Occupational therapy claims in personal injury matters

Sep 9

Written by: newseditor
Thursday, August 21, 2014  RssIcon

Kathy Clarkson, Director of Melbourne Occupational Therapy Associates and medico-legal expert, recently presented to Lander & Rogers’ Health Law and Liability teams and clients as part of our presentation series.

Kathy explained how occupational therapy claims are assessed and quantified, including the components of an assessment and the process for making and costing recommendations for therapy, support services, care support and equipment.

Kathy is often asked to critique occupational therapy opinions. Some of the common issues she finds in conducting these critiques are:

  • A lack of therapeutic reasoning and/or any indication as to how allowances have been calculated - A claim for therapy, support services, care support or equipment must be based on an assessment that this assistance will have a therapeutic benefit. However, there is not always a clear basis for the recommendations made in reports.
  • Making therapy recommendations which do not anticipate change - Therapy is meant to improve a person’s condition and if it does not do so, it is no longer of any benefit. Accordingly, therapy recommendations should be for a fixed period only in anticipation of future improvement.
  • Inappropriate recommendations - Recommendations should have regard to a person’s disability and functional capacity. For example, travel should not form part of a claim if the person does not or will not travel. Further, recommendations should reflect life stages. Not all services will be required for the rest of a person’s life and accordingly, they should only be recommended for a fixed period. Claims should also not be made for standard household items.

Kathy also explained a number of trends that she has identified working as an expert, including an increase in wrongful birth claims, the increasing value of occupational therapy claims and a reduction in the number of occupational therapists doing medico-legal work.

Comment

Occupational therapy opinions are commonly obtained by parties in serious or catastrophic personal injury cases involving large claims for therapy, equipment and attendant care.

It is important to understand how these claims are assessed and quantified in order to determine their reasonableness and whether an opponent’s contentions should be challenged. Keeping an eye on common inconsistencies will greatly assist this process.

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