Presentation on theme: "Michael Shahnasarian, Ph.D.. Medical Issues Psychological Factors Education, Training, and Specialty Skills Work History, Acquired Experience and Skills."— Presentation transcript:
Medical Issues Psychological Factors Education, Training, and Specialty Skills Work History, Acquired Experience and Skills Formulation of Opinion New Evidence Extant Evidence Formulation of Opinion New Evidence Extant Evidence Ancillary Factors Subject-Specific Factors Labor Market Research Earning Capacity Opinion Data from Examination Processes Involved in Conducting An Analysis of a Claim of Loss of Earning Capacity From Assessment of Earning Capacity, 3 rd Edition (Shahnasarian, 2010)
DriversInhibitors Stability of Career Development Work Propensity Demonstrated Earnings History Career Motivation Cognition Phase of Career Development Subject Specific Issues Ability to Apply Prior Skills Future Career Development Prospects Prognosis Need and Capacity for Retraining Preexisting Vocational handicaps Acquired Vocational Handicaps Vocational Adjustment Issues
1. When evaluating loss of earning capacity claims, there are premorbid and postincident factors that could be facilitative (drivers) as well as detrimental (inhibitors) to a claimants vocational rehabilitation. These factors merit analysis. 2. ECAF-2 factors that are inhibitors include high scores on 9 items (see handout). 3. ECAF-2 factors that are drivers include high scores on 5 items (see handout). 4. Drivers and inhibitors can be quantitatively and qualitatively evaluated by qualified vocational rehabilitation evaluators.
5. Drivers and inhibitors have an interactive effect on vocational rehabilitation potential, assuming an individual is motivated for this. 6. Drivers can help mitigate earning capacity damages, assuming an individual is motivated for this. 7. The ECAF-2 quantitatively and qualitatively evaluate drivers. 8. The ECAF-2 quantitatively and qualitatively evaluates inhibitors. 9. Driver and inhibitor indices can be used to assess claims of loss of earning capacity, with corresponding degrees of loss. 10. At times, drivers can take on inhibitor qualities, and inhibitors can take on driver qualities.
Guidelines for Assessing Loss of Earning Capacity Claims PrognosisAccessibility to Premorbid Occupations and Career Development Opportunities Likelihood of Generating Compensation at a Level Commensurate with Premorbid Level Viability of Continuing Career Development GoodNo Loss/Mild FairMild/ModerateModerate/Severe GuardedModerate/Severe PoorExtremely Severe/Catastrophic
Lawyers do not have confidence that vocational evaluators findings are either consistent or objective. No differences between plaintiff and defense attorneys in opinions about the need for a standardized approach to conducting vocational evaluations. The study provides strong support for the development of more universal, comprehensive, and perhaps quantifiable methods of assessing vocational capacity.
ECAF users rated the instrument positively and found the instrument helpful. Specifically, they rated the ECAF most positively when asked about its ability to offer a standardized approach to assessing earning capacity. Generally, variances among ECAF users assessments of loss of earning capacity were less than variances among nonusers. Generally, variances among trained ECAF users assessments of loss of earning capacity were less than the variances among untrained users, indicating that use of the ECAF reduced within group variances in estimates of loss of earning capacity. ECAF can be particularly useful in cases in which the assessment of latent or future loss of earning capacity is intuitively evident but difficult to quantify.
In 75% of the cases, vocational experts agreed or strongly agreed that the ECAF was helpful. Cognition and career motivation were most often judged by vocational experts to be an individuals best prognosticators for success in pursuing vocational rehabilitation and minimizing earning capacity damages. Among ECAF factors, the highest correlation was between demonstrated earnings history and work propensity. Results from the factor analysis identified three significant clusters among the 14 ECAF factors: global factors affecting career development, disability-related factors, and ability to apply prior skills. Eleven of the 14 ECAF factors demonstrated loadings on one of these three clusters. This finding lends credence to the factors being material and comprehensive correlates of earning capacity.
Reported changes in subjects physical conditions since their vocational rehabilitation evaluations approximated changes in their reported mental health conditions. Two factors alone - general intelligence and positive work attitudes were highly predictive of postlitigation vocational behavior. The model most predictive of a return to work included the MAB-II, Full Scale IQ, and the MMPI-2 Work Interference scale, resulting in a 83.3% correct classification rate. Significant correlations emerged between return to work and both high levels of education and measures of intelligence. A negative relationship emerged between return to work and the MMPI-2 L-scale. Less than one-half of the subjects were employed from 5 to 7 years after their vocational rehabilitation evaluations. In the overwhelming majority of cases, though, those employed were satisfied or very satisfied with their employment – albeit at lower levels of compensation.
For three case studies, test-retest correlations measuring subjects assessments of percent loss of earning capacity were significant at the.01 level. The overall test-retest reliability coefficient, collapsed across all cases, was.98. All 14 ECAF factors demonstrated significant test-retest reliability across the three case studies. Test-retest correlation coefficients associated with ECAF drivers and inhibitors were, likewise, highly significant. In all three cases, subjects found the ECAF even more helpful with their second use of it. The variance that emerged between same ECAF factor correlation coefficients across cases is consistent with Shahnasarians assertions about a cases uniqueness and, correspondingly, the need to evaluate a pending case on the bases of its facts and intracies.
Generally, vocational experts and insurance company employees viewed the loss of earning capacity claims similarly. When significant differences arose, the insurance company employees were more conservative in their damages appraisals; vocational experts assigned a higher percentage of loss of earning capacity in both cases where significant differences on this variable were present, and they determined the presence of more inhibitors in the third instance of significant between-group differences. Only two of the eight coefficients were significant; accordingly, the investigators concluded that the findings provided insuficient support to proceed with a determination of ECAF cut-off scores to assign impairment to earning capacity ratings. Significant between-group differences occurred in cases involving mild and moderate/severe loss of earning capacity, rather than the extreme no loss and catastrophic loss case study scenarios. Interestingly, significant findings between ECAF Inhibitor scores and loss of earning capacity ratings emerged in both gray area cases. Differentiation between driver and inhibitor factors provides a useful framework to describe vocational capacities/limitations.
Earning Capacity Assessment Form, 2 nd Ed (Fall 2010) Assessment of Earning Capacity, 3 rd Ed (Late 2010) Prototype