Section 42

Section 42 provides for independent evaluations. The insurance adjuster is responsible for selecting an individual with appropriate knowledge and experience to provide an unbiased opinion on the need for a service or good. The section 42 assessor is should not provide treatment unless the conflict is waived by both the insurer and the client, or the assessor relinquishes his/her role as an independent assessor and becomes a section 24 provider. If a section 42 assessor makes recommendations for treatment or equipment, the client should be notified of his right to select his own therapist to fulfill these recommendations.

Section 24

Under Section 24 the client is entitled to his/her own choice of service provider. It is only under section 24 that the client can access treatment as section 42 is for assessment only. Treatment can be provided to address independence in benefit areas as well as to facilitate return to function in all pre-injury life roles. The rehabilitation benefit is meant to reduce or eliminate the effects of any disability resulting from the impairment or to facilitate the insured person's reintegration into his or her family, the rest of society and the labour market.

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In-home Functional Occupational Therapy Assessment

Our occupational therapists consider the context within which the person functions, then evaluate and analyse the person's ability or inability to perform daily tasks. Standardized testing and functional evaluation are utilized to assess the client's cognitive, physical and psycho-social ability in order to determine the impact of dysfunction in any of these areas on the client's Occupational Performance. The results are used to determine the need for benefits and/or to develop a treatment plan to facilitate return to pre-injury function.

Cognitive Occupational Therapy Assessment

As per the recognized definition of cognitive rehabilitation by the Brain Injury Interdisciplinary Special Interest Group (BI-ISIG) of the American Congress of Rehabilitation Medicine, our occupational therapy cognitive assessment utilizes standardized testing specifically designed for the evaluation of brain injuries, as well as informal functional procedures. The occupational therapist is adept at analysing the impact of cognitive, physical and psychosocial deficits on the individual's functional performance within relevant life roles to determine the intervention plan. The purpose of the cognitive occupational therapy assessment is to determine the client's learning style and to develop an optimal individualized treatment plan.

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Housekeeping Benefit

The findings of the In-home Functional Occupational Therapy Assessment are used to determine the client's need for housekeeping assistance.

Caregiving Benefit

The findings of the In-home Functional Occupational Therapy Assessment are used to determine the client's ability to provided participate in pre-injury care giving activities and the client's entitlement to caregiving benefit.

Attendant Care Needs

As a result of an automobile accident, the client may require assistance in personal care and personal management activities. Following a thorough in home functional occupational therapy assessment, which may include cognitive testing, the occupational therapist provides a narrative to explain the need for assistance as per the Form 1. Cognitive and physical impairments are considered in this assessment to determine the ability to be safe at home.

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Mobility

Due to physical and functional impairments the client may require mobility devices to be more independent. An occupational therapist can evaluate, recommend, prescribe, and provide training in the use of a variety of these devices. The physiotherapist may recommend intervention to facilitate balance, mobility and gait training.

Safety & Accessibility

Due to physical or cognitive impairments, the environment can often present barriers to daily function. The occupational therapist assesses and provides recommendations for solutions to these barriers so that the client can return to independent function as quickly as possible. Recommendations may be temporary or permanent, depending on the diagnosis and prognosis of the client.

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Accessibility Modifications / Universal Design

We are experienced in providing assessment and consultation to facilitate access in home, schools and workplaces and remain current with developments in equipment and technology. Both temporary and permanent modification requirements can be addressed. We routinely work with Accessibility Design Specialists on complex designs for spinal cord injuries, amputees or other complex neurological or orthopaedic conditions.

Computer Skills

The client's need for the physical or cognitive benefits of technology is evaluated. This assessment incorporates all aspects related to the use of a computer or other technology; the person's knowledge of computer operation and specific software, keyboarding ability, cognitive and physical deficits and needs are determined. The suitability of specific technology and modified equipment is evaluated. An ergonomic evaluation of the workstation may be incorporated into this assessment. Recommendations may include a computer, an adapted mouse or keyboard, voice recognition or other specialized software, lightweight laptop, etc.

Driving

A person's ability to begin or resume driving following a medical illness or condition is determined through a comprehensive assessment of cognitive, physical and visual skills as well as an on-road driving test. Approved by the Ministry of Transportation of Ontario our assessment determines driving safety and makes recommendations to the Ministry.

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Work Capacity Assessment

This assessment determines the client's ability to perform a specific job successfully. The client's current functional abilities and the job demands are cross-referenced, while taking into consideration the impact of the demands of other essential daily occupations.

Ergonomics

Ergonomics is the science of matching the work to the worker and the product to the user. Occupational therapists use ergonomics to ensure a good fit between the individual and the environment so that individuals' occupations do not impede their health and well being. An ergonomic assessment consists of evaluating the required work equipment (e.g. workstation or tools), job design and the work environment. Therapists then provide recommendations for modifications, job accommodations or environmental adaptations, education and training to enhance a client's return to work and/or productivity. Recommendations may include adapted equipment such an adapted mouse or keyboard, headsets, wheeled bags; changes to procedures; modifications to work surfaces, etc.

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Job Demands Analysis

Often referred to as a Physical Demands Analysis, a JDA consists of a comprehensive analysis of the cognitive, physical and psycho-social demands of the job and the workplace environment. It can be used as a means of planning a rehabilitation program or as part of a work capacity assessment to determine the client's ability to return to a job. The assessment also provides an opportunity to explore with the employer the possibility of modified hours or duties. The comprehensive job demands analysis is recommended for all individuals as it ensures that subtle barriers to return to work are not overlooked in the prevocational stages of therapy. It is particularly important for the brain injured individual where all aspects of function can be affected by the injury.

Catastrophic Determination

Swanson & Associates is experienced in coordinating CAT Assessment Teams, selecting the appropriate professionals to deliver a comprehensive evaluation. An executive summary is provided along with the individual reports to provide overall conclusion of the assessment. The occupational therapist provides the clinical expertise required to assist in catastrophic determination under Section 2(1)(1.2) (e(ii)) and (g) 2 (1)(1.2) of the SABS, where the functional status must be evaluated. The result of this important assessment cannot be overemphasized. As clients age, their individual circumstances and demands often change; therefore the ability to access a larger fund of benefits is paramount. We also coordinate multidiscipline rebuttals to ensure that the client is evaluated comprehensively and that all facets of their injury are considered.

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Work-life Balance

The ability to return to work while meeting the demands of all other pre-injury life roles and responsibilities is evaluated.

Physiotherapy Assessment

Comprehensive assessment of orthopaedic physical deficits is provided for the purpose of preparing a treatment plan or for independent evaluations.

Speech Language Assessment

Cognitive linguistic, expressive and receptive language skills and speech/ articulation abilities are evaluated for the purpose of preparing a treatment plan or for independent evaluations.

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Medical-legal

Due to the nature of our comprehensive assessment our medical-legal reports have been used successfully to award damages fro both SABS and Tort Claims. Our therapists are experience in the delivery of expert testimony and are able to educate a jury with respect to a client's functional limitations and resultant needs for medical interventions, attendant care home modifications, assistive devices and support services. Many of our medical-legal reports have assisted at mediation, resulting in the file settling prior to trial.

Rebuttal

At Swanson & Associates our evidence-based assessments (and reports) are difficult to overturn. Our knowledge of the SABS and the Insurance Act as well as our research base in our therapies allows us to be able to refute unfounded opinions. We have had success in changing Insurer Examiner's opinions so that more appropriate recommendations are made for the client. Rebuttals are prepared for assessments related to treatment plans, eligibility for benefits and for Catastrophic Determination Assessments.

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