Need to Retain an Expert? I’m Here to Help!

As a forensic rehabilitation consultant, I could be available as your next retained expert! I’m Here to Help You Help Your Client! Unique consulting services help identify insights into your litigated case while first-hand testimony helps others to understand it.  In fact, listing me as an expert may spark some much needed movement in the litigation process.  rp_Professional-Expert-Witness1.jpg

And, the sooner the better! When you involve an expert like me on certain cases early in the process, you’ll be in a good position knowing you have a professional on hand for the duration of your case.

My companies Vocational Resources Plus LLC and Life Care Planning Resources Plus LLC lovingly co-exist. I’ll celebrate the beginning of 19 years in private practice on September 15, 2017 (and they say it’s my birthday too, yeah)! Although I’ve been in the field of vocational rehabilitation from the start….that’d be 1999, forensic rehabilitation and life care planning are both new specialties!

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In celebratory style, I’m reaching out to attorneys who are passionate about helping clients.

Here on this website you’ll find various links to my writings about serving in various capacities within my field, such as my focus on life care planning (with a vocational rehabilitation component), vocational consulting, placement, and serving as an expert witness.  I like to blog about why my work is important and to help people identify how to use my services. Further, it’s fun to write and I like to showcase my credibility, methodology and expertise. (Read my disclaimer!)

LightbulbWant to help your clients even more? Consider tapping into my creative resources!

My analysis and opinion of how I can help your case will be straightforward, honest and grounded in rehabilitation. As such, this may or may not support your case. I can usually determine whether or not I can help your case within the first few hours of research, and will limit such fees based on our agreement.

Please keep in mind that permission to use my name, or in any way indicate that I am an expert witness or consultant for your side of a case, either informally or formally with other parties, is not granted until a retainer is secured. Contact me for information on retaining me!

FootballIf I have to pass on a case, I’ll do what I can to offer recommendations.

So, give me a call at at 515-282-7753 and let’s have a conversation. I promise to value your time!

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My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Balance Your Case With Your Client’s Real Story

(Original post May 2016)

In her teen days my sister Janice (the Floridian) was quite adept at gymnastics, particularly on the balance beam where she made great use of her balancing skills. When Janice moved on to college, dad cut up the balance beam for a new use as exit steps from a sliding glass door to the back patio!

Balance BeamDad constructed a balance beam and re-purposed it as well!

Balancing is involved in many areas of day-to-day living and is critical to an abundant life. People balance tires, bank accounts, relationships, priorities and work….you get the idea. Finding balance is an ongoing lifetime project. I’ve heard the comment that it’s good to fall / fail because it means you were trying. If you think about your success, you will be successful. If you think about your falls or your failures, you’ll learn to improve.

My dad’s balance had not been good lately, although he was working on improving it. He moved continuously during each day, but a stroke and a fall down steps lead to no return to life on earth. Dad died a week after he turned 83 in the morning on 5/5/16. I’ve blogged about Death as Part of Living, and can now fully realize one has to die from many things in order to move through life and live fully….and there’s always a story to tell.

Highway BalanceRichard R. Prochnow

4/26/33 – 5/5/16

As my dad aged, he never stopped working hard and to his best ability. There was a balance in how he lived his life, and I’ll never stop learning from him! I can calm my mind and simply hear his voice when he called on the phone….“Hi Amy, this is your dad.” [Like I didn’t know!] Then he’d talk about what was happening! And it was real, interesting and well-balanced for the soul.

In whatever situation you’re in, keep on practicing finding balance, and you’ll find a way to not fall; or a way to increase your sense of balance at its core. You may lose direction, or momentarily become blinded, but you’ll find your way again. Trust yourself. Just like my dad did driving thousands if not millions of miles on the road traveling to participate in the world around him.

On a lighter side (yes, I cried but I want you to think about your own life with no tears involved), as part of my personal story, I remember an incident a long time ago while I was working as a banquet server for a hotel…walking into the room full of diners with a large tray of full drinking glasses (tea/water)….well, never mind. Let’s say there was an imbalance that could’ve been disastrous!

Spilled WaterI learned to readjust the next tray and focus on my goal…..just to get the glasses on the table safely without spilling!

