Medical Care Coordination (Case Management) 

The goal of medical care coordination (MCC) is to assure proper medical treatment occurs in a timely and logical sequence in order to minimize disability and recovery, reduce costs, and expedite the return to work at suitable gainful employment for people with injuries and illnesses.  This goal is accomplished by coordinating physical rehabilitation services, providing health training to the employee/family and monitoring the injured employee’s recovery.

Medical care coordination involves, but is not limited to, coordinating physical rehabilitation services (such as medical, psychiatric, or therapeutic treatment for the injured employee), providing health training to the employee and family, and monitoring the employee's recovery.  The purposes of medical care coordination are to minimize the disability and recovery period without jeopardizing medical stability, to assure proper medical treatment and other restorative services are provided in a timely manner and logical sequence, and to contain medical costs.

Determining the need for MCC is usually based on the following factors:

1. catastrophic cases (should automatically be referred for MCC)
2. the severity/complexity of the injury
3. anticipated prolonged recovery period/potential for complications
4. general state of health prior to the injury and the presence of pre-existing conditions
5. degree to which the injury threatens job related functions
6. the employee is determined to be at risk of remaining unemployed or unable to obtain suitable gainful employment after a review of the following:

                -client's age
                -client's average weekly wage at the time of injury
                -work history and type of work at the time of injury
                -educational level
                -location-availability of work in the geographic area  

Medical care coordination is a voluntary service that can be offered by the carrier only through a department-approved qualified rehabilitation provider, Section 440.491(7), Florida Statutes, and 6A-22, Florida Administrative Code.  The carrier is encouraged to work with the QRP and to follow the recommendations of the rehabilitation professional they hired.  Early intervention along with clear communication between all parties is the key to successful return to work.

Reemployment Assessments 

A reemployment assessment is a written assessment performed by a qualified rehabilitation provider (QRP) and provides a comprehensive review of the medical diagnosis, treatment, and prognosis.  It includes conferences with the employer, physician, and injured employee and recommends a cost-effective physical and vocational rehabilitation plan to assist the employee in returning to suitable gainful employment.  After identifying the worker’s education, training and vocationally relevant skills and abilities, and taking into account the limitations imposed by the medical impairment, the QRP recommends the services with the highest probably of returning the injured worker to work.

Reemployment assessments are particularly important if the injured worker is at risk of remaining unemployed and/or if the case involves catastrophic or serious injury.  In workers’ compensation cases, is not necessary to receive the consent of the injured employee or his representative prior to contacting the employer or health care provider for the purposes of conducting the assessment.

REEMPLOYMENT SERVICES 

Usually as a result of a reemployment assessment, a QRP provides the reemployment services the injured worker needs to attain suitable gainful employment.  These include, but are not limited to:

• Vocational counseling to assist in resolving obstacles to employment
• Job seeking or employability skills training designed to provide tools and assistance, such as resume preparation and interviewing techniques
• Ergonomic job analysis to collect and synthesize information about a specific job through personal observation or conversation-important in matching a person’s skills and limitations to a particular job
• Transferable skills analysis that examine and analyze work history, experience, and skills to determine which skills may be transferable to another type of job within an injured employee’s physical abilities
• Selective Job Placement, which requires special interventions, such as job modification recommendations, and is considered a specific matching of a injured employee’s needs and abilities to job activities
• Labor Market Surveys to search for and identify specific type of jobs and employers

Other services, such as education or training, vocational and on-the-job training, may also be considered, as needed, to secure suitable gainful employment or that which is reasonably attainable in light of the employee’s age, education, work history, transferable skills, previous occupation(s), and injury, and which offers an opportunity to restore the individual as soon as possible to his or her average weekly earning at the time of injury.

SSDI Vocational Expert 

Vocational Experts (VEs) are professionals who provide impartial expert opinion evidence at the hearing level of the Social Security disability claims process.  The Social Security Administration contracts with and commonly requests vocational experts attend administrative hearings, at which time these expert witnesses would address their testimony to the claimant's particular and highly individual situation. 

On the basis of residual functional capacities, and in consideration of age, education, vocational experience, skills and other relevant factors described above, the vocational expert provides testimony on the employability of the applicant.  Testimony includes the specific jobs, if any, the claimant can engage in as well as how many of those jobs exist in the state and nation.  Vocational experts emphasize analysis of the transferable skills earned from past relevant work and testify as to the (other) occupations the claimant could perform with those skills, taking into account the claimant’s residual functional capacity (physical and mental limitations), education and aptitudes.

A VE provides both factual information and expert opinion, based on the following experience and expertise:

• An up-to-date knowledge of and experience with the existence and incidence of jobs in the labor market, work settings, and the skill level and physical demands of jobs; and
• A working knowledge of the concept of transferability of skills as defined in SSA regulations.

The VE’s opinion evidence will concern the assessment of the vocational evidence, in answering specific questions from the Administrative Law Judge (ALJ), or the claimant or his or her representative.  The VE’s testimony is evidence the ALJ considers along with other types of evidence in deciding a case.  The VE has no stake in the outcome of the case.  Their testimony is most relevant in steps four and five of the sequential evaluation process.

The SSA Office of Hearings and Appeals has established criteria for an individual to qualify as a VE in the Social Security disability hearings program.  VEs must have:

• Up-to-date knowledge of and experience with industrial and occupational trends and local labor market conditions;
• The ability to evaluate age, education and prior work experience in light of residual functional capacities;
• Current and extensive experience in counseling and job placement of adults with impairments and disabilities;
• Knowledge and use of vocational reference sources including:

• Dictionary of Occupational Titles           
• Occupational Outlook Handbook  
• Job analysis and vocational surveys performed by vocational experts
• Local Chambers of Commerce 
• Selected Characteristics of Occupations Defined in the D.O.T.
• Complete Guide for Occupational Exploration
• The Revised Handbook for Analyzing Jobs
• Lists of Unskilled Light and Sedentary Occupations
• National and State labor market figures, published by the Bureau of Labor Statistics  
• State employment services such as the Florida Agency for Workforce Innovation

An Administrative Law Judge may request a vocational expert’s testimony when:

1.        the ALJ is determining whether the claimant's impairment(s) prevents the performance of past relevant work; or

2.        the ALJ cannot decide whether the claimant's impairment(s) prevents the performance of any other work because:

•  the claimant's residual functional capacity falls between two exertional levels; e.g., the claimant may be able to perform more than the full range of sedentary work but less than the full range of light work;
• the claimant has solely non-exertional limitations; or
• the claimant has a combination of exertional and non-exertional limitations; e.g., back impairments with limited sitting or standing tolerance.

Though paid for his professional services, the vocational expert is not an agent of the Social Security Administration. He or she is expected to remain completely objective and impartial in expressing his or her opinions, whether they are favorable or unfavorable to the claimant. Identifying with neither the Social Security Administration nor the claimant in what is legally a non-adversary procedure, the expert dispassionately contributes his vocational evidence toward an equitable decision.  View the history of Vocational Experts and more information on their roles in SSA hearings.