The term ‘forensic’ evokes images of investigators at a crime scene digging through microscopic clues for evidence. In the vocational rehab world, legal and forensic evaluations generally don’t involve CSI, but the inspection process can be similar. In rare cases, experts are brought in to review claims in detail, searching for anything that has been missed or that might lead to a different recommendation for an injured worker.
“Forensic evaluations are essentially a deep dive into what’s happened with a case,” says Kevin Leneker, co-owner and founder of Single Handed Consulting. “Often a client will send us a complete file in an effort to get a determination or recommendation overturned. We examine it to identify if mistakes were made and provide an expert recommendation.”
Accurate Forensic Evaluations Are Important
Forensic evaluation requests can come from the Department of Labor and Industries (L&I), attorneys, or employers. In the latter case, the review may be the last step before legal action or a formal protest of a previous decision.
Results matter to employers; when a vocational rehabilitation counselor recommends that an employee needs to be retrained, the costs involved can be staggering. Medical bills, time loss payments and retraining costs add up quickly so it’s in a company’s best interest to make sure that the recommendation made is accurate.
“An employer will call us and say, ‘Can you look at this recommendation?’” says Leneker. “Usually they’re not happy with something in the claim and before they file a suit or protest a decision, they want another set of eyes to see if their position has merit. We can provide an expert opinion.”
In the evaluation process, reviewers pore over every aspect of the claim looking for errors related to the injured worker’s ability to return to work and the wages or compensation they should receive. “Experience has let us know where the weak points often are in a case or the places where people make mistakes,” says Leneker.
Single Handed consultants also look at factors like the state of the economy at the time of injury, the local economy in the geographical region where the injury occurred, and the dollar amount an employee should receive based on their transferable skills and previous experience. Considering that level of detail may yield a different result than the previous recommendation.
Often such cases have been open for several years, says Dale Bristow, a vocational rehabilitation consultant with Single Handed. “Cases that involve traumatic injuries or psychological conditions may be referred or there may have been multiple referrals with different outcomes.” Claims that have been held up for long periods frequently hinge on medical issues, he notes.
Experienced and Informed Recommendations
Once the review is complete, consultants like Leneker provide a recommendation based on their findings. “It may go in the injured worker’s favor or the employer’s,” says Bristow. “It backs up the last vocational recommendation or says it was incorrect and explains why.”
Reviewers also provide suggestions on ways for the injured worker to move forward both medically and vocationally. Ultimately, decisions about how to proceed rest with L&I. In rare instances, cases remain open even after a forensic review.
Whatever the recommendation, the result saves employers substantial costs in two ways: if the evaluation finds that an injured worker is, in fact, employable, they save big on retraining costs and time loss expenses. “If we find that mistakes were made in the initial assessment and the worker has transferable skills based on job history, that saves the huge cost of vocational training,” says Leneker. “Two years of time loss plus retraining costs can be as much as $100,000.”
If, on the other hand, the evaluation finds that the last recommendation was valid, employers still save by not initiating costly lawsuits or fighting battles they will ultimately lose. “We may tell them that our expert opinion is that everything was done correctly and there’s no room for litigation,” says Leneker. Because Single Handed and other legal and forensic evaluators are neutral parties and experts in their field, the employer can feel confident in abiding by their findings.
Providing Peace of Mind
Forensic evaluations remain a rarity in the worker’s compensation world, mainly because they’re so labor intensive. When necessary, however, they can save employers considerable costs while providing peace of mind. Like their CSI counterparts, forensic evaluators simply follow the evidence.