We balance our bodies in many, many ways. Balancing skills make use of poses and states of mind to focus attention on work, yoga, aerobics, tabata, healing touch, hiking, golfing, bike riding…being with the person you love. You get the drift, physical activity that involves any number of exercise moves or mental positions.

Yes, simply thinking with a sense of balance is very, very good and helps avoid failure (and falling). Jurists use a balancing test to weigh the importance of multiple factors in a legal case. If you want to highlight these factors, I am more than ready to help you bring a balanced case to court.

Because my work is my life calling and I continuously learn and practice balancing, I will help you help your client. Call me at 515-282-7753 to educate me on your case. A vocational evaluation or a life care plan may provide just the balance you were looking to tell your client’s real story.

P.S. At times I am asked to simply evaluate a specific aspect of a case. Or my opinion on what someone else has already reported. Even how I feel about various aspects of a person’s capacity to succeed….. Don’t hesitate to call me : )

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Life Care Planning Helps Attorneys in Many Ways & in All Phases of Litigation! Yes, Really!

Image result for projection cartoonLitigation strategies include many a plan!  

Life Care Planning helps because it becomes a comprehensive document that provides for the future care and associated costs of a person facing a serious illness or injury.

In earlier phases of litigation, a life care plan helps evaluate the potential value of a case. During settlement negotiations, a life care plan helps identify monetary ranges. And of course during trial a life care planner can be critical to your litigation success!

Life Care Planning Services Help Attorneys in Many Ways, Here’s A Few:

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  • Project future cost of care ~ When someone has sustained a life altering injury, trying to determine the correct and fair amount for a settlement is a daunting task. It’s difficult to properly analyze all aspects of an injured party’s condition. A professional life care planner can help you assess the current needs of a patient and project future complications with a systematic approach to analyzing the injured party’s current and future conditions. After analyzing all injury-related documents, interviewing the injured party and communicating with medical professionals, the life care planner will produce a plan that considers future costs in order to ensure a fair and reasonable quality of life. The plan will consider financial, physical, and psychological factors. In the end, you’ll have a thoroughly researched document that will prove bulletproof at settlement conferences and in the courtroom.

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  • Consider likely complications ~ When it comes to catastrophic injuries and long term illnesses, you have to expect the unexpected. Almost undoubtedly, complications will arise in association with the life-altering events somewhere down the road. With that in mind, an experienced life care planner will identify the most likely future complications, allowing all parties involved to understand and adequately provide for these unforeseen circumstances.

  • Expert Testimony* ~ An experienced life care planner provides crystal-clear medical testimony for depositions and trial. Life care planners can accurately and simply describe the injured person’s lifetime of needs and justify the associated costs.      *In Addendum, as a Vocational Expert, I am also qualified to testify on the injured person’s work life and earning capacity.

Able to be customized ~ Not all cases require a full-blown life care plan. However, that doesn’t mean a life care planner can’t help you. The injury or illness doesn’t necessarily have to be catastrophic in order to benefit from future care cost projections. Versatile life care planners offer abbreviated plans for these special situations that allow you to evaluate case value and strategize early on.

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  • Establishes a level playing field ~ Regardless of what side of the fence you stand on, you can benefit from hiring a professional for life care planning services. A life care plan helps all parties know what to expect and thus helps settlements be reached more quickly. A life care planner can aid in strategizing to ensure the best possible outcome. It’s not just a time-saver. It’s a tool that gives you the key insight of one with an understanding of medical needs and the associated costs.

If you represent someone who has suffered a serious injury or illness, or a defendant accused of being responsible for an injury, consider obtaining a life care plan. Doing so will allow you to understand the future care needs of the affected party, which will result in a speedy, fair settlement.

Source for above written article: http://www.articlesbase.com/health-articles/benefits-of-life-care-planning-in-all-phases-of-litigation-3466273.html  Oct 13, 2010 • By Nancy Fraser

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Contact Amy E. Botkin, a Certified Life Care Planner at 515-282-7753 to discuss how a life care plan can help you to help your client. *I have the expertise to include Vocational Rehabilitation Services and Recommendations, when needed, into a person’s plan, and am trained in expert testimony.

