Why Seek a Fitness for Duty Evaluation?
Fitness for Duty Evaluations (FFDEs) can be instrumental in assisting employers to promote workplace safety and to help them ensure their employees can safely and competently perform their essential job tasks. If employers have concerns that an employee poses a direct threat to themselves or others or that they cannot perform their essential job tasks and suspect this is related to a mental condition, then a FFDE may be exactly what to seek. Not requesting a fitness for duty evaluation may lead to legal implications for your company and jeopardize workplace safety.
Why not have the employee’s treating doctor perform the FFDE?
In the past, employees’ treating doctors have both treated their patients and offered legal opinions to their patients’ employers about dangerousness and/or ability to work. This is no longer seen as best practice. In clinical treatment exams, doctors typically develop a therapeutic alliance with their own patients and are often not neutral. Further, treating doctors frequently do not have the training to conduct FFDEs in a manner designed to withstand the scrutiny of court. In contrast, a forensic FFDE doctor does not establish a standard doctor/patient relationship. FFDE doctors do not treat the employee and therefore do not have a primary obligation to the employee. They are specifically trained to conduct FFDEs and focus on impartially gathering data to provide the employer the most relevant and objective evidence to make necessary employment decisions.
Why not seek a low budget FFDE?
In today’s economy, employers reasonably ask what might be done to reduce the cost of psychological fitness for duty and violence risk assessments. One avenue is to search for budget evaluations. Sometimes these assessments yield solid results. However, all too often, they give the mistaken impression that a thorough assessment was performed by a doctor when this was not the case. Unfortunately, these evaluations can lead employers to make the wrong managerial decisions. Such mistakes often cost valuable employees and result in multi-million dollar lawsuits, decreased workplace productivity, and even death. Therefore, employers might want to carefully reconsider decisions to give a high priority to cost rather than quality. These inadequate evaluations can be particularly difficult to spot by those who do not have advanced training in forensic psychology or psychiatry.
Why shouldn’t the employer or EAP choose the doctor who performs the evaluation?
When the employer chooses a doctor, others might perceive that the employer has unfair influence over that doctor. Often, employers believe their EAP can provide the FFDE. In most cases, this is not the case because EAPs do not have the necessary forensic training or experience. Further, providing FFDEs for employers is generally viewed as being in conflict with EAPs’ frequent role of counseling employees.
Why should I use PsyBar for FFD evaluations?
When EAPs and employers refer employees to PsyBar for evaluation, they gain the confidence of knowing that a skilled expert will perform a thorough assessment. This is achieved through the implementation of quality control measures that are unique to our company. Professional consultation is provided to our doctors serving to decrease the potential for critical errors during the assessment and on the evaluation report. The use of carefully constructed consent and release forms not only addresses release of information issues, but also the nature of the evaluation, potential uses of the information obtained and possible consequences to the employee. Moreover, the selection of well-credentialed forensic experts further serves to ensure quality. Collectively, these measures increase the value of assessments while minimizing risk for all parties.
What are some ways I can ensure a cost-effective FFD?
- Count the number of addenda required for each vendor because initial reports were not clear, were inconclusive, or were poorly thought out. Requests for multiple addenda or repeated reviews may be perceived as pushing the reviewer(s) for an answer that will save the insurer money, thus inviting expensive bad faith and unfair claims practices litigation. To minimize indirect costs, maintain emphasis on quality over originally quoted price.
- Have each report rated by an internal insurance doctor or nurse who is medically sophisticated in the specialty of the review. Ask them to consider clarity of expression, inclusion of objective data, and solid support for the final opinions expressed.
- Ask how the vendor assists their doctors in meeting current practice standards. FFD vendors should offer their doctors ongoing continuing education to ensure they maintain optimal standards of practice.
- Determine who actually looks at report drafts during the vendors’ draft review process. Some vendors who claim that their QA process is performed by doctors have doctors in place only to oversee the QA area. Less qualified individuals actually read the reports. While this saves the vendor money, the risk is that critical errors, potentially damaging to claimants and expensive for insurers, will slip by their QA measures.
- Determine how detailed vendors’ formal performance expectations are for their expert panels. Vendors who send reviewing doctors only cursory instructions on how to prepare their reports may receive only cursory reports, which could increase the number of addenda requests, repeat reviews, and raise costs even to the point of settling or litigation.
- Insist that objective psychological testing be available for every behavioral health FFD. Psychiatrists do not typically administer psychological tests. A good vendor’s QA program offers clients the option to have a psychologist work with a reviewing psychiatrist, and supplement FFDs with tests such as the MMPI-2-RF. Measurable tests add objectivity and validity to the assessment. For a very reasonable cost, this additional insight enhances the reviewing doctors’ ability to firmly support the right opinion. Solid substantiation with the first review adds clarity to claim direction/decisions and decreases defense costs.
- Inquire if the FFD vendor offers formalized assessment options, including detailed culturally sensitive assessment protocols, for claimants whose native language is other than English. Culturally sensitive assessments protect claimants’ rights and protect the insurer from potential litigation.
- Look at turnaround times pragmatically. Faster is not necessarily better. Often, a little extra time allows your vendor to retain doctors who are particularly skilled (and likely booked farthest into the future). Your result is a more thorough report.
- Asking claimants or reviewing doctors to travel initially costs more. Quality vendors look for the most competent reviewer. Ask vendors to explain their doctor selection process, including when they might recommend travel even if a local expert is available.
- Determine how many claims from each vendor go for costly appeals and litigation. How often does the appeals area need to request additional independent opinions? Higher numbers from any given vendor might indicate poor quality evaluations. Expensive settlements and litigation are often the price of mediocrity.
