COMPLEX CASE MANAGEMENT DIVISION
FREQUENTLY ASKED QUESTIONS: (COMPLEX)
1. WHAT CRITERIA DO YOU USE TO DETERMINE THE “COMPLEX CLAIMS” THAT ARE SUITABLE FOR YOUR INTENSIVE CASE MANAGEMENT PROGRAM?
ANSWER
Criteria for selection of complex case management files:
- Treatment resistant mental illness.
- Complaints that have failed to resolve through traditional medical treatment in the expected period of time.
- Chronic disorders that have a relapsing and remitting pattern and may stabilize with time and appropriate treatment (e.g. Multiple Sclerosis, Crohn’s disease, HIV, etc.).
ANSWER
They can be off for virtually any time period, although most cases come to us after the individual has been off work from between 3 months to 3 years. We have also been asked by our clients to assist employees who are still at work, but in need of our services so that they are able to remain on the job.
3. WHAT HAS BEEN YOUR SUCCESS RATE WHEN WORKING WITH THESE COMPLEX CLAIMS?
ANSWER
Historically we have achieved a success rate of approximately 65%, based on working with over 1300 claimants. The vast majority of our successes are the result of an individual returning to work full time.
4. CAN YOU IDENTIFY A CANDIDATE FOR YOUR COMPLEX CASE MANAGEMENT PROGRAM FROM AN IME OR AN FCE?
ANSWER
Yes. In a number of cases we can observe pain focused behaviours or self-limiting behaviours during the course of an IME or FCE. If there is a lack of objective findings of impairment, these people may well be candidates for our program.
5. HOW IS CHRONIC PAIN EVALUATED AND MANAGED THROUGH YOUR PROGRAM?
ANSWER
In addition to the presence of psychological issues, people suffering from longstanding pain will demonstrate measureable physiological signs of impairment and will show objective evidence of functional limitation. It may be difficult to differentiate between ongoing, learned pain and associated coping behaviour, as opposed to guarding or protective mechanics associated with actual pain or disability. Whatever the reason for the pain, in complex and chronic cases, the Complex Division uses a peer-reviewed approach to include the insight and recommendations from our team on each file. In doing so, decisions regarding file progression are not solely based on one professional. It has been our experience that a simple reported inability to perform a specific task does not necessarily constitute a disability, and as such additional information will need to be obtained and analyzed.