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

What Did Your Grandfather’s Father Do for a Living? Need Evidence on An Occupation?

My mother Ann Dodge Prochnow, researched a book titled “Genealogy of the Dodge Family of Essex County, Massachusetts 1629-1894” authored by John Thompson Dodge Ph.D. Dr. Dodge was born in 1850 in Vermont. Dr. Dodge was a railway civil engineer. And he’s directly related to my mom!

My mom read the book (Ann’s brother Gerry Dodge accessed it for her online). It clearly took a lot of work, but my mom (with great speed, skill and accuracy of course!), typed several pages summarizing her research; and gave me a copy as a Christmas gift! I read it with fascination! While reading my mom’s paper, I heard myself saying hum, wow; and really?…and laughing a time or two!

Genealogy Book Cover Tree

It’s exciting to learn about a family’s genealogy!

Here’s my synopsis of my mom’s synopsis:

The Dodge’s are all direct descendants from Richard Dodge who was born in 1602.  My mom’s great-grandfather is Vilas Luther Dodge, born October 28, 1847 in Vermont. Vilas worked as a farmer and stock raiser in Jersey County, Illinois. He was County Supervisor and School board member, and also Director of Jersey County Agriculture and Mechanical Association. He was 5’9’ and 200 pounds! (sounds shaped kindly like someone I know….)

Vilas married Laura Dannel on February 21, 1871. Vilas and Laura had children born in Kemper, Illinois: Mary born in 1871, infant son born and died in 1872, George Dannell (my mother’s grandfather) born July 21, 1876, Ann Charlott born 1978, Fred Leroy (my mom’s Uncle Fred) born 1881 and Harriet (my mom’s Aunt Hattie) born 1886.

Genealogy of Dodge Family Book CoverThe Book Cover

George Dannell Dodge married my mom’s grandma Helen Porter in Jerseyville, Illinois in 1907 and moved to Chicago. There they had William, John Vilas (my grandpa), Helen and Laura. Later they moved to Evanston, Illinois. All their children attended Northwestern University. George died in Jerseyville in 1960s and Helen in her 90s in New York.

My grandpa Jack married Jean. They had Ann (my #1 Mom), John, Gerald and Kathleen.  By the way, Mom and Gerald (my Uncle Gerry who lives in San Francisco) are planning to get to the Plate side of Jean’s family in the future.

Throughout these years in history, the men of the Dodge name held many jobs with professions spanning many fields (read on below please…).

My grandpa John (“Jack”) Vilas Dodge was an incredible man and had an amazing career that took him all over the world! He worked in writing, as a publishing executive. I am very proud to be one of his grand-daughters! Mom tells me that her dad’s father had an insurance agency and his father’s father did too! (I need to talk more with mom or Gerry Dodge and get more detail!)

For my blog, I focus on colleges the Dodge family graduated from; and occupations employed by the Dodge family throughout the generations:

College graduates were from Harvard, Williams, Yale, Middleburg, Dartmouth, Colby, Vermont, Wisconsin, Amherst, Bowdoin, Brown, Columbia, Anion, Andover and Emory. Graduates included a few women!

Austin Hall, Harvard Law School Picture

Austin Hall, Harvard Law School

Occupations included: Farmer, carpenter, teacher, physician, lawyer, tailor, tanner, minister, legislator, shoemaker, shipping business, cooper, factory owner, cabinetmaker, blacksmith, mason, currier, leather dealer, stone cutter, stock breeder, clothier, editor, military service, insurance agent, constable, cotton manufacturer, banker, merchant, bookkeeper, newspaper business, lumber business, land surveyor, steamboat captain, harness maker, musician, and civil engineer. Pretty incredible careers  during this time!

Do for A Living

Lawyer, Teacher, Physical Therapist, Registered Nurse, Doctor, Accountant, Social Worker, Paralegal, Psychologist, Dentist, Engineer, Police Officer…..Chef! All Incredible Careers! 

I had to look up one job (not found  in O*NET but guess what, it is in the DOT!)….a cooper. A cooper is someone in the trade of making utensils, casks, drums and barrels and other accessories, usually out of wood, but sometimes using other materials. In other words, the cooper used many tools to do his work, he had craftsman skills with a keen eye for detail and a focus on quality control! I could consult with Living History Farms for a job analysis!

