What Do We Really Need to Develop a Vocational Opinion?

Our customers often ask what factors are related to pre- and post-wage earning capacity and how we use that information to develop our vocational opinions. Some of the most important information can be obtained during discovery, interrogatories, depositions, and engagement of other experts. To gather this data, we advise our customers to: 1) identify who holds the pertinent information 2) get access to the information holder 3) ask the right questions; 4) get detailed and useful answers. To facilitate the efficient flow of information, here are some key issues that are central to our vocational assessment process:

1. Current medical status of the injured individual. Many people return to work before maximum medical improvement is achieved. It is helpful, however, to have a firm medical prognosis, so that we can better predict the final outcome and more accurately project vocational capacity into the future.

2. Ability to work. Regardless of medical status, it is important to know if an individual is currently able to work, and, if so, when the individual returned to work post-injury. An accurate timeline regarding the claimant’s work status assists us in calculating earnings associated with any “lost time” that the injured individual was not able to earn wages in the labor market.

3. Physical and Mental Restrictions. Restrictions are often the most important piece of information in determining whether an injured individual can return to their previous job, and, if not, what jobs they can do. It is essential to know if permanent physical, cognitive, or emotional restrictions exist so we can apply those restrictions to the outcome assessment.

4. Medication effects. The effects of medication can strongly impact potential restrictions that can impact workplace safety, making the need for detailed medication list crucial. It is important to know if adjustments could be made to the medication regimen to mitigate any side effects that negatively impact employability.

The Physician’s Opinion Report form and Physical Capacities Work Restriction form are tools we have developed that can be used as guides for gathering the specific information we require. These two forms are available upon request free of charge.

For a complimentary consultation with one of our experts at Stokes & Associates, Inc. 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, MHS, CRC, LPC, LRC, CLCP
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP

Life Care Plans and Physician Conferences

As is stated in each of our reports containing a medical cost analysis, life care plans are derived from several sources of information, including an initial interview, a review of medical records, physician, and allied health professional recommendations, and research regarding the standard of care for each specific injury. We utilize a structured interview to gather preliminary information regarding an individual’s medical, social, and psychological history and current functioning. This information provides the framework for building a life care plan, which is supplemented with research, and, when possible, we rely on corroborating and supplementary information learned via communication with treating or consulting physicians and allied health professionals.

While some of these important recommendations can be obtained during a review of medical records, more often than not records do not outline the care likely to be necessary throughout an individual’s life expectancy. Further, even when recommendations are found in medical records, the frequency and duration of those recommendations are rarely offered. To address this, when possible, we use the medical record review to identify information pertaining to an individual’s treatment needs and to generate questions based on each specialist’s area of expertise. With targeted questions in hand, we then contact the treating or consulting physicians or allied health professionals and offer to send them a questionnaire or to schedule a telephone conference. Physicians and allied health professionals tend to appreciate the option regarding how to communicate their recommendations, as well as our targeted and well-developed questions.

As an example, when generating questions for an orthopedic physician who has been providing pain management interventions for an individual, we would ask about the frequency and duration of future interventions that are required, as well as the threshold, if any, for transitioning from interventional pain management to surgical options. In addition, we would inquire about the medications and therapies necessary for generally treating the injury or illness, as well as medications and therapies associated with acute post-procedural or postsurgical care. We also inquire as to the probability of those recommendations - recommendations are only included in the life care plan if they are described as more likely than not, indicating a greater than 50% chance of being required.

While we are not always able to communicate with treatment providers, whether due to time constraints, lack of response from the provider, or difficulty obtaining approval to contact the providers, we always make an effort to do so. Communication with physicians and relevant allied health professionals gives us the opportunity to ask pointed questions and get detailed answers, often above and beyond what is contained in a chart note or progress report. The richness of information we are able to gather during that communication enables us to generate a valid and reliable life care plan.

Through a complimentary consultation, we are happy to share any information about our experience with utilizing physician conferences to benefit a specific case.

To strategize with one of our experts at Stokes & Associates, please call David Barrett at
504- 454-5009, visit our website, www.stokes-associates.com or email dbarrett@stokesassociates.com.

Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, MHS, CRC, LPC, LRC, CLCP
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP

Using Wage and Employment Statistics in a Vocational Assessment

As vocational experts at Stokes & Associates, we rely on various resources to help formulate our opinions regarding an individual’s employability and earning capacity or loss of earning capacity.

Our labor market and wage research consists of two parts. One is to identify and describe suitable vocational alternatives for an individual (“confirmatory research”). We accomplish this by conducting a Labor Market Survey, which is comprised of searching for specific jobs with potential employers in a specific geographic area to determine job requirements, availability, and suitability for our evaluees. The other part of our analysis is to investigate the employment outlook and earnings of the respective occupations (“exploratory research”). We utilize the Occupational Employment Statistics (OES), which produces the Occupational Employment and Wage Survey. The OES is a cooperative program between the Bureau of Labor Statistics (BLS) and individual State Employment Security Agencies. Each state produces wage and salary information by region or metropolitan statistical area, which allows us to conduct research nationally.

As an example, if we were looking for occupations in Louisiana, the published data would provide us with:

• The “mean” wage and three percentile measures ranging from the 25th (low), 50th (median), and 75th (high) based on straight time, gross pay;

• Wage estimates for 799 national and 716 Louisiana statewide occupations in over 400 industry classifications;

• Earnings data for 8 Regional Labor Market Areas in Louisiana;

• Occupational groupings that are industry specific.

What is NOT included in this published data are specific job titles within the occupational group, which are classified by Standard Occupational Classification (SOC) code. Any given SOC code may have several individual job titles that fall within that code. For example, in determining earnings for light delivery drivers, “couriers and messengers” is the occupational group, based on SOC code 43-5021. The following information can be obtained for “courier and messengers” for New Orleans Regional Labor Market Area for 2015:

Number Employed
310

Entry Level
$19,717

Median
$26,979

Experienced
$32,612

With this, we ascertain annual earnings ranging from the 25th percentile ($19,717) to the 75th percentile ($32,612), in addition to the number employed (310). This statistical data is then confirmed by a Labor Market Survey, which also expands our understanding of potential employment opportunities by providing information regarding actual job availabilities, accommodations available, and the corresponding earnings. Many times, the information obtained from a Labor Market Survey corresponds with the statistical data reviewed; however, if there are discrepancies, we can then explain how and why there are differences.

We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our 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, MHS, CRC, LPC, LRC, CLCP
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP

Case Records Review

Vocational and Life Care Plan Evaluations require detailed information about an individual’s past and current social, professional, and medical functioning; however, self-report is subject to both conscious and unconscious biases that may skew the final opinions. For this reason, our experts at Stokes & Associates, Inc. utilize other sources of information to corroborate the information learned in an evaluation, which ensures our opinions and reports are based on the most accurate and complete information available. One important collateral source of information is a thorough record review.

When generating a life care plan, we rely on medical, psychiatric, and psychological records to provide detailed information relating to an individual’s treatment, medications, prognosis, and medically-derived restrictions or limitations. This information allows us to create a life care plan that is precisely tailored to the specific individual, incorporating explicit recommendations provided by their treating physicians and utilizing knowledge of their exact needs. The recommendations included in our life care plans are directly linked to the medical, rehabilitation, and psychological records, which gives our reports the strong foundation necessary to be presented and defended in court.

With vocational analyses, we also rely on educational records and documentation of earnings to supplement our understanding of their pre- and post-injury earning capacity and employability. For example, most individuals are generally aware of how much money they earn, but few can provide detailed salary and tax information off-hand. When we are able to access and analyze an individual’s tax documents we can survey their earning history and more reliably calculate their post-injury lost earning capacity. Further, records pertaining to an individual’s work ethic, work stability, and return to work attempts can aid us in identifying viable future employment opportunities for that individual.

We take pride in being thorough but efficient, so our record review process is scrupulous but well organized. To consult with one of our experts at Stokes & Associates, Inc. about what records you should send to us and how we will utilize them, please call David Barrett at 504- 454-5009, visit our website, www.stokes-associates.com, or email dbarrett@stokesassociates.com.

Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, MHS, CRC, LPC, LRC, CLCP
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP

FCE and Vocational Analysis

Determining an individual’s vocational capacity following an injury requires a multi-disciplined approach. At Stokes & Associates, we rely on many sources of information in making this determination, including an in-person evaluation, doctor recommendations, and thorough record review. When the records include a Functional Capacity Evaluation (FCE), we are provided with a detailed and reliable description of the individual’s work-related physical capabilities; this information contributes to our ability to successfully match the individual with work he/she can effectively perform in environments he/she can tolerate.

FCEs are comprehensive examinations typically performed by occupational or physical therapists, as these professionals are uniquely qualified to understand the dynamic interactions between the person, the environment, and the occupation. The specific components of the evaluation depends on the purpose of the assessment (i.e., return to work versus determining appropriate treatment course), though it almost always involves a client interview followed by several reliable and valid functional tests, including:

• Material-handling and strength (i.e., lifting, carrying, pushing, pulling);

• Positional tolerance and flexibility (i.e., sitting, standing, walking, balancing, kneeling, stooping, reaching, crouching, crawling);

• Coordination and balance (i.e., right versus left side ability).

An FCE report often describes the individual’s subjectively reported pain levels and objectively witnessed pain behaviors throughout the functional tests. Finally, an FCE report includes information about the individual’s effort and motivation, which is indicative of willingness to return to work and to perform at his/her optimal ability.

As job placement and vocational analysis specialists, we value ecologically valid data regarding an individual’s limitations and abilities. Often times, an FCE is the best predictor of future success in returning to and maintaining work following an injury, as it facilitates matching individuals with job demands suited to his/her range of functioning.

To consult with one of our experts at Stokes & Associates, Inc. about whether you should pursue a FCE for a specific case and/or to get recommendations for evaluators in your area, 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, MHS, CRC, LPC, LRC, CLCP
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP

Vocational, Life Care Plan Experts and Preferred Providers

At Stokes & Associates, we recognize the importance of selecting the right experts and consultants to appropriately assess and define the damages portion of your case.  We believe the expert's role is to be a knowledgeable educator who adds value by informing and assisting the trier(s) of fact regarding the issues at hand. 
 
As Vocational Rehabilitation and Life Care Plan experts and consultants, we often analyze the work products of other experts and providers, and we are very familiar and comfortable with the interdisciplinary nature of physical rehabilitation teams.  We welcome the opportunity to consult and collaborate with physicians and other allied health professionals who have an impact on the outcome of your case.
 
Encouraging collaboration and communication with other key treatment providers or evaluators allow for more accurate assessment of the rehabilitation potential, employability, earning capacity, and future medical care needs of the injured party.  In networking and collaborating with other healthcare and forensic professionals, we have generated a database of key specialists and providers who we frequently recommend to referral sources. By consulting us early in the process, we can assist you to find and secure the team you need to achieve the outcome you seek.
 
Through a complimentary consultation, we are happy to share any information about our experiences with other providers who may be a positive impact on your case.

 
To strategize with one of our 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, MHS, CRC, LPC, LRC, CLCP 
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP

Case Records – Do We Have What It Takes?

We realize it is not always possible to provide a complete set of records when referring a case for a vocational assessment or life care plan. Records tell a story, and in order for us to provide a comprehensive assessment, having a complete set of documents in our possession prior to rendering our opinions is crucial. In general, the more information we have early in the process, the better able we are to see the whole story.

After records arrive, we can get the file opened, begin our review, and determine if any additional information is needed such as a medical consultation, second medical opinion, FCE, etc. This is particularly important when the assignment is a RUSH (less than 30 days for vocational and less than 45 days for life care plans).

In determining how soon we need to get an evaluation scheduled and records reviewed, we consider:

• The discovery or cutoff for expert reports; not only our own but those that rely on our report such as an economist. In order for the economist to complete their work, we usually have to get our report in one week earlier than their deadline.

