This article was originally written for the summer issue of the Georgia State Bar Workers Compensation Law newsletter by Michael Dresdner, MobilityWorks Director of Customer Care
When I first entered the field of accessible transportation in 1990 consumers as well as payers had few choices as to what was provided to a claimant. Additionally, there was little adherence to safety standards and mobility equipment dealers were literally praised for forging raw steel into useful transportation solutions and alternatives. Very few “manufactured devices” were available and if instructions were provided they contained phrases like “field modify as necessary”.
A great deal has changed in 22 years. There have been improvements in how products and solutions are provided. Most devices and conversions are now precision-manufactured by high quality companies. Much has been accomplished and changed for the better, but there is still work to do. In many cases the knowledge of these changes and how to leverage that knowledge to insure the best outcome for the claimant has not kept pace. Many rehabilitation professionals in the field of workers’ compensation infrequently work through the details of providing mobility vehicles or mobility equipment and therefore never become “experts”.
Unlike the way mobility equipment dealers operated in 1990, we are now typically a well run enterprise resembling an auto dealership, stocking vehicles as well as equipment that can be readied in days versus months. Clean, fully accessible facilities are now the norm. In today’s world vehicles as well as equipment and the installation of the equipment must meet multiple federal standards. Mobility equipment dealerships mandate that employees receive ongoing training and certification in their unique fields of expertise. Vehicles now have advanced electrical systems that require significant skill to troubleshoot and repair. Where we were once praised by payers and consumers for the rudimentary devices we cobbled together, both now have serious expectations of mobility equipment dealers and mobility vehicles in general. In many cases all parties hold us accountable to the highest standards of quality, safety and functionality. Unfortunately, in some cases, expectations are not clearly outlined or properly communicated and less than ideal outcomes occur.
The process of providing a transportation alternative to a person with a disability has become a complex task. When you merge the complexity of our products and services with the “unique cocktail” that is the workers’ compensation system, sometimes the outcomes do not make sense. These mixed outcomes are what motivated me to write this article. The pressures from the workers’ compensation system often force the sourcing of product through odd channels, and the end result befuddles everyone involved! It is not uncommon for three or more different parties to request a quote from a mobility equipment dealer and the party that makes the purchase is often influenced by factors that do not prioritize the claimant and keenly focus on his or her needs. For example, a request for a quote could potentially come from an insurer, a re-insurer and a managed care provider and sometimes from a local case manager or possibly an outside “consultant” -- or any combination of the five! This chaotic mix rarely yields the best outcome and it may not end up being cost effective. Controls are often sacrificed due to the multiple parties involved with their differing agendas.
Equipping a car or van for someone with a disability is unique to that individual’s disability, lifestyle, and personal mobility device (wheelchair or scooter). The vehicle modification can yield positive outcomes, but there can be outcomes that just do not work or worse can cause physical problems for the user. One scenario that repeats itself often with seasoned claimants (those seeking a replacement vehicle) as they age is that the claimants mistakenly believe that they have good transfer skills and that they are not at risk for shoulder issues. They are often reluctant to let go of transferring to an automotive seat versus driving from the wheelchair. Someone has to say, “no” and clearly explain the risks. Many times, I have found myself as the one who seriously raises this issue.
The best way to avoid problems is to follow a plan, not unlike the claimant’s plan for rehabilitation.
Driver Evaluation, Fitting and Training
Regardless of whether the claimant is a passenger or will be an independent driver, be certain that he/she is evaluated by a CDRS (Certified Driver Rehabilitation Specialist). The CDRS recognizes disabilities, has an awareness of the available adaptive equipment and knows the implications each has on driving or being transported. These professionals are certified by the Association of Driver Rehabilitation Specialists. If you are not familiar with those that serve your area, find a CDRS at www.aded.net. Here in the Atlanta area we have two programs that employ CDRS’s as well as Occupational Therapists: the Shepherd Center Assistive Technology Program and Freedom and Mobility, a private firm. Both programs often travel to see a client. Your investment in a driver or passenger evaluation will definitely pay off. Without an evaluation you will not have a specific set of specifications to use to request quotes. Once “apples and oranges” get mixed, the process can fail.
The need for evaluating a driver may seem obvious, but why evaluate a passenger? There are a number of problems that can arise when a disabled passenger is not evaluated. These can include safety issues, claimant fit, as well as weight issues. Designing a modification plan is varied and complex, even for a passenger.
In addition to the initial evaluation, the CDRS should meet with the claimant and the vendor at the time of the vehicle delivery to confirm the claimant’s ability to use the equipment, that the vehicle is delivered as promised and that all the equipment operates properly and safely. If the vehicle is to be driven independently, the CDRS would confirm the placement of all driving controls (fitting), work with the mobility equipment dealer to make final adjustments and then drive with the claimant. Additional training over an extended period of time could be required depending on the complexity of the equipment or the type and severity of the disability. It is recommended that a representative from the payer be present at the delivery of a