Plus I wanted to know the difference between work as a currier (a specialist in the leather processing industry) and  that of a tanner (a person whose occupation is to tan hides, or convert them into leather by the use of tan) so I looked it up! I’ve toured a tanning facility with my eyes bugging out at the strength needed by the tanners to throw the hides! In this case, what I could do is interview with a person who actually does the heavy work to get first hand information!

Heart

I love assessing  worker skills! I love researching workplace environments! I love analyzing jobs! I love interviewing workers! I love my work!

As far as the numerous other occupations held by the Dodges, they range greatly. The Dodges used brain power, brawn power and the power to influence others (for example: attorney, banker, musician, steamboat captain, physician, engineer, insurance agent, legislator minister and …. clothier!) They used all types of machinery, hand tools and up-to-date-for-that-time technology. The tools of any trade are tremendous! The talent from performing daily work and the credibility in a community becomes tantamount to a successful career. Boy would I have loved to interview any one of these talented individuals!

A Clothier

A Clothier Was Popular…Dapper Indeed!

I am completely fascinated by what people do for a living! If I can help you with your litigated cases, please let me know. Thank you for reading.

Take some precious time and check into your parent’s parents’ work background. You well have well spent your time and you may be quite surprised! I was with the Dodge family that helped to form part of who I am! (Guess which part and win a prize!)

Bonus: Do You Love Your Work? Why?

Contact me, Amy (Prochnow) Botkin for vocational guidance or evidence on any occupation or career!  BTW, I don’t believe there were many forensic rehabilitation counselors back in the day…..which always brings to my mind the mystery of the working world.

Vocational Resources Plus LLC        515-282-7753 VocResources@gmail.com

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

 

Want to Buy Some TIME From Me…an Educator and a Counselor?

You’re a good attorney, and you care about the people you represent. You’re also busy and spend a lot of time on time. In fact, you even buy TIME. And, I’m writing to help you make a more comfortable purchase from me!

MoneyTime

I fully realize attorneys buy TIME

Time – Because you bill by the hour (and so do I), I promise to help you be more productive and, thus, more successful by providing value laden services.

Pinky SwearI promise to always respect your time.

 

Information – Because I totally understand why you HATE looking stupid (and so do I), I will provide accurate information that you want or need.

Pinky SwearI promise to always ensure you have a good reason for working with me.

 

Money – Because saving money and making money are the goals for almost every law firm (and for every consulting firm too), I will effectively use all the resources available to help with your case.

Pinky SwearI promise to be accurate and fair with my billing.

 

Education – Because lawyers always need continuing education (and so do I) to maintain your license, I am available to present to any group that would benefit from learning about work and disability. In addition, as I’m an educator and a counselor, I can help you and your clients in many ways.

Pinky SwearI promise to bring new light to your litigation strategies.

 

Time on HandsHow much TIME would you like to have on your hands…especially when working on a complex case that has to do with work and disability? So there it is!  But wait, there’s more

I, Amy, promise to Always Be True at My Core, Apple Butterflybecause that’s all I have ever had and have ever needed! And I’m willing to share.

Enjoy a piece of quality fruit (preferably on an empty stomach!) and then give me, Amy E. Botkin, a call to discuss your case. 515-282-7753

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Alaska and Her Rehabilitation Plan…Patience Beyond that of a “Normal” Cat Owner!

Okay, another cat blog! Yes, I’m a cat lover and I love all pets and care for all living creatures! I’m not a cat fanatic, it’s just that felines have always been a part of my life and I love it! I love to write too. I love my work. I love my family. I love my life! I love a lot actually! Amy means beloved….so it’s reciprocated in many ways : ) Read on! I’d love it!

Cat Plate
Cat Plate

Little did we know that 3 months after Max my manx was murdered in early 2002 by something in the street, (I don’t love creatures who kill pets and on the other hand I don’t like it at all when my pets kill creatures), a tiny meow would emit from our neighbor’s garden. Oh my, this long haired kitten was awesome! Felix! Welcome! (Okay, this blog is not about Felix today!)

