Catastrophic Application/Rebuttal and
Pre/Post 104 Disability Assessment/Rebuttal Services
 

ψ Dr. Salmon’s unique methodology to address evolving case law ^{link new}

ψ Desbiens & Related Case Evolution: Directing... CAT Ratings ^{link new}

ψ Review of Pain Disorder re. Evolving Case Law ^{link new}

ψ CAT Panel Recommendations (2011) which under government consideration ^{link new}

Co-Leaders, CAT Team

Drs. Salmon and Guerriero co-lead a highly trained and experienced group of medical and clinical support experts performing multi-disciplinary CAT assessments in collaboration with RTW Integrated Health Management.

Dr. J. Douglas Salmon, Jr. [ click for CV] has been providing Catastrophic determination assessments from the outset of the CAT entitlement process. He was the Chair of the original Minister of Finance’s CAT DAC Mental/Behaviour Subcommittee and member of the Glasgow Outcome Scale Subcommittee, with activities including development of the original CAT clinical guidelines in these spheres and development and training of all CAT DAC OTs throughout the province. He was subsequently a consultant to the Minister’s DAC Committee on specific CAT matters. He is a senior faculty member with the only university based AMA Guides/Catastrophic Impairment Certification & Training program in Ontario (CMCC/CSCE); in this capacity, he has trained hundreds of medical and allied health professionals in the brain injury, mental/behavioural and Desbiens CAT rating protocols. Dr. Salmon is on the Board of Directors for the Alliance for Community Medical and Rehabilitation and Co-chairs the organization’s Standards & Guidelines Committee and is a member of a similar committee for the Canadian Association of Psychologists in Disability Assessment. He had previously been the Associate Canadian Vice President/Ontario Vice President, Association for Scientific Advancement in Psychological Injury and Law since its inception.

Dr. Rocco Guerriero is a registered chiropractor with a fellowship designation in Chiropractic Sports Sciences, Rehabilitation Sciences and Chiropractic Orthopedics. He is an associate professor at the Canadian Memorial Chiropractic College (CMCC) with over 20 years of chiropractic teaching experience. He is the president of the North York Rehabilitation Centre and was a chiropractic consultant at UHN Rehab Solutions, Bloorview MacMillan Children’s Centre and St. Michael’s Brain Injury Assessment Centre. He is one of the founders and past-president of the Association of Designated Assessment Centres, was the Past President of the Canadian Society of Chiropractic Evaluators, and is currently president of the College of Chiropractic Orthopedics (Canada). Dr. Guerriero was on the Pre-approved Framework working group, designing new PAF guidelines and was on the Superintendent's RISC committee overseeing the new SABS and its implementation on September 1, 2010. He is currently the President of the Association of Independent Assessment Centres (AIAC) and is certified in the AMA Guides impairment rating (4th and 5th editions) with training in the 6th edition also. He is the Coordinator and a senior lecturer of the CMCC/CSCE certification program on AMA Guides, 4th edition and Catastrophic Impairment. Dr. Guerriero was on both working groups in the development of the CAT DAC assessment guidelines. He was also was on the Whistler Medical Team for the VANOC 2010 Winter Olympic Games.
 

Catastrophic Impairment Applications (OCF 19)

On the basis of a comprehensive file analysis, a detailed charting of the recognized diagnoses and impairments to date is prepared. The file analysis concludes with identifying the specific expert team of medical/mental health practitioners and clinical support staff required to address each of the noted diagnoses/impairments that will be considered for the Catastrophic Impairment Analysis. Typically assessment protocols are delivered in a staged cost-effective manner. An OCF 18 for multi-disciplinary CAT determination assessment is then submitted along with the supporting file analysis report. In accordance with the Sept/10 SABS, an OCF 19 Catastrophic Application is then submitted by a medical specialist or neuropsychologist depending upon the specific CAT criteria met. The CAT ratings always include consideration of the Desbiens case law of combining psychological and physical impairments and utilize Dr. Salmon’s unique methodology to address evolving case law. Given that CAT rebuttals are no longer insurer funded, the OCF 18 based multi-disciplinary assessment is the best opportunity for comprehensive non-IE evaluation.

Catastrophic Impairment IE Review & Challenge

In conjunction with RTW Integrated Health Management, this service provides state of the art specialty medical, neuro/psychological and/or OT functional assessment towards addressing MVA Catastrophic Impairment entitlement. The process commences with a careful review of the CAT IE Report to identify clinical and/or methodological errors in the report including but not limited to the following issues:

• Improper or insufficient assessors

• Impairments which were omitted from the total rating

• Inappropriate rating methodologies and protocols

• Inappropriate application of the AMA Guides

• Incorrect diagnoses

• Lack of empirical basis for conclusions (especially psychiatry whereby rarely are psycho-diagnostic or cognitive measures utilized to support opinion)

• Inconsistencies between IE opinions within the IE multi-disciplinary report

• Failure of diagnostic assessors to integrate functional findings of OTs

• Failure to utilize best practices, state of the art methodology for OT In-Home Assessment to provide evidence base for the Mental/Behavioural ratings

• Failure to utilize a Situational Work Assessment to provide evidence base for the Adaptation domain rating

• Failure to provide a Desbiens rating at all

• Failure to provide Desbiens rating that is consistent with that directed in the case law (e.g. the California method has not been supported)

Upon identifying the weaknesses of the CAT IE report, a cost-conscious staged approach is utilized to provide a report which challenges the IE assessment on the basis of evidence based assessment(s). The CAT ratings always include consideration of the Desbiens case law of combining psychological and physical impairments and utilize Dr. Salmon’s unique methodology to address evolving case law. Moreover, highly rigorous objective testing is employed to measure actual shortfalls in independent functioning (including parental responsibilities and daily financial independence) relative to the requirements of the Glasgow Outcome scale. Additionally, when indicated specialty medical investigations (e.g. EMG, specialized radiological investigations) may be utilized to assure maximal rating considerations.

Pre and Post 104 Week Income Replacement Assessments/ IE Review & Challenge

In conjunction with RTW Integrated Health Management, this service consists of a multi-day situational work assessment to provide an evidence based disability assessment to evaluate the client’s capacity to sustain attention/concentration, work activity pace, persistence, productivity and stamina at a competitive level in consideration of presenting cognitive, emotional, social-interactional and/or physical impairments in the context of work demands across these same domains. Standardized work samples and simulated work activities form the basis of the evaluations. The following two disability criteria may be distinctly evaluated using this methodology:

(a) the “own occupation” (pre-2 year) disability status is evaluated by considering the client’s capacity to perform pre-condition essential job tasks at a competitive employment level. The evaluation may be used as an initial assessment or as a rebuttal to an insurer examination.

(b) the “any occupation” (Post 104 week/2 year) disability status is evaluated by considering the client’s capacity to perform occupations previously selected as being suited by reason of “education, training or experience” at a competitive employment level. The evaluation may be used as an initial assessment or as a rebuttal to an insurer examination.

If used as a rebuttal to an insurer examination (IE), the assessment considers whether the IE selected appropriate occupations for the individual, and whether the IE considered the case law requirements of “commensurate remuneration” and “commensurate socioeconomic status” in rejecting the client’s Post 104 week eligibility. It also provides a multi-day situational work assessment to ascertain the individual’s actual competitive employability on a full time basis as required of the Post 104 case law, but typically ignored in Post-104 Week Disability IE assessments.