Function Based Case Management Strategies

Function Based Case Management Strategies

A decade ago, the way the personal injury cases were analyzed and valued was typically via diagnoses, impairment ratings, and imaging studies. Multi-trauma diagnosis that were correlated with positive imaging findings of fractured bones, herniated discs, and ligamentous tears; etc. were substantial evidence that the injured’s  impairments were somehow catastrophic and warranted an appropriate settlement. 

Those days are long gone and providing the insurance company with that level of documentation and evidence of impairment is subpar. It no longer educates the insurance company on how the injuries that your client has sustained, equate to a loss of functional ability to return to their previous level of function and engage in their life the way they did prior to the collision; more specifically, their ability to perform work related activities, activities of daily living, and leisure activities. 

Today, case management MUST be centered around your client’s functional loss from the collision, slip-and-fall; ect. The question you must ask yourself when going through a case is, “how do the impairments that have been documented through treating practitioners and experts, equate to a functional deficit that leads to a disability?”

What if you had an extensive evaluation that you could present to the insurance company that would confirm the diagnosis, impairment rating, and / or imaging studies, and would actually quantify their severity? This evaluation exists and is the only trial-tested, objective, reliable, and valid way to determine how their injuries affect their livelihood. If you haven’t guessed it, the evaluation I’m referring to is the Functional Capacity Evaluation.  

The Functional Capacity Evaluation is designed to take the injured evaluee through a thorough series of functional tasks that allow the evaluator to determine functional impairments. These tasks measure fine / gross motor control and dexterity inadequacies, positional tolerances, lifting and carrying deficits; etc. and make valid conclusions reguarding the functional limitations found during testing and how they equate to functional impairments.  

Functional impairments are the new gold standard of documentation in personal injury cases. The functional impairments discovered through the functional capacity evaluation will help guide you through your demand letter settlement request and help pave the way for other experts involved in the case to make more holistic opinions on the permanency of your client’s impairment.  

Dr. Brad Poppie has over 20 years of personal injury experience providing care as a treating doctor, coordinating rehabilitative case management, and expert trial testimony services.  If you have a client that you would like to discuss their need for an expert report, please contact me directly at 720-982-2000 or email me at:

Dr. Brad Poppie, DPT, CLCP, CFCE, CSCS  
Doctor of Physical Therapy
Certified Life Care Planner
Medical Cost Projection Specialist 
Certified Functional Capacity Evaluator
Certified Strength and Conditioning Specialist

The Role of the Rehabilitation Doctor in a Personal Injury Case

The Role of the Rehabilitation Doctor in a Personal Injury Case

From a healthcare standpoint, personal injury cases can involve a wide array of professional disciplines including medical, chiropractic, physical therapy, speech therapy, and psychology to name just a few.

These different healthcare specialties not only treat the patient to help them return to their prior level of function, but each discipline can offer specific insight into the patient’s progress and future prognosis.

Many times, however, an expectation is put upon the treating medical doctor to give an opinion about the overall prognosis of a patient. While medical doctors can say whether they think a person has achieved maximum medical improvement, they typically have to consult with the patient’s rehabilitation doctors to determine the patient’s actual rehabilitative potential. The difference here is that medical doctors diagnose and treat pathology and rehabilitation doctors such as physical therapists, evaluate and treat dysfunction.

To further break this down consider this: If you asked a physical therapist to prescribe certain medications or read an MRI report, they wouldn’t be able to do so because it’s out of the scope of their practice and not licensed in this field. On the other hand, if you asked a medical doctor to perform a physical therapy rehabilitative treatment regimen they would not be able to successfully treat this patient because they simply aren’t trained in doing so. Each respective discipline, both medical and rehabilitative, have their own unique training and skill sets that give them credibility to opine on specific aspects of the patients’ overall prognosis.

Now knowing that your patient’s medical doctor can only opine on a portion of your client’s injury and recovery, you can see why a collaborative approach with various healthcare professionals is critical when determining a patient’s overall prognosis. When the question “what is the patients’ rehabilitative potential” or “has the patient achieved maximum medical improvement” is inevitably asked in trial, if the appropriate experts are not in line to give an expert opinion on this topic, it will be difficult to prove to a jury if maximum medical improvement or maximal rehabilitative potential has been achieved.

As a Doctor of Physical Therapy, I have testified in trial numerous times against medical doctors ranging from orthopedic surgeons, physiatrists, and interventional pain physicians. Most often, the opposing opinion of these experts is different from mine in regards to the improvement of the patient.

It’s not necessarily that their opinion is wrong, it typically comes down to their opinion being based off of the client’s pathological condition and if that diagnosable condition has been cured or if there is an impairment that still exists. From the rehabilitation doctor’s perspective, we are looking at the overall rehabilitation potential of the patient and whether their function will improve or regress over time; thus providing a rehabilitative prognosis.

From a medical standpoint, the person may have reached maximum medical improvement from a disease or pathology standpoint, but the doctor of physical therapies’ view is if the person has reached maximum rehabilitative potential. The physical therapist has the education, experience, and expertise to opine on this question with certainty and should be integrated into determining the overall prognosis of the patient.

Make sure you provide the insurance company and or jury members both the medical doctors’ AND rehabilitative doctors’ opinions in order for an accurate and well-rounded prognosis to be made.

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