Showing posts with label Future Costs. Show all posts
Showing posts with label Future Costs. Show all posts

Thursday, January 24, 2013

Future Losses, Statistics and Assumptions, TLABC Conference, Mexico, 2013


This was one of the most intriguing  talks at the conference.  Howard Teasley, an accountant and economist, takes into account actuarial information, all manner of sources and 'number crunches' to give a reasoned future cost profile. He joked that the best thing with a sausage was eating it, not seeing what goes into it.  I have difficulty following my accountants information so its no surprise there are serious gaps in these very rough notes. It does give a jist of the very involved consideration that go into helping decide settlements. Again I apologise for the notes. The slides were informative and the presentation was excellent. It was great seeing it all come together and I fear I was listening and watching the maths on the slides more than making notes.

Future Losses: Statistics and Assumptions
Howard Teasley MA (Econ) CGA, Vancouver,BC
TLABC Medical-Legal Conference , Mexico, 2013

Future earning-capacity loss - diagnosis to estimate 

Distinguish future earning- capacity loss (general damages, hasn't happened, might not) from past income loss (has happened, add up, deduct tax and ei) and non pecuneary loss (assess without expert help

Follow a claim for loss of future earning capacity - and see where you matter -...

Translate experts - to expected and residual work

and translate these future loss into present day dollars

Assumed facts - hard part
-apply medical, occupational and vocational evidence to....
-define what earning capacity she or he had but has lost .....

-put all the education, employment files etc together

Has a paper in the handouts - determinate -  Jack Spark, prospective electrician - know what he was going to do and what he would
Indeterminate (fuzzy) - Ms Joan Smith, single mother, never worked but needed to , now impaired

Assumed facts
date of birth and normal life expectancy
(BC 05-07 life expectancies)

expected education
expected work
expected earnings (own record or statistics)
contingencies and expected working life, effectively given by the participation contingency

Effects of the accident
 - where the medical Ot and vocational repts
-injureies resolved and persisting
-effects on education if any
-effects on work (different job, shorter hours, retire early, statistical reduced capacity, etc
-effects on earnings

Pain a major cause of disability

Contingency statistics

Lower - average income entry job - $16,493
  higher - has high school diploma - $29,329
Less education more likely to work on feet rather than exercise mind


It's hard not to make $10,000 a year so that may be minimum estimate of loss

Other common loss patterns
-work fewer hours
-retire at 55 versus 65

Estimating contingency adjusted present value

Another example
40 year doctor has lost $50 grand  = 1 1/2 million since she plans to retire at 70
Investing a dollar at 2 1/2 %  return less than dollar
Supreme Court  = law and equity act - used 3 1/2 for general earning 
You're discounting
To get the 30 years she has to live
Actuarial/ multiplier considered 
She has to work full time

When we put all the information together
instead of 1 1/2 million gets 1 million instead

Higher your education the more cost when you don't work
Females have more competing responsibilities
Work history eliminates nonparticipators from comparison

Occupational Therapy Medical Legal Reports, TLABC Conference, Mexico 2013

These are my rough notes on a very interesting discussion of the increasing need for standardization in assessment of home support services, return to work and future costs assessments. This just gives a taste for the developments in the field and new tools available. Beth Inglis' presentation was excellent. 

"Keeping it Clean" How to assess Home Support Services Beth Inglis, B.Sc. OT, B.Sc. In Occupational Therapist JR Rehab Services. Inc. TLABC Medical Legal Conference, Mexico 2013 "I am the person who assesses function in home and work."

 I do OT Medical Legal Report'

Goals of the cost of future care report -maximize function independent -maximize participation - prevent medical complications

Cost of Future Care Report Medical care

Diagnostics Medication Medical supplies