacent level fusion within 17 years from their initial fusion date. Based on Mr. Doe's age of 47, he would require an additional surgical intervention on a more probable than not basis (included in a life care plan.) Dr. Smith also recommended associated pre-and post-operative care. If we had not explained further and communicated effectively, Mr. Doe's life care plan would have been underfunded.
It is essential to document the information obtained in consultation and use accurate language so there is no confusion about the life care plan's recommendations.
To strategize with one of our vocational rehabilitation or life care plan experts at Stokes & Associates, please call Dave Barrett at 504-454-5009, visit our website, www.stokes-associates.com, or e-mail dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Elizabeth Peralta, M.Ed., LRC, CRC, CLCP
Suitability of Return to Work Offers
The primary goal after an injury is to return the worker to their pre-injury place of employment. The employer may tender offers of the same, modified, or alternate job that impacts the individual's vocational outlook and employability. It is essential to assess this return's appropriateness and "suitability" based on physical restrictions and job requirements, which is the purview of qualified vocational rehabilitation counselors.
For example, in the case of an offshore tankerman with a work-related knee injury, the employer of injury offered a return to work as an inland tankerman. The physical restrictions outlined by the physician included no lifting greater than 80 pounds, no jumping, occasional climbing of stairs and ladders, and no work on "unstable ground." The vocational expert's opinion was that offshore work involved "rough waters" (unstable ground); however, work as an inland tankerman did not require work on rough waters and was within the medical restrictions assigned by the treating physician. The employer's detailed job description fell within the physical restrictions outlined, so this was considered a suitable job offer.
In another example, a nurse involved in a motor vehicle collision who sustained a low back injury was eventually released for light level work and prescribed narcotic medication for pain control. Her job of injury was classified as medium-level work beyond the restrictions outlined. Her employer offered her an alternative position as an office nurse to accommodate her physical limitations. The vocational expert contacted the employer for more details concerning the job offer and learned that using prescription narcotics would prohibit her from returning to work. This job offer, therefore, was not considered "suitable."
Key actions taken by vocational counselors in determining the suitability of a job offer include:
Obtain a detailed written job description of the job offered, including all the essential functions and job tasks, specific physical requirements, work schedule, and educational requirements.
Conduct an on-site job analysis to personally assess the worksite to obtain and clarify job requirements, physical requirements, and whether any modifications or accommodations can be made by the employer, as necessary.
Use sources such as the Dictionary of Occupational Titles, Selected Characteristics of Occupations, and the Revised Handbook for Analyzing Jobs to clarify and validate physical requirements (exertional and non-exertional), skills, and education required.
Provide a detailed written job description of the job to the treating or consulting physician for approval concerning the individual's physical ability to perform the job with or without modifications.
Provide follow-up services for at least 30 to 60 days once the injured worker returns to employment to offer any assistance necessary to ensure a successful return to work.
A successful return to work of an injured individual is not only of benefit to the injured worker but can greatly assist in determining the value of a wage loss claim. To do so, the vocational consultant should assess the job offer's details to determine if the job is appropriate and suitable for the individual and not merely accept the offer at face value.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Elizabeth Peralta, M.Ed., LRC, CRC, CLCP
Vocational Profile and Alternate Jobs
As vocational consultants, we rely on an individual's vocational profile to analyze the types of alternate jobs they can perform. The vocational profile incorporates multiple factors, including age, education, work history, transferable skills, geographical location, vocational test results (if applicable), and physical/cognitive capabilities or limitations. These factors are analyzed to arrive at a vocational prognosis.
Vocational consultants frequently identify alternate jobs for an evaluee precluded from returning to a position held at the time of the injury. We look closely at the individual's vocational profile to determine the most appropriate, reliable, and realistic alternate jobs that the person can likely perform and are available in the labor market. Essential questions include: Has the person obtained the education requirements for this position? Has the person acquired skills that would transfer to this type of work? Is this type of occupation readily available where this person lives or within a reasonable commutable distance? What are the physical demands of this position, and is the person capable of performing this work?
