File Review & Quality Assurance Services
Hal Disability offers several services through its QA branch.
First and foremost, our Quality Assurance (QA) mission is optimizing expert medical legal reports, providing file management and guidance.
Our vision is delivering cost effective expert reports while maintaining current medical legal standards.
Our value is noting what can, and cannot, be provided in the way of medical legal evaluations prior to the financial commitment of such reports and then once the reports are drafted, ensuring that they meet the current medical legal standards requirements as set out by the Canadian Society of Medical Evaluators (CSME).
File Management Review
HAL reviews files with respect to projecting probable outcomes of expert assessment reports based on our current roster of assessors and the facts of each case.
HAL provide a summary of relevant reports within the medical brief provided and then provide a projection analysis of the types of actions to be considered (including CAT referenced earlier), along with other AB issues, injury related Tort issues, as well as Long-Term Disability (LTD), Canada Pension Plan (CPP) options where applicable. Much of what is referenced in the CAT service, is also applicable to the AB benefit of post-104 evaluations and a similar approach is provided.
Along with the projection we provide recommendations as to what type of assessments to consider optimizing management of various claims from a medical/legal perspective.
One way cost effectiveness is captured by determining what assessors may be able to address, across a range of issues/disputes, thereby spreading the cost through different actions as applicable (blended reports). Another way is by determining the likelihood of a particular assessor adding significant value to the file, relative to the cost of obtaining the report. This is particularly important for some of the assessments that tend to be at the higher end of costs, for example surgical and medical and mental health subs-specialties.
Report Quality
QA takes an active role in reviewing drafts of expert reports to ensure that they are consistent and effective and in keeping with required medical legal report standards.
This can be done in a variety of ways in a graded fashion as follows:
- Spelling/grammar corrections
- Formatting
- Data/information inclusion from medical records
- Accuracy/consistency of information provided in the report
- Diagnostic inclusion
- Maintaining report in area of expertise
- Avoiding appearance of advocacy
- Logic trail context – is the opinion(s) provided consistent with the information obtained.
It is NOT the responsibility of QA to inform or provide the expert opinion of the assessor. That is sole purview of the assessor. It is the responsibility of QA to ensure that the assessor’s opinion is accurately portrayed and effectively communicated in the report, to a non-medical audience reading the report.
Dialogue/Liaison with Expert Assessors
QA maintains an active dialogue with expert assessors to provide support and assistance to them.
QA also provides preliminary training/supervision to expert assessors who are new to the field of medical legal evaluation and are learning to familiarize themselves with the discipline of medical legal evaluation.
Dialogue/Liaison with Legal Counsel
QA maintains an active role of direct communication with legal counsel regarding various files and issues. This is in addition to the file management paper review process discussed earlier. This can take the form of phone discussions regarding specific cases, group meetings in a “lunch and learn” or continuing education format or discussing specific service strategies going forward.
QA also understands the need for timely reply to feedback from legal counsel regarding draft reports and ensuring that any inaccuracies/inconsistencies are dealt with promptly. QA maintains the role of providing prompt and effective communication avenues between legal counsel and the applicable expert assessors.
QA maintains an active involvement in the two principal organizations presently involved in the discipline of medical legal evaluations. These are Canadian Society of Medical Evaluators ( CSME)/Canadian Academy of Psychologists in Disability Assessment (CAPDA) and MLST (Medical Legal Society of Toronto). Both organizations provide multiple courses/conferences each year. The QA branch regularly attends these meeting/conferences in order to maintain current knowledge of the medical/legal environment.