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| Disability Implications File Review |
While physicians determine impairment, CCM's Independent Vocational Implications File Review ascertains vocational and return-to-work implications of a medical or nonmedical impairment. Until recently, an individual's ability to return to work was typically determined by a physician. Both medical associations and courts now deem disability and non-medical determinations are not within the exclusive expertise of physicians.
C CM provides Independent Vocational Implications File Review for motor vehicle accidents, workers' compensation, long-term and short-term disability, personal injury, malpractice, liability, divorce, and employee assistance due to reductions in force [RIF] or downsizing. CCM has conducted thousands of Vocational Assessments and Expert Consultations.
Vocational Implications Of a Disability
Until recently, physicians determined return-to-work options by completing a form and filling in a return-to-work date with that date often based on the patient's subjective account. A clear relationship between the return-to-work date and patient's ability to return to the preinjury job or another job was not always considered in determining both disability or benefits paid. Physicians do not customarily perform job analyses, relate capabilities to work, or consider vocational alternatives such as changing jobs or job modifications. Alternatives may not even be considered prior to the physician's determination of "totally disabled."
Defining some terminology may be useful. The World Health Organization defines disability, as "any restriction or lack of ability (resulting from impairment), to perform an activity in a manner within the range considered normal for a human being." Disability is distinguished from an impairment, or medical condition that may lead to disability, loss or abnormality of psychological, psychological, or anatomical function.
The American Medical Association, Guides to the Evaluation of Permanent Impairment (1994) distinguishes between disability and impairment. According to the AMA, while disability ratings are founded on impairment, physicians must: "...refrain from speculating about nonmedical consequences of an impairment." In addition, "it is not possible for a physician, using medical information alone, to make reliable predictions about the ability of an individual to perform tasks or to meet functional demands." Recent court decisions recognize that physicians cannot speak as vocational experts; i.e., Carl B. Adams v. Margaret M. Heckler in U.S. District Court, Northern Division of Indiana, upheld by the 7th Circuit (580 F Supp. 315 1984).
Vocational experts are more readily utilized to determine vocational implications of medical and non-medical impairment and disability; no longer exclusively physicians. The National Association of Disability Examining Professionals, Standards of Practice states, "Disability evaluation requires a collaborative approach to data collection and decision making. The primary evaluating clinician is obligated to utilize and accept the expertise from other clinical practitioners whose training is in other related but applied fields. For example, a [physician] should solicit the expertise of a Certified Disability Examiner [includes vocational evaluators, case managers, rehabilitation counselors] regarding worker traits, labor market analysis, or psychological issues. Similarly a Certified Disability Examiner clinician should require the consultation of a [physician] regarding physical limitations and diagnosis prior to having the evaluatee participate in physical testing activities, to include work samples and materials handling assessment."
Each specialist has a unique area of expertise in the evaluation of disability. Therefore, it becomes increasingly essential that each specialist know the limits of their field of expertise and devise a team approach process. If an expert, in the Courtroom, steps outside their area of expertise, risk that the testimony may be less valuable or even rejected increases.
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