Max, (nope this blog not about you either, meooowww) a dearly beloved yet wild cat, found me ~1987 when I was renting the basement of a brick home in Windsor Heights (it had a pool in the back yard.) Speaking of cat claws!…A word of advice from a long timer cat owner, (counselors shouldn’t give advice, but in this case, listen to me!): Don’t think it’d be fun to give a cat a ride on an air mattress in a pool. Trust me. Sure looked like I had open heart surgery!

kitten-3Now, here’s a blog devoted to Alaska. She’s the cat who strutted on down the street one Spring evening in 2012 (following my son Jacob and his friend Josh) directly into the house and to a bowl full of cat food. Score!

I recall saying “Wow I’ve always wanted a white cat!” She’s all white with beautiful eyes (I love the green one; no, I love the blue one!). Oh dear, upon her arrive she was a very thin stray! And oh dear, oh my, oh dear, I would have no idea what trouble she would end up causing over the next year or two (…..) you really don’t want to know…..it involved lots of $$$$ over time (furnishings….another word of advice regarding leather furniture and cat claws). More costs $$$ credited to this white cat was the vet bills due to her actions toward the existing female feline (my love of all cat loves SamiJo.)

The cat looked like a kitten, however the excellent vet (Dr. Michael Forret) said she was about 7 months old when she decided to ditch being a stray and chose a home. She was hungry and dirty! Even her ears where filthy. Jacob named her and she has a middle name too, but I don’t think I should let you on to that just yet!

Alaska Our Putty TattyI rehabilitated Alaska TF into one big healthy white cat!

Part of Alaska’s rehabilitation included a lot of touching. She didn’t like being touched much, probably because she had not experienced much touch. She still to this day has to be touched only upon her terms….but I like to make her think she loves being petted which she really does but tries to hide it (cats).

kitten-in-toteAJ & AK bonding!

ArinJune figured out a way to carry her around in a tote bag (and to this day I often find her lounging in one of these she found!) to feel safe. With ongoing rehab,  regular vet care, good food and water, and lots and lots of love and attention, she thrives! Treats are nice too!

AK is much calmer of late into her more mature cat years. She loves the freedom to do what felines do (….sleep…and read above [hunt]…). She continues to be “a wild one” however and she herself does her share of “killing and delivering….” But, how can I stop a cat from that? Her hunting is actually of value to where we live because of an unkept property or two in the hood. But the dismembered gifts by the back door, come on! Enough. I have purchased her a new collar with a loud bell that will hopefully help plus she only goes outside about once or twice a day.

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Alaska helping me on a case!

Good communication and problem-solving skills are required in order to counsel others. I truly in my role as a rehab counselor, want to be empathetic and I want to reveal my desire to help people fulfill their goals. Counselors need good listening skills, compassion, and patience while working with individuals who have suffered serious injury and disability.

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She found this case interesting and pauses to reflect!

I know I have patience beyond that of a normal cat owner! Thank you my felines for teaching me how to listen and show my true self.

If I can help you help your client with a life care plan that includes vocational rehabilitation, please let me know!

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My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Central Value of Consulting with Me…What You’ll Find!

I provide forensic vocational rehabilitation consulting services that focus on life care planning and placement. My goal as a consultant is to work with attorneys with passion; those who truly care about their clients.

You’ll find we make a nice pair when we focus on your client!

Life care planning involves identifying and facilitating health care recommendations so complications to daily living are minimized. Placement involves valuable counseling sessions and access to creative resources so obstacles to return to work are circumvented.

Please take your time to review information about my professional services. Life care planning and forensic rehabilitation counseling are unique to vocational rehabilitation. That’s why I chose to work in this field! It takes a lot of knowledge yet common sense to truly help others.

Work Hard Stay HumbleYou’ll find I work hard for you and just as hard for your client!

If you, Attorney Person, need help with how to quantify AND qualify an individual’s earnings capacity within a life care plan, I am the consultant you need.

I believe work is central to the existence of adult functioning. It provides funds needed to live and supplies status and security for an individual. You’ll find value in how I approach my own work in a qualitative way. You’ll see I’m grounded in neutrality, sincerity and resolve to never give up until the facts make sense.