In addition to these questions, demographic factors can dramatically impact the overall vocational prognosis when assigning alternate jobs. Take, for example, age. An individual's age drives work-life expectancy, which describes the likely time period one can expect to generate realistic earnings when returning to the workforce. For example, if a woman is 25 years old, she will likely have the opportunity to increase earning potential with time, experience, or additional training, which would upgrade her vocational prognosis. On the other hand, if she is 65 years old, she will likely be limited in her time in the labor market and may not reach the potential to earn above starting wages in alternate occupations.
Another vital element of the vocational profile that affects alternate jobs is work history. In vocational rehabilitation, the goal is to return the injured worker to the same or accommodated position with the same employer. If not possible, we look for the same or similar job with a different employer. If that is not possible, we look for related jobs in the same field. And finally, we consider new jobs in a new field. This hierarchy reasons that it will take less time to transition if the new or alternate job more closely approximates the position at the time of injury.
To determine this trajectory, we look to work history. We can glean a trove of information from someone's work history, but most importantly, we can identify the transferable skills they have acquired along their vocational journey. These skills are the key to matching the worker to a suitable alternative job.
To strategize with one of our vocational rehab or life care plan experts at Stokes & Associates, please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com, or e-mail dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Elizabeth Peralta, M.Ed., LRC, CRC, CLCP
Obtaining Life Care Plan Recommendations from Health Care Providers
Obtaining appropriate Life Care Plan recommendations from treating or consulting providers for present and future care requires specific collaboration. The sources must know the patient's history and be qualified to render opinions about the recommended care. This patient-specific knowledge flows from physical examination, treatment, review of records, research, and experience. Documenting treatment into the future, beyond the acute phase, does not seem to be the norm for many providers. For example, surgeons focus on symptoms and indications for surgery, including pre-operative and follow-up services, too, in essence, "fix" the broken anatomical structure. It may not be clinically significant to document projected future treatments or even inform their patients of likely medical outcomes. Medical documentation's general purpose is to memorialize what has happened or is happening in the immediate future, not to forecast possible long-term consequences.
Litigation or the possibility of testifying in deposition or trial can inhibit the provider's willingness to consult with a Life Care Planner. One concern is the potential exposure to the risk of liability for the treater's opinions. The presence of litigation should not affect a provider's medical care recommendations, but unfortunately, it may. Another hesitation to collaborate with the Life Care Planner is the potential time loss from clinical practice to attend trials and depositions. The provider may feel too busy with their patients to lose revenue while attending legal proceedings. Some of the more elusive consultations are with pediatric medical care projections and medical malpractice cases. There is a natural hesitancy to give recommendations or directly critique other professional colleagues.
Much of the success achieved in consultation depends on the preparation and skills of the Life Care Planner. Disclosure of litigation and a thorough explanation of the provider and planner's roles are essential at the beginning of the process to limit ambiguity and reassure the provider. A consultation with the provider needs to be scheduled in advance, with an estimated time required for the consult. It is best to provide signed consent to release medical information forms and potential questions before the consultation to expedite the process. Consultations and the opportunity to discuss the recommendations are preferred to written questionnaires in certain jurisdictions. The exchange of ideas allows the participants to discuss additional issues or information previously not known. If a provider will not agree to a consultation, the use of a completed, signed questionnaire similarly communicates the importance or the validity of the recommendations.
After the consultation, it is recommended that the Life Care Planner summarize in writing the recommendations provided to ensure accuracy and invite the consultant to review the summary and communicate edits. More complex cases may require more than one consult with the provider to account for the dynamic nature of medical needs. The ultimate goal is to produce a thorough, well-researched Life Care Plan built on strong medical recommendations communicated from the treating providers on a more probable than not basis
To strategize with one of our vocational or life care plan experts at Stokes & Associates, please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com, or e-mail dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Pediatric Life Care Planning - In Amputation Injuries
When conducting a life care plan for a child with an amputation injury, the specific treatment needs can vary considerably among amputation types and changing needs of the individual because of growth and development through aging. An adult who becomes an amputee as a child will have different needs than those who became an amputee as an adult (Reddick-Grisham, 2004).
