The responsibility of rehabilitation
The recent judgement on Loughlin v Singh by Mr Justice Kenneth Parker (June 2013) ruled that there should be a 20% reduction in the past care/rehabilitation costs as a result of poor rehabilitation goal setting. This has highlighted several key issues for Rehabilitation Case Managers (RCMs) working within claims in the UK insurance sector – in terms of the importance of their responsibility to the injured party, but also to the insurance claim as a whole.
In summary, the judgement decided that the RCM involved in the case did not follow through appropriately when identifying strategies to overcome rehabilitation barriers. Consequently, the rehabilitation and care regime resulted in dependence not independence for the claimant.
For the purposes of this blog, we will look at the importance of goal setting in rehabilitation case management in order to progress injured parties towards their optimum independence. We will also consider the implications of poor goal planning on the claimant and the insurance claim.
The importance of goal setting
By definition, rehabilitation is a series of treatments and intervention designed to facilitate the process of recovery from injury, illness or disease to as close to pre-event as is possible. In many cases, this is often a lengthy process and requires expert guidance by a RCM. There are many stages to rehabilitation and it is therefore vital that the RCM adopts goal planning and that goals are reviewed and evaluated throughout the lifecycle of rehabilitation. If this is not done properly then rehabilitation will simply drift with no outcome identified thereby wasting time and money and, most importantly, limiting the benefits for the service user and/ or claimant.
What makes good goal setting?
QBE Rehabilitation are advocates of the SMART goal setting philosophy – that is that all goals should be specific, measurable, attainable, relevant and time-bound. SMART goal setting is client centred and has proven to be a successful way to overcome identified obstacles presented in rehabilitation. It encourages the RCM to plan goals that are unambiguous and clearly defined and, most importantly, that are relevant to the service user. This is key to success. By using such goal planning techniques and starting from the smallest, most basic goal, the RCM ensures that they are making rehabilitation progressive with many smaller goals working towards the ultimate goal of greater independence. SMART goals should be the building blocks to successful rehabilitation. To coin a phrase from Benjamin Franklin: “If you fail to plan, you plan to fail”.
The implications of poor goal planning
In Loughlin v Singh, on assessment of the claimant’s needs, the RCM identified that a poor sleeping pattern was having an effect on his daily activity, something which was corroborated by medical experts. Rather than developing and progressing a plan to tackle the claimants poor sleep hygiene, the RCM set up a 24/7 support package to assist the claimant with his daily function. This caused the claimant to become more dependent on the care regime and not independent. The judgement ruled that there should be a 20% reduction in the past care/rehabilitation costs as a result.
The Cost of rehabilitation in insurance claims has never before been more scrutinised. Now more than ever, it is a requirement that rehabilitation is “evidenced based” on the setting out of past, present and future rehabilitation/care costs and that the RCM is able to provide demonstrable benefit of their input for the injured party if called upon by the courts. The 2013 Ministry of Justice reforms, as well as the Loughlin v Singh ruling, show that the courts are getting serious about asking for accountability of rehabilitation costs which further emphasises the need for effective goal planning techniques. Think SMART.