As a neuropsychologist with over 37 years of neuropsychological testing experience I have a keen appreciation for the time and cost of neuropsychological testing. A key question to me is what value does this expensive assessment have to the injured worker or to his payor of medical services?
In answering this question I am reminded of a case several years ago as Clinical Director of Cambridge Rehabilitation Services. Called on to consult by a private disability insurance carrier, this man had been a top salesman in New Jersey for a national company for many years. Unfortunately he suffered a brain injury from which he physically recovered but left him with mild cognitive impairments. The referral included his medical reports and a Neuropsychological Test report. This report was not from a local neuropsychologist but by a leading expert from New York. The expert, well published and a professor, made many correct observations and conclusions about my patient. However, it was my belief that the report missed the mark on informing his disability insurance carrier about his rehabilitation potential in terms of return to work.
I went over the test data and concluded that the expert, retained by claimant’s attorney on behalf in his disability claim, presented a very static view of his capabilities. As with many Neuropsychological Test reports I have reviewed over the years, several critical work related questions went unaddressed. The expert simply opined the claimant had suffered cognitive impairments and that returning to his job “as is” was not possible. With the simple “yes he is disabled” conclusion, a disability “payout” was inevitable with this report in hand.
After an interview with the claimant, I imagined a very different outcome for him, one that he was eventually very pleased with in the long term.
My report to his insurance carrier pointed out several missing factors left unaddressed in the prior report.
- Job related cognitive limitations – The specific cognitive changes causing his loss of work functions
- Potential benefits of rehabilitation efforts– the specific interventions and their projected benefits to improving his work product
- Emotional and motivational factors– the personality factors which could be tapped into and leveraged to assist him in perservering with a rehabilitation program that would assist him in accepting personal changes
- A specific time line for return to work and projected costs– a detailed outline of the time and cost of the rehabilitative efforts.
His insurance carrier offered him our cognitive rehabilitation program in lieu of a full and permanent disability payout, with the option of the payout if the program failed. He chose the rehab offer.
Our team of a neuropsychologist, speech pathologist and cognitive therapist went to work on an intensive basis with interventions in his work environment itself. Remediation efforts attacked his critical cognitive weaknesses that blocked him from success and within 3 months he returned to work. While his work output was still diminished (after all he had been national top salesman for several years, allowing quite a bit of leeway), he was happy he could see himself successful earning a living, competing in the workplace as he always had.
The full cost of our cognitive rehab program was less than 4 months of the disability payments that would have been paid to him had our interventions not been successful! A net win-win for all.