Ask some questions and learn what I, Amy E. Botkin, can do to help.

Amy Pic 9-29-15

You’ll receive a humble reply!

Vocational Resources Plus, LLC * lcpresourcesplus.com * 515-282-7753  * VocResources@gmail.com

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My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

When, Where & Why You Need a Life Care Planner for Your Litigated Case & Who Can Help You!

When Do You Need a Life Care Planner?

Typically a life care planner is helpful for legal cases involving catastrophic injuries or chronic health conditions.

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  • Lawyers, physicians, and insurance companies can hire a life care planner to research, analyze and develop life care plans for patients who experience catastrophic injuries or chronic health conditions related to birth, brain injury, spinal cord injury, stroke, amputation, trauma, burns, and other serious injury.

Where Do You Need a Life Care Planner?

A life care planner is useful in a variety of jurisdictions.

  • In legal cases that include workers’ compensation, personal injury, medical malpractice and marital dissolution
  • A plan is also useful to protect assets when aging, disability or chronic disease raises tough questions about estates
  • Other civil lawsuits, estates and probate needs

Why Do You Need a Life Care Planner?

A life care planner is beneficial for individuals, families and funding sources for many good reasons.  A good planner is able to ~

  • Provide the individual and the family with an outline of future care
  • Guide people through the complex maze of rehabilitation and long-term care coordination
  • Assess diagnoses and work-related disabilities
  • Network and make connections with health care providers and holistic practitioners
  • Educate, motivate and support the family regarding their loved one’s needs
  • Help insurance companies set reserves

Who Do You Need to Be Your Life Care Planner?

Amy Pic 9-29-15Amy E. Botkin, MS, CRC, CLCP, Certified Life Care Planner

With my extensive training, experiences and knowledge, I am able to zero in on vocational rehabilitation needs….often a key component when attorneys and insurance companies are settling or trying a legal case involving an individual of working age.

Please take into account a child deserves the opportunity to work and make money in their future, and if permanently and totally disabled, many factors come into play when assessing their potential earning capacity.  

I can help you help your client and your client’s family.

CLCP Certificate expires 2-28-21

Contact Amy E. Botkin at

515-282-7753 or vocresources@gmail.com for more information on life care planning services.

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My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Working on a Case Involving Work & Disability? I’m Here to Help You…Depose & More

I can help you in a number of ways with any case you’re working on that involves work and disability, whether it be medical malpractice, personal injury or workers’ compensation or other litigation. One way I can help you is to design creative questions skillfully as part of the discovery process allowing a much deeper inquiry into the person’s “world of work”.

My goal is to inspire you even more to do what you love to do…ask questions, right!? And to be the best attorney you can be, double right!!

Depo

I’m sure questions you ask a deponent include those to: determine the nature of previous jobs; amount of money making; for whom s/he was working; why employment was terminated; and what qualifications and experience s/he had for the type of work s/he was doing [when injured].

You also question what work the individual has done, if any since the disabling condition, describing job duties; and determining previous employers and earnings.  Questions posed to encourage a deponent to detail what it is s/he can and cannot do are important, too.

These are all good questions from you yes, and critical of course (although kinda boring in my humble opinion!). Would it help you to have at your fingertips specifically designed questions (based on evidence to date) at deposition that will produce a much deeper inquiry into the person’s vocational background? I get excited when I think of sooo many other questions you could ask that really get into the meat of the matter!

meatAnd I don’t eat meat!

I’ve heard 90% of malpractice cases are settled before trial, and the deposition often is the turning point in those cases. I’d like to help you prepare questions that will lead to responses offering plenty of material for you to work on your case. My aim is to help you skin that cat in many ways and be ready for the most likely responses from your witness. I hope my help with your deposing techniques is valuable pre-trial as well as if the transcript is used for court.

Object

Plus, please keep in mind, I can definitely help you in more ways to better understand the individual’s disabling condition. A life care plan is perfect for that! Expert witness and testimony services are available as well.

I am here to help you help your client!

