The name MATHESON has been synonymous with industry leaders and the highest quality of evaluators and evaluations for more than 45 years.
Dr. Leonard Matheson has lead the way in the field of capacity evaluation and work hardening through research and clinical work at the highest of levels.
Roy Matheson, the brother of Dr. Matheson has been guiding force behind the training company side of the Matheson brand. Roy Matheson and Associates has worked to develop industry leading training which is respected throughout the world.
WHAT DISTINGUISHES THE MATHESON FCE?
Functional capacity evaluation (FCE) is an umbrella term that refers to the physical evaluation of an injured worker or accident victim in the areas of strength, endurance, speed, flexibility, and physical effort.
Our industry-leading approach to evaluation and rehabilitation is to provide answers to questions that foster equitable case resolution, free of bias toward the injured worker or the fee payer. As thinking evaluators, we view each evaluation as unique— each client has a unique diagnosis and a unique set of referral questions. Using the practice hierarchy of safety, reliability, validity, practicality, and utility, we strive to answer the referral source’s questions and measure the injured worker’s potential for return to work while gauging his or her level of safe effort. We do not attempt to “trap” an evaluee who demonstrates inconsistent effort.
After safety and validity, our underlying emphasis is medical-legal defensibility. The core Matheson evaluation protocol comprises validated tests whose results have appeared in peer-reviewed scientific publications (contact us for a bibliography). These studies satisfy the requirements of the United States Supreme Court rules of evidence in a manner that is superior to all other FCE systems. Indeed, the Matheson FCE has been widely accepted in the highest courts in both the United States and Canada. See “What about court and defensibility of FCE results?”
WHAT QUESTIONS DOES AN FCE ANSWER?
Unlike other FCE’s which address a list of physical abilities the Matheson FCE focuses on a specific purpose for each and every FCE. The Matheson FCE prides itself on designing the evaluation to answer questions outstanding in the case. While addressing general work ability (aka feasibility for employment), the Matheson FCE may also address disability, temporary alternative duty planning (ADA), future cost of care determination, or product liability–based loss of future earning capacity.
HOW LONG IS THE MATHESON FCE?
As the Matheson FCE is customized to answer a referral sources questions the evaluation can be tailored to those specific questions.
Philosophically Matheson advocates a longer one-day assessment to accurately assess functional abilities as required during a typical workday. Tests tend to take four to six hours to administer, with one hour of report preparation following the administration. The evaluator is free to shorten or lengthen the evaluation in response to the referral source’s questions and to maximize the predictive validity of the result. Test length depends on the referral questions asked, the type of evaluation and the physical demand level of the target job (heavy work versus light, highly repetitive work).
When needed the Matheson FCE process lends itself to utilization over multiple days.
HOW DO I KNOW IF MY CLIENT TRIED HIS/HER BEST DURING TESTING?
It is not uncommon for evaluators to get referrals where the question is “Tell me if this person is legitimate” or “Tell me if this person is faking or not”. To a well trained evaluator this translates into “Did the client perform with high levels of physical effort?”
In the Matheson system such a determination is based on a multifaceted, approach allowing the Matheson-trained thinking evaluators use a battery of standardized tests to present the injured worker with complex isolated and whole-body tests. Measures of heart rate, muscle recruiting, stance, speed, pace, and end-range of motion are correlated with observations of competitive test performance on each test. The aggregate of the full battery of tests is then considered to determine the level of effort generated in each test and for the evaluation as a whole.
Physical effort during an evaluation affects both the reliability and the validity of the result. Effort testing at its peak gives the reader of the functional evaluation report confidence that the results represent a true picture of the worker’s ability on the day of the evaluation. Reports compromised by less than full effort are read as representing the worker’s minimum ability.
CAN LESS-THAN-FULL-EFFORT EVALUATIONS BE USED TO ATTAIN A DURABLE CASE RESOLUTION?
Yes. One of the unfortunate legacies of occupational rehabilitation is the misguided belief that the results of an FCE are invalid if the client did not put forth full effort throughout the evaluation.
In the real world of workers’ compensation and personal injury, there are two types of validity: pure “test instrument” validity and “case resolution” validity.
