Accepted condition only?
Wed, 07/01/2009 - 1:01pm
I was recently referred an FCE by a vocational counselor and was told that the accepted condition was a right shoulder sprain. I was also told that the doctor tried to get the cervical and thoracic sprain accepted also on the claim but did not have any success. This vocational counselor told me that for the PCE I am only to look at and comment on the right shoulder and how the shoulder limits (or not) this person's functional work ability. My question is...How do I do that without considering the other areas of the body? How do I have the person reach overhead doing the Valpar 9 and not say anything about their neck?
I am finding this more and more with referrals where they are saying that the worker's comp system is only taking care of one part of the body (accepted condition) and nothing else. I can see their reasoning though... They don't particularly like it if I say that a person who has a knee injury can't lift more than "X" amount of weight at or above shoulder level because "how is the knee involved in lifting at that level? It is just the arms". I also do FCEs for attorneys and they have information/case law where the worker's comp system has said basically that "consideration of whether a worker is unable to work as a result of an industrial injury requires a study of the whole man as an individual - his weaknesses and strengths, his age, education, training, and experience, his reaction to his injury, his loss of function, and other relevant factors."
How would you handle this situation? Any thoughts on this would be greatly appreciated.
Jon Harrison, OTR/L, CWCE, CEES
The evaluation process, based on the Practice Hierarchy, and the claims management process work in two different paths. The FCE has to consider the whole person. Since the referral question is, "How does the right shoulder limit his/her functional work ability" then focus the evaluation on the functional/work abilities most affected by that extremity. As I know you know, those will include lifting, carrying, pushing, pulling, reaching, overhead work (not an official DOL term). It could involve grip and pinch. It may involve climbing, bending (if the individual tends to use his/her extremity for support or balance).
The referral source seems to have an impairment strategy to case closure rather than an employability strategy (unfortunate). Given that, I would focus my report on the findings related to the identified physical demands/abilities affected by the extremity.