Call me ~ Amy Botkin at  515-282-7753 or shoot me an email message at vocresources@gmail.com and I’ll get back to you. Thank you for reading! Good luck with your legal work.

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

How to Handle Conflicting Medical Opinions? With a Forensic Approach, of Course!

Upon referral of a vocational case, I review a variety of  medical data (i.e., treating physician reports, FCE’s, IME’s) and/or psychological data (i.e., psychometric testing, psychological evaluations, psychiatric evaluations) found within the file. During a workers’ compensation litigated claim (for that matter, all claims that involve work and disability), it is important to understand the individual’s medical situation based on the data contained in these records.

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Good thing I’ve had medical records training…and enjoy the review!

If a file has more than one Functional Capacity Evaluation (FCE), I can expect the reports to have conflicting opinions. Commonly one physical therapist will recommend the claimant has the physical capacity for light work, while the other says medium work. Often the therapists also have conflicting information about the individual’s maximal (or lack of) effort put forth during the evaluation.

I Did My Best

The claimant needs to say honestly and sincerely  “I Did My Best!”

Assisting the individual (who used to be referred to as the injured worker, the patient, the claimant, the testee, the evaluee, and potentially the client)  in returning to work following an injury is a central role in my specialty of placement. This involves finding the best occupational match within the individual’s own labor market. A person’s “doctor imposed restrictions based on an FCE” should not direct the provision of placement services.

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With conflicting opinions from professionals, what data should I rely upon to perform a beneficial service?

To resolve discrepancies I first ask myself, why is an FCE being used for this specific claim? The utility of this type of scientifically based evaluation, the training sources, performance methods, test protocols and standards to measure them are numerous. Professionals may have opposing views for their own reasons but I must be able to articulate their reports into vocationally-relevant terminology and tell a story about meaningful and gainful work.

WORK

I love writing reports rich with detail about a person’s world of work! And I love reading medical data rich in detail about a person’s world of functioning!

A functional capacity evaluation is actually a term with various definitions, purposes and constructs. A functional capacity evaluation (FCE) evaluates an individual’s capacity to perform work activities related to his or her participation in employment. It seems that in essence, by having a functional capacity evaluation a person is likely to be put in a position of deciding whether he or she is willing to return to work. This is unfortunate.

From what I know, there are approximately 10 different types of commonly used functional capacity evaluations. Here in Iowa, I am most familiar with FCEs with names like the Isernhagen Work System, the Blankenship, Matheson, WorkWell and X-RTS. The reliability or validity of any system is somewhat irrelevant to me because the testing is already entered into “evidence.” What is relevant to me is whether or not I comprehend the results and recommendations contained within the evaluation. Sometimes I can, sometimes I cannot. I always use a “Does This Make Sense?” test!

Image result for conflictingIt’s up to the dualing physical therapists to make their best points during litigation, I’m not in that ring!

I feel fortunate of connections with several physical therapists allowing insight into their clinical practice. Recently I attended a continuing education program that helped me understand various approaches to FCE’s and I am rather fascinated with the X-RTS Lever Arm.

Thinking Cap

The X-RTS Lever Arm passes my make sense test!

So within the context of my vocational consulting work while cautiously putting any judgment aside (which seems hard when I know I know certain things), I analyze and compare each FCE while considering the testing results.

I analyze and compare FCEs! Whoa!

I note whether the FCE report is readable and user friendly. I assess if I understand terminology and methods used, how long testing was administered, what actually was administered, the claimant’s behavior during the test, and how the evaluator came to his or her conclusions. Does it make sense? I look for descriptors regarding the results of testing in relation to real jobs. Are there concrete and realistic recommendations regarding (strengths and weaknesses) in relation to performing physical demand levels of various work situations? I definitely look for the goals and expectations for the evaluation, and whether maximum and consistent effort was made by the evaluee. Comments on the suitability of the testee’s future employment options along with the evaluator’s observations are valuable!

Thinking Cap

Continuing on with analyzing and comparing FCEs! Whoa! It’s important to note what body part/extremity the therapist focuses on in relation to what body part/extremity was injured. For example in one report, the therapist discussed lower extremity activities, when in fact it was an upper extremity injury. If the report cites examples or uses too many percentages, it’s important to understand how the therapist justifies examples. I’m familiar with a therapist who changes the percentages of the same examples from report to report. That doesn’t make sense to me.