Test instrument validity looks at whether the test measures what it purports to measure. For example, the EPIC Lift Capacity Evaluation is used to measure an individual’s ability to lift in both the “occasional” and “frequent” physical demand categories. Research shows that in 95% of cases, the test will identify those not giving full effort. In terms of valid lifting ability, what does this mean? It means the reader will know that, for those giving full effort, the ability demonstrated is their maximum safe ability on the day of the evaluation; for those who did not give full effort, the result represents their safe minimum ability on that day.
Both results have next-step case resolution validity. In the case of the person who gave full effort, job placement can be accurately made.
In the case of the person giving less than full effort, case resolution can be achieved in five ways:
- Job placement at the minimum ability level
- Bona fide offer of alternative employment
- Filing for case resolution for failure to remediate
- Placement in a short-term return-to-work program with a focus on development of the worker role and determination of true physical abilities
- Reduction of award based on failure to remediate
WHAT ABOUT COURT AND DEFENSIBILITY OF FCE RESULTS?
After safety and validity, Matheson’s underlying emphasis is on medical-legal defensibility. The core Matheson evaluation protocol comprises validated tests whose results have appeared in peer-reviewed scientific publications. These studies satisfy the requirements of the United States Supreme Court rules of evidence in a manner that is superior to all other FCE systems. Indeed, the Matheson FCE has been widely accepted in the highest courts in both the United States and Canada.
Vendors of FCE systems are routinely asked, “Does your FCE hold up in court?” Although many answer yes, the truth is that many have not been successful in court. There are two primary reasons for this. First, FCEs used in the workers’ compensation arena do not go to court, and second, several FCE systems are no longer used in jurisdictions that have a tort system because they failed in court.
Case in point: A great deal of the contemporary, best-practice work in FCE is done in British Columbia. The provincial automobile insurance system is based on the tort process. The preponderance of expert witness testimony involving FCE results is heard in deposition or supreme court proceedings in this province. It is no coincidence that FCE systems using a secret “validity profile” to judge physical effort or a secret formula to predict ability to work are no longer accepted as expert testimony. The results of an FCE have to be supported by a trained evaluator’s thinking, and able to be discussed in an atmosphere of peer review.
Here are just three cases that illustrate the defensibility of the Matheson protocol:
- Paki v. Muni and Messer
- Adamson v. Charity
- Leger v. Tribune Company
WHAT SHOULD A PHYSICIAN, CASE MANAGER, OR ATTORNEY LOOK FOR WHEN SELECTING AN EVALUATOR?
A fee payer or referrer for service should look for completion of the five phases in an evaluator’s development:
1. University preparation. The foundation of a good evaluator is university-level course work in such subjects as anatomy, physiology, and vocational assessment.
2. Participation in specialized FCE training. At a minimum, an evaluator should participate in intensive FCE training. It is important that such training be focused not on use of a proprietary piece of equipment but on the FCE thought process. This training should include an evaluation philosophy, be focused on case resolution, and be taught by actual evaluation practitioners, not equipment sales staff.
3. Advanced FCE certification. While the Matheson Functional Capacity Evaluation Certification Program is the most rigorous training in the field, it is not enough to produce an outstanding evaluator. After completing an intensive training, the evaluator should go on to complete a certification process. This process should be based on review of the evaluator’s fieldwork, not on a theory-based paper and pencil test. The Matheson Certified Work Capacity Evaluator (CWCE) designation is an example of advanced certification and fieldwork. Fee payers who refer for service to Matheson-trained professionals should seek those who have achieved designation as a CWCE.
4. Answers to your evaluation questions. One of the most important, and easiest to discover, skills of a functional capacity evaluator is the ability to clearly and succinctly answer referral-source questions. Ask to see one of the evaluator’s reports. Does it clearly list the evaluation questions to be answered? Unclear questions predict an unclear, useless answer. Next, read the first few pages to see if the evaluator quickly answered the questions. If the report reads as a progress note, it is not an FCE. If it contains lots of numbers but yields no actionable findings, it is not a good evaluation report.
5. Advanced training. All seasoned functional capacity evaluators participate in ongoing education. The evaluator’s curriculum vitae should include topics in the areas of report writing, critical thinking, forensic rehabilitation, and life care planning. An evaluator whose credentials are current will have participated in ongoing training with no more than a two-year gap in the training. All Matheson-trained evaluators are encouraged to attend training in as many evaluations systems as possible.