Virtual CAT assessments

Thank you to everyone who attended our Thomson Rogers Webinar Series  “Virtual CAT Assessments” held May 15, 2020 conducted by Thomson Rogers’ personal injury lawyers Leonard Kunka, Stacey Stevens and Matthew Sutton.

Questions & Answers

Q1: What level of detail should be recorded in clinic notes, especially in light of the fact most insurers are only approving 15 mins per session?

The level of detail in the clinic note can be determined on a case by case basis. It is anticipated that not all sessions will produce a significant amount of information that assist in documenting your client’s impairments. Having said that, it is important to keep in mind that your clinic notes help illustrate the client’s struggles. It should be considered best practice to incorporate descriptive summaries of challenging events that have occurred and struggles the client has had in reaching certain goals as well as the positive developments.

Where a client is exhibiting increased difficulties coping due to the current COVID-19 restrictions, it is important to document those increased difficulties because they may lead to additional therapy the client will require. In addition, because we are likely to be in this state of affairs for some period of time, it is likely that there will be increased deterioration in many client’s conditions over time. As discussed during the webinar, increased difficulty in coping due to the current pandemic is not really different from difficulty in coping with any other of life’s stressors. While this stress may be unique, in that we have not encountered it before, it should not be viewed differently than any other activity in life which an injured person has difficulty coping with. Life throws us all kinds of different stressful situations, and if an injured party is having difficulty coping with stressors due to their injury, how is this stress any different than life’s other stressors?

If you find your clinic note is becoming too time consuming, you may want to consider contacting the lawyer on the file to determine if it is appropriate to incorporate that into an interim progress report.

Q2: Since COVID some insurers are continuing with CAT assessments while others have cancelled them. By this time, clients have exhausted, or are near exhausting, their medical rehabilitation benefits and are left without treatment. What can be done to assist these clients?

In cases where it is likely the client will be deemed CAT it would be worthwhile for the lawyer to speak to the adjuster to negotiate the approval of an additional treatment plan in order to prevent the client from deteriorating. Alternatively, the lawyer could approach the lawyers on the tort side of the claim to see if they would be amenable to making an advance payment to cover the costs of the treatment plans.

Q3: I have a client that was discharged from the hospital right when the pandemic started and as a result she has not had opportunities to mobilize in the community (due to both her physical challenges and concerns regarding the pandemic). How would you advise an OT to comment on their independence outside the home on the GOSE, under the current circumstances?

In those circumstances it would be difficult to comment on independence outside of the home. Keep in mind the client’s physical challenges will have no bearing on the GOS-E assessment. From a TBI point of view, you may want to consider whether the TBI impairments are increasing the client’s concerns regarding the pandemic or preventing that person from making a rational decision as to whether it is safe to go into the community wearing PPE. If that is the case, then that may support a conclusion that the client’s inability to make a rational decision leaves him/her incapable of accessing the community independently.

Q4: I have been asked by Adjuster to withdraw my OCF18’s for a neuopsychological assessment due to COVID and to resubmit only after in persona assessment can be conducted. Should I do this?

The first step would be to reach out to the adjuster and discuss the protocols you have in place to ensure that the test results will be valid. It may be a case of the adjuster needing to be educated on this point. As we know the College has issued a directive that prohibits in person assessments and in response, many neuropsychologists have moved to using a virtual platform where possible. If the adjuster still refuses to approve the OCF-18 then you can refuse to withdraw it and insist on a denial based on the criteria set out in the SABS It will be up to you to decide, in conjunction with the lawyer on the file, whether you should do the assessment on a protected account basis.

Q5: How safe is it to go into people’s homes or take clients into the community when the government still has restrictions in place?

It will be up to the therapist has to assess each individual situation and make a judgment call. If you are hesitant to provide in-home service because you are concerned the client may not have taken appropriate protective measures in their own home, ask the client what they have done to keep their home safe, and if you are not comfortable with that, then do your sessions by zoom or other platform. It is not just about protecting the client, it is about protecting yourself as well. Similarly in terms of community engagement, therapists should not be taking clients out into the community where it will be difficult to maintain social distancing. (ie. do not go for the walk on the boardwalk in the beaches where it will be crowded and instead find a secluded area or park to go for a walk). If going out into public, ensure the client is wearing a mask, and that social distancing is maintained. It will be important to eventually get clients to engage in activities in the community with protective measures in place, because this is likely going to be the norm for at least some period of time ( and perhaps for a long time) and therefore it is going to be important to see if injured parties can cope with this “new normal” of social interaction.