Transcript Nedlife Retrenchment Claims Management

Life Seminar 2008
The value of the
occupational therapist
Yolanda Skei
21 February 2008
MRoA/MMRC
Munich Re Group
What this talk will be about…
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MRoA/MMRC
Munich Re Group
Core competencies of the occupational therapist
Disability claims assessment – why an OT?
Models of OT utilisation in disability insurance
Pointers for when to utilise the services of an independent
occupational therapist
Last words
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Core competencies of the occupational therapist
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MRoA/MMRC
Munich Re Group
Human occupation
Components of function
Knowledge of medical conditions
Holistic view of individuals
Rehabilitation focused on functional ability
Vocational rehabilitation
Interviewing - Observation - Reporting
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Domain of Occupational Therapy Practice
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MRoA/MMRC
Munich Re Group
Center on Human Development and Disability, Clinical Training Unit, University of Washington,
Box 357920, Seattle, WA 98195-7920 [email protected]
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Domain of Occupational Therapy Practice (2)
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MRoA/MMRC
Munich Re Group
Occupational therapists
are skilled
both physical
and psychiatric
Occupational
therapists
arein skilled
in both
physical
disorders
and psychiatric disorders
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Disability claim assessments
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MRoA/MMRC
Munich Re Group
Why should you even contemplate using an OT?
 A disability claim seeks to determine the impact of an impairment on a
claimant’s ability to perform work tasks.
 A disability claim is about vocational competence.
 Depending on the definition of disability, an opinion on rehabilitation /
recovery / likelihood of return to work is required.
 Depending on the definition of disability, an opinion on the transferability of
vocational and other skills is required.
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Models of occupational therapy involvement /
employment in disability insurance
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MRoA/MMRC
Munich Re Group
Employed by a Life Office as Claims Assessors / Consultants
Employed by a Life Office as Case Managers
Performance of independent assessments
Performance of case management by an independent
occupational therapist
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Pointers for when it would be beneficial to utilise the
services of an independent occupational therapist
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MRoA/MMRC
Munich Re Group
Functional capacity evaluations
 Medical evidence lacks sufficient information to determine the impact
of the impairment on functional ability and vocational capacity.
 Lack of objective reasons for stated limitations
 Observations do not support the degree of disability reported / claimed
 History / background to the claim is unclear
 Complex cases with a multitude of diagnoses
 Determining the potential duration of disability
 Rehabilitation within the original occupation is unlikely
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Pointers for when it would be beneficial to utilise the
services of an independent occupational therapist (2)
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MRoA/MMRC
Munich Re Group
 Home visit / Field visit
 Better understanding of limitations / symptoms
 Activities of daily living
 Work site visit
 Insight into actual work task requirements
 Reasonable accommodations
 Explore / identify suitable alternative occupations
 Observation of workplace dynamics
 Review assessments
 Brief evaluation comparative to a historical view of claimant
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Work site visit – assessment of accessibility for
persons with physical disability
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MRoA/MMRC
Munich Re Group
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Pointers for when it would be beneficial to utilise the
services of an independent occupational therapist (3)
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MRoA/MMRC
Munich Re Group
Case management
 Feasibility of candidate selection
 Source appropriate medical service providers
 Obtain quotations
 Case management programme planning
 Facilitate appointments and source reports
 Ongoing contact with claimant
 Liaison with the employer
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Last words
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MRoA/MMRC
Munich Re Group
Referral brief has to be clear and comprehensive
Standardised tests - ?interpretation and analysis
Quality of reports
Suitably skilled independent occupational therapists
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The value of the occupational therapist
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MRoA/MMRC
Munich Re Group
THE
END
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