One difference when conducting a pediatric life care plan for amputation injuries is bone overgrowth, which can appear until the child reaches skeletal maturity. Therefore, the life care planner will need to consider surgeries to correct bone overgrowth. There could also be complications associated with early onset of degenerative conditions, for example, overuse injuries of the other limb/joints as a result of an amputation. This overuse could result in the need for orthopedic treatment, therapy, or surgeries as the individual ages.
Another main difference between adult and pediatric life care planning is the replacement frequency of prosthetic devices and associated supplies due to the child's growth and development rate. A child will need their prosthesis replaced more frequently than an adult, and this replacement frequency should be considered and included until the child reaches adulthood.
As in all amputation cases, aids for independent function will need to be addressed and included in the life care plan accordingly. For individuals with upper extremity amputations, items such as a toothpaste dispenser, a rocker knife, and a button hook can assist significantly with activities of daily living. Adaptive clothing may also be necessary. Adaptive devices to help the child engage in extracurricular activities may need to be included in the plan.
As the child ages, there will be additional needs to consider, such as vehicle modifications and adaptations, architectural renovations, as well as vocational and educational implications. When aging with an amputation injury, other considerations may include wheelchair needs for long-distance ambulation and the increased need for assistance, including home care or facility care.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Vocational Analysis: Elements in the Process
Vocational Rehabilitation Counselors (VRCs) use the Dictionary of Occupational Titles as a reference text when conducting a vocational analysis. The text categorizes and outlines jobs by several variables that are analyzed by the VRC, including specific vocational preparation (SVP), general educational development (GED), and aptitudes.
The SVP is the typical training or educational time a worker requires to be able to function in an average capacity in that specific occupation. The SVP can range from unskilled to highly skilled. The SVP numbers, from lowest skill to highest skill, include the following:
Short demonstration only
Anything beyond a short demonstration up to one month
One to three months
Three to six months
Six months to one year
One to two years
Two to four years
Four years to ten years
Over ten years
The Dictionary of Occupational Titles also assigns every occupation a GED level for reasoning, math, and language. GED refers to aspects of education required for satisfactory job performance. The reasoning skill levels range from the lowest skill to the highest skill and include the following:
Applying common sense when understanding one to two-step instructions
Applying common sense when following detailed written or verbal instructions
Applying common sense when completing instructions in written, oral, or diagrammatic formats
Using rational systems to solve practical problems with a variety of concrete variables
Using logic and scientific thinking to understand problems, collect information, establish facts, and reach conclusions while dealing with abstract or concrete variables
Using logic and scientific thinking to understand a variety of intellectual and practical problems while dealing with non-verbal symbolism such as scientific equations
The math skill levels also range from the lowest skill to the highest skill and include the following:
Adding and subtracting two-digit numbers, performing simple multiplication and division
Adding, subtracting, multiplying, and dividing all units of measure and having the ability to work with decimals, fractions, ratios, rates, and percentages
Performing basic geometry, algebra, and having the ability to calculate interest, discounts, volumes, weights, and measures
Performing intermediate algebra, geometry, and shop math
Having the ability to perform advanced algebra, basic calculus, and basic statistics
Having the ability to perform advanced calculus, modern algebra, and advanced statistics
The language skill levels also range from the lowest skill to the highest skill and include reading, writing, and speaking. The language skills are based on grade equivalent as follows:
1st to 3rd grade
4th to 6th grade
7th to 8th grade
High school
College/graduate level
The Dictionary of Occupational Titles also assigns an occupation-specific aptitude level. Aptitudes refer to the ability to perform or learn a given work activity, and there are 11 aptitudes measurable in an occupation. The aptitudes are general learning ability, verbal ability, numerical ability, spatial ability, form perception, clerical perception, motor coordination, finger dexterity, manual dexterity, eye/hand/foot coordination, and color discrimination.
These are just a few of the variables analyzed by the VRC when developing a transferrable skills analysis. By understanding the individual’s skill level, general educational development, and aptitude levels of their work history, the Vocational Rehabilitation Counselor is better able to assess future employment options and vocational prognosis.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Establishing Earning Capacity of a Business Owner
Vocational experts typically rely on several sources to help develop opinions regarding one’s earning capacity, including self-reported earnings, statistics, payroll documentation, and tax records. There are situations in which one resource may be a better representation of an individual’s earning capacity. A complicated example is assessing the earning capacity of a business owner. There is no specific reference to statistical wages for business owners when trying to support earning capacity. Therefore, using tax records as a foundation for one’s opinion is often necessary.