• Whether a mediation or settlement conference is scheduled and when. We need to prepare our information in order to assist you with a successful mediation or settlement conference.

There are times when we do not have the opportunity to conduct an interview or assessment of the evaluee, and in these cases, our opinions are based on a record review, research, and our knowledge of best practices. In these cases, it is paramount that all records are received in a timely fashion in order for us to effectively and efficiently complete a report.

For vocational referrals where employment outlook is assessed, it is extremely helpful to review records to determine if physical restrictions have been outlined. Likewise, when assessing earning potential, it is helpful to have received tax and earnings records. Additionally, having educational and/or school transcripts are beneficial if determining an evaluee’s potential career path and training potential. These types of records may take time to acquire, so requesting these documents from the proper source early on will help us do our job well.

When developing a life care plan or medical cost analysis, it is essential to have file records at the time of referral or shortly thereafter so we will be in a position to determine if additional medical information is warranted to assist with our opinions or if a consultative evaluation is needed.

When referring vocational assessments or life care plans, consider the following:

• Do I have all the file material ready to send to the expert? (See our Document Checklist)

• Do I need to obtain school records or transcripts?

• Do I need to order earnings records such as tax returns and or Social Security earnings records?

Receiving file materials and essential documents early save us time, reduce inefficient billing, and ultimately help with a smoother workup of your case.

We offer complimentary consultations concerning "hypothetical matters." To strategize with one of our experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokes-associates.com.

Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, MHS, CRC, LPC, LRC, CLCP
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP

Life Care Planning: What is the Foundation?

A Life Care Plan (LCP) is a dynamic document based on published standards of practice, assessment, and research which outlines future needs and costs for individuals with catastrophic injuries or chronic health needs. The LCP is an essential component of assessing future medical costs in litigated matters and offers a detailed road map for quantifying future damages. But, what is it based on? How do life care planners determine which goods and services to add to the plan, and how can we be sure that the plan neither overfunds nor underfunds future expenses?
 
Life Care Planning involves a specific procedure, governed by published best practices and generally accepted methodologies. An item listed in a LCP is considered a probable occurrence with a greater than 50% likelihood of occurring in the future. There are three main ways of determining whether to include an item in a LCP, and it is common practice to use one or more methods when building a plan. First, Life Care Planners carefully review available medical records paying particular attention to recommendations offered by treating physicians and independent medical examiners. If the recommendations are stated clearly with a likely onset date, frequency of occurrence, and duration of treatment, the item can be added to the plan if the provider is clear about the probability of occurrence. Unfortunately, most medical treatment notes lack one or more essential components when discussing treatment plans that prevent the simple population of the LCP.
 
A second and more common approach to researching a LCP is to communicate directly with the treating providers. The simplest method is to generate a comprehensive set of questions asking for specific recommendations, frequencies, and durations. The benefit of such an approach is the ability to ask detailed relevant questions of the treaters to cover most future medical scenarios. The challenge is that these written questionnaires can become quite long, which may dissuade busy providers from taking the time to reply. In many cases, an in-person or telephone conference can usually provide the necessary information needed by Life Care Planners and allows for follow-up questions and other queries to provide a richer plan.
 
Finally, Life Care Planners can turn to the literature to determine likely future medical needs. When using published research, it is important to ensure that the studies or publications involve a sufficient sample size of study participants who closely approximate the demographic qualities of the plan’s subject. For research to be relevant, publications should be recent, appear in peer-reviewed journals if available, and add important information regarding frequency, duration, and the probability of occurrence.
 
A thorough, defensible LCP is constructed using the best available information. However, the individual’s needs may change over time pending updated medical treatment information, the passage of time, or technological advancements. Therefore, it is important to remember the flexible, dynamic nature of the report and recognize that even the best plans are subject to change.
 
We offer complimentary consultations concerning "hypothetical matters."  To strategize with one of our experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokes-associates.com.

Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Lacy Sapp, MHS, CRC, LPC, LRC, CLCP 
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP

What's in a job? Using the DOT as a basis of vocational evaluation.

Determining wage-earning capacity has its roots in the analysis of transferability of skills, and the transferability of skills to other jobs has its roots in the DOT. The DOT, or Dictionary of Occupational Titles, a publication of the U.S. Employment Service (USES), has been used since 1939, thereby having decades of information and research on which it is based.  The DOT provides a wide range of occupational information with application to job placement, occupational research, career guidance, and labor market information. The DOT, however, does not provide information about wages, hours worked, or other contractual issues.

The DOT defines occupations, not jobs.  Job requirements are defined by the particular employment situation.  The USES specifically recommends when specific job requirements are needed that information should be supplemented with data from jobs in the relevant community. Changes in job requirements due to technological advancement, labor market conditions and job task restructuring continue to occur at a rapid pace making the gathering of specific duties of a job essential.

The DOT is assigned a unique code which includes information about the industry, category, division and groups to which the occupation belongs.  The code provides information regarding the worker functions and training needed to perform the job.  Training is identified by the specific vocational preparation time or skill attainment it takes to learn the job. Skill levels are outlined as unskilled, semi-skilled, and skilled.   The general educational development is also defined in the code. Education and training are achieved through school, technical programs, military, work experience, and apprenticeships. The general educational development includes reasoning, math and language development.

Particularly important is the identification of the Physical Demand Strength rating included in the DOT Code. This rating corresponds to physical restrictions outlined by an evaluee’s treating physician and is often the basis for determining which occupations may be appropriate post-injury. The strength rating is expressed by five terms which are generally described as follows:

Sedentary – Exerting up to 10 lbs. of force occasionally, and/or a negligible amount of force frequently. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time.

Light – Exerting up to 20 lbs. of force occasionally, and/or up to 10 lbs. of force frequently, and/or a negligible amount of force constantly.

Medium – Exerting 20-5- lbs. of force occasionally, and /or 10-25 lbs of force frequently, and/or greater than negligible up to 10 lbs. of force constantly.

Heavy – Exerting 50-100 lbs. of force occasionally, and /or 25-50 lbs. of force frequently, and/or 10 to 20 lbs. of force constantly.

Very Heavy – Exerting in excess of 100 lbs of force occasionally, and/or in excess of 50 lbs. of force frequently, and/or in excess of 20 lbs. of force constantly.

Although some consider the DOT outdated, it is still the best-published source for occupational information we have. It is a guide or starting point that is supplemented by research conducted by the prudent Vocational Rehabilitation consultant.

We offer complimentary consultations concerning "hypothetical matters."  To strategize with one of our experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokes-associates.com.

Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
Lacy Sapp, MHS, CRC, LPC, LRC, CLCP 

How do Transferable Skills Influence a Vocational Assessment?

When determining factors related to post-injury earning capacity, the individual’s vocational profile is analyzed in order to assess viable post-injury employment options.  A vocational profile includes key elements such as age, level of educational attainment, work history, vocational test results, transferable skills, and residual limitations.  Transferable skills are those skills that are typically acquired through education, training, work experience and leisure activities, and can be generalized to alternate types of jobs. 

Transferability is most probable and meaningful among jobs in which:
 

1. The same or lesser degree of skill is required;

2. The same or similar tools and machines are used;

3. The same or similar raw materials, products, processes, or services are involved.

 
Transferable skills vary regarding how cleanly applicable they are among jobs.  In general, the greater the degree of acquired work skills, the less difficulty an individual should experience in transferring skills into other jobs. 
 
At Stokes & Associates, we use vocational inventories along with conducting a transferable skills analysis to identify those transferable skills that can assist with post-injury career exploration and job search. Appropriately identifying one’s transferable skills can allow for an easier adjustment and transition back into the labor market post-injury.
 
We offer complimentary consultations concerning "hypothetical matters."  To strategize with one of our experts at Stokes & Associates, please call David Barrett at 504-454-5009 or email dbarrett@stokes-associates.com.

Larry S. Stokes, Ph.D.
Aaron Wolfson, Ph.D.
Todd Capielano, M.Ed., LRC, CRC, LPC, CLCP
Lacy Sapp, MHS, CRC, LPC, LRC, CLCP