I try really hard to make sense of most things and situations!  No sense

If I am able to square an FCE in my mind after careful and prolonged study, is it possible the claimant could do the same? That is fortunate!

How does the claimant (not actually a patient at this time in a workers’ compensation case when referred for an FCE by their own attorney; with an additional FCE visit to a different physical therapist by the defense attorney) perceive discrepancies in the results? Sadly in my eyes, the FCE often gets “interpreted” through an attorney. The repeated pattern of thinking of one’s functional capacity as “poor” does not help me to help anyone return to work.

If there is an IME (Independent Medical Exam), it may seem more geared towards one of the FCEs. Regardless, I try to comprehend all reports, noting the one I understand the most. I’m not so sure that an IME is really a “fresh set of eyes” in the workers’ compensation cases I’ve recently worked on. This topic is another blog in itself.

Putting both, or multiple opinions in a vocational report and making use of other documentation to support my ultimate and final opinion is a great idea, however I have to be cautious to not put myself in a role that isn’t mine (making a medical opinion).

If I am able to provide a doctor (ideally the most recent treating occupational health or rehabilitation doctor) detailed information directly related to a specific occupation or line of work and any resources that could help understand how such work is performed in a smart, safe and effective manner, many benefits arise.

Related image

Clean your lenses!

There’s a clearer understanding of the vocational rehabilitation process and with agreement from all involved, there’s a higher likelihood one could see a successful common outcome (return to work). This certainly helps solidify my vocational opinion and make recommendations. Yet, this type of opportunity is not frequently available (certainly is though with a life care plan!). Please know I always search for a way to best express my vocational opinion.

In my reports, I document what medical records I’ve reviewed and then use the actual words from the individual during an interview describing how s/he details their physical impairment.  Often I hear verbatim what one doctor wrote in their restrictions. The evaluee will respond to my open questioning about any physical limitations (sometimes after the evaluee refers to his/her doctor’s letter) and read or have it memorized saying: “no lifting over 20 pounds, avoid twisting, bending, stooping, sit and stand as needed.”  No sense

What do those words really mean in real life? The individual doesn’t seem to know either. Ask an employer if they have a job that involves no lifting over 20 pounds, no twisting, no bending, no stooping, no this, no that …. and that’s not talking their language!

The evaluee who responds to me in this fashion (using verbatim restrictive words) needs future vocational counseling. Vocational counseling (which may or may not be provided depending on the nature of the litigation) helps to gain a clearer understanding of how the person’s medical situation has changed their daily living (especially in the context of their own world of work). This understanding leads to the ability to articulate the individual’s capacity for success to others (family, friends, job interviewers, etc.).

Please keep in mind, the term “restriction” is not conducive to a successful job search. The ability to explain who you are and what you can do from a functional perspective to help a business make or save money is what is conducive to a successful job search. Restrictions should never be the focus of job placement. Skills are!

Counseling is especially important if the individual is searching for a job, requiring job seeking skills training on how to or (how not to) disclose. The personal attributes gained from training helps the placement process move forward with common goals avoiding getting stuck within a few words that don’t apply to working reality.

WORKWhile staying true to my convictions and firm beliefs that a person can work if the person wants to work and has the capacity to work, I need to understand the dichotomy between science and clinical practice is more imagined than real.

If healthcare professionals submit conflicting reports on the same individual, I need to be able to resolve inconsistencies to better understand and appreciate the opinions offered. It is not my role to determine which opinion is correct. It is my role to utilize available information, provide a beneficial service, and make a sound vocational opinion regarding the individual’s strengths and weakness in relation to work capacity and employability.

Matching People With Their World of WorkIt’s rewarding when I can clarify a person’s sense of their own world of work.

I strive to extend the value of FCEs in the litigation process. I am trained not only in understanding a client’s functional abilities at work, but at home and at leisure. (Need a life care plan?) Together my knowledge with those of other experts, contributes to decisions about the economic losses, or damages, for which the person receives compensation.

Give me a call 515-282-7753 and let me get to work for you!

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.