The business’ tax documents are studied to determine the gross earnings of the company, along with documented expenses required to operate the business. The documentation should outline business expenses, including materials and supplies, employee compensation and benefits, company vehicles, repairs and maintenance, advertising, rents, depreciation, taxes, and licenses, etc. Assuming the business owner has accurate records, the expenses can be deducted from the gross earnings to develop a reasonable estimate of the profit the business made for that calendar year, and thus earning capacity.
Consider a scenario involving the owner of a small pile driving company whose gross annual earnings are $550,000.00. Business expenses would include employee compensation, pilings, and related materials, rental fees, and maintenance of equipment used to drive the pilings, mortgage or rent for the warehouse and small office, company trucks and fuel, insurance, etc., for a total of $375,000.00. After deductions for expenses, the net income is $175,000.00. The net income may or may not be an accurate representation of the owner’s earnings for that year, depending on several factors, one of which would be whether the owner drew a salary. In that case, his salary plus net income would represent his earnings for the year.
Vocational experts must also consider that people do not always submit proper, accurate, or complete information to the IRS, rendering tax documentation unreliable. As a result, the approximated earnings would be invalid if the vocational expert were to rely solely on tax documents. It is the expert’s responsibility to request the full and accurate tax documentation as support for their opinion on an individual’s earning capacity as a business owner.
To strategize with one of our vocational or life care plan experts at Stokes & Associates, please call David Barrett at 504-454-5009, visit our website, www.stokes-associates.com, or e-mail dbarrett@stokes-associates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC
Brandy Bradley, MHS, CRC, LRC, CLCP
Medication and Work
After an injury and a medical release for work, individuals may continue to take prescription medicines such as muscle relaxers, anti-inflammatories, and pain medications. As vocational experts, we get asked “how” these medications may affect a person’s ability to obtain or maintain employment.
A vocational expert is not a medical expert and must rely on treating or consulting physicians to determine what limitations/side effects, if any, can be expected as a result of medication use. It is the vocational expert’s purview to assess job functions and employment requirements. If a physician limits a person from certain activities because of the side effects of medication, then the vocational expert can determine what jobs can or cannot be performed with or without accommodation.
There are instances when the physician does not specify limitations regarding the medicines and work. The vocational expert could assume that if prescribed narcotics produce sedating effects, it may be unsafe for the individual to operate a vehicle, heavy equipment, or dangerous machinery, and should avoid work at unprotected heights. As responses to medications vary, it cannot be assumed that all individuals are unemployable in any capacity.
Questions to clarify work suitability while taking medication include what effect, if any, do these medications have on this specific individual (e.g., drowsiness, etc.)? What type of job is the person performing or seeking (e.g., assembler, carpenter, etc.)? How often is medication being taken, and can it be taken after work hours? Do certain occupations or professions have legal or statutory restrictions regarding narcotics or related medication use (e.g., registered nurse, crane operator, commercial truck driver, etc.)?
For example, we performed a labor market survey for an individual taking pain medication who was released to work by his physician in a light capacity. Potential employers were contacted based on jobs that were within his physical restrictions and educational experience, including sales clerk, parts clerk, and office assistant. We asked employers whether the use of prescription pain medication would affect his potential hire/employment. Of the four employers contacted with suitable job openings, all reported that this individual would not be precluded from employment consideration because of prescription medication usage if the medication was disclosed upon pre-employment drug screening.
Medication effects vary regarding the impacted functions in jobs available in the labor market. Some medications come with warnings; however, these warnings do not neatly translate to job limitations but are merely cautions. The bottom line is, if a person is taking medication that hinders their ability to perform a job, then the position is not suitable for the worker. If, however, the person taking medication is not negatively affected by the drug, regardless of the cautions and the physician does not restrict the worker, then medication status is not a disabling condition. If there is no danger or risk, then medication is not the objection.
We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our life care plan experts or vocational experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokesassociates.com.
Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLC
Ashley Lastrapes, MHS, CRC, CCM, CLCP, LPC, LRC