Q&A: Estimating Client's Potential Abilities in an FCE
Posted on Tue, Aug 02, 2011 @ 12:10 PM
Hi Roy, I really enjoyed the Baker vs. Barnhart webinar. I've recently relocated from BC, Canada to Washington state, so it was good to learn lessons that apply both here & there. I do have some questions I would like to ask:
You said that we should not just be estimating a person's abilities, since we are being asked to provide accurate data, and you stated that as evaluators we need to comment on short-term potential ability (related to RTW). You talked about making a projection of the client's abilities, however I'd like some guidelines about how "projective" we should get.
Can you give some concrete examples to make sure I'm following you? And do you mean that we should be relating their abilities to a particular type of work? Typically in BC, we may give some examples of types of work, but try not to get too much into that since vocational experts have more data & experience to draw from. That way we're not seen as limiting the client or retainer to those examples. Also I'm assuming you say "short-term ability" because the client's abilities and limitations may change over the long term - is that what you meant?
From my observation of the federal courts and conversations with fee payers, I sense that the world of return to work is moving away from physician-issued prophylactic restrictions to an emphasis on abilities. The impetus for this can be found in any one of the many ADA-driven federal court cases, as well as state court cases such as Poljarevic v. Independent Foods (Idaho) and the Almarez/Guzman cases in California.
The issue has to do with the referral questions such as, “What are the client's current physical tolerances?” and “Is the client able to return to work as a (name of target job) at this time?”
When an evaluation with these questions is administered with a client who presents with less than high levels of effort the evaluator is left with the need to navigate the Scylla and Charybdis of demonstrated ability versus actual ability. The referral question begs for an answer to the actual ability query. Past practices, in many cases, have prematurely ended at the point of an invalid answer premised on demonstrated ability data. (In this case the evaluation is not invalid; the answer to the question is invalid.)
My point during the July 7, 2011 webinar was that seasoned evaluator’s achieve a higher level of Utility (re: the Practice Hierarchy) when they carefully estimate the client’s short-term ability. In this case short-term refers to today.
My view is that making the estimate requires such a high level of judgment, and provides such a high level of Utility, that one does not need to estimate ability at some future point in time. Remember, an FCE does not predict the likelihood of an individual returning to work, it predicts the ability of that individual to return to work.
To address your question about estimating types of work the person can do versus estimating abilities: the tests we administer tend to look at a sample of physical abilities. Results are often stated in terms of incremental lifting, carrying, pushing, pulling, grip, etc. These results are not directly related to a specific job unless that level of inquiry results from the reason for the evaluation. In that case the demands of the job are known and can be compared to the individual’s demonstrated or estimated ability.
In today’s world, most FCEs do not compare performance against a series of jobs or classifications. That comparison is left to vocational experts and others who have knowledge of the regional labor market and of workers compensation guidelines for case resolution. Evaluator’s are typically not burdened with answering this question.
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