 ABCs Part Two
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Part Two: ManagingPsychiatric Disability Cases |
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 Part Two: Table of Contents
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The ABCs of Managing Psychiatric Disability Cases is a recently updated on-line version of an FHIPA publication distributed to insurance disability specialists and adjusters. Written by Dr. Leonard Grossman and adapted for the web by Mr. Michael Castellano, Part Two, Managing Psychiatric Disability Cases, details our flexible, five step strategy for managing psychiatric disability cases and improving the IME process. Part Two also includes sample letters and correspondence and cites actual confidentialized case histories and outcomes.
Part Two: Managing Psychiatric Disability Cases
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In case you're curious, the above confidentialized request yielded a very interesting treatment summary in which the care giver cleared the claimant to return to work part-time (20 hours a week). After working 15 - 20 hours a week for about six months, the claimant returned to full time duties. While "Mr. Maverick" would probably have eventually returned to work anyway, close monitoring of his case clearly brought the issue to a head much sooner. In point of fact, his return to work had been postponed three times over a one year period prior to our being assigned the case.
While a written treatment summary is preferable when making an initial first contact with a care giver, we sometimes opt for a direct one-to-one phone consultation with an FHIPA professional consultant. The interactive nature of a direct phone consultation is especially useful in situations where the case file is skimpy and little or no prior medical history is available. Also, many care givers are overburdened with paper work, and prefer to be interviewed over the phone.
I can recall one case in particular -- about three inches thick! -- sent to us for an IME which had gone on for 11 years, yet had never been formally reviewed. The company, which will of course go unnamed, insisted that a record review was not necessary. "Just arrange a psychiatric IME," we were told.
After convincing the claims representative that it would be a good idea to review the file, I it was ascertained that the claimant's chief complaints involved dementia-type symptoms and various cognitive complaints. In other words, a neuropsychological IME with testing was called for, not a psychiatric IME. The bottom line was that a battery of neuropsychological tests found strong evidence of symptom exaggeration and/or out-right faking, a diagnosis of malingering was entered, and the claim was finally resolved after 11 years!
A professional review of the case file can also protect claimant interests. In this case from a few years ago, a consultant not connected with FHIPA had reviewed a case and the results of a neuropsychological examination and concluded that the claimant was capable of gainful employment because his cognitive impairments were only "mild." The case was appealed by the claimant and sent to us for a second review, this time by one of our neuropsychologists.
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We cannot emphasize enough the importance of professionally individualizing your IME questions letters such as in the above confidentialized sample, which yielded an excellent IME report which well-documented its provisional findings. I never cease to be horrified by the inferior quality and near uselessness of the crude generic IME letters submitted by many IME venders -- which virtually guarantees you'll receive a poorly focused, ineffective IME report.
We also assess the claimant's recovery prospects and include a separate report detailing our follow-up recommendations. If recovery potential exists, pursuing the right follow-up measures can sharply increase chances that the claimant will one day be cleared to return to work. In the next section, we will learn more about measures can be taken to monitor the recovery process and prevent your cases from falling through the cracks.
But about half the cases at this stage of the process are assigned a "presently disabled" determination but have a "fair to good" back-to-work prognosis. It is these LTD cases that must be monitored carefully and aggressively.
And exactly what do mean by monitoring a case? One particularly useful strategy we employ is setting up regular professional-to-professional phone consultations with the care giver. When done from the perspective of information sharing and progress-reporting, there is no interference with treatment, and no abridgement of the doctor/patient relationship.
Encouraging a "Maximum" Treatment Program
One case in particular that I can recall involved a young attorney out for a year with major depression. The man seemed genuinely interested in returning to practice, but was making little progress. A close checking of the records and a call to the care giver revealed that he was being treated and medicated for his depression by an internist -- and not by a mental health specialist/psychiatrist.
Before I was through with consultation, the care giver agreed his patient was not progressing, and shortly thereafter referred him to an excellent psychiatrist/psychologist team. The attorney made steady progress thereafter and was off claim in six months. Had we not called, this story may not have had a happy ending.
Another interesting case involved a young stock broker suffereing from depression and alcoholism who had managed to stay sober for almost a year, except for periodic marijuana smoking. While the care giver felt the marijuana abuse was minimal, we reminded her of the repeatedly postponed back-to-work dates, and respectfully questioned whether or not one addiction had supplanted another. In the course of the next few months, and at the urging of his therapist, the marajuana smoking was discontinued. After also enrolling in AA, the young man found another job with a reputable Wall Street firm.
However, if this is so, then why do so many companies make such a minimal, and ultimately self-defeating, commitment to claim management? There is a pervasive view in many firms that the expense and potential legal entanglements engendered by more aggressive strategies outweigh the potential benefits. This would indeed be true if each and every case -- regardless of it merits and recovery potential -- were vigorously pursued.
Keeping your Claims on the "Right" Track
The key, of course, to making such a tracking system work is timely case classification by your professional psychiatric disability consultant. Companies which practice early professional intervention provide better services to their claimants while also better identifying potentially unsubstantiated claims.
For more information on utilizing professional case management strategies in psychiatric disability cases, please contact Dr. Leonard Grossman at (888) 779 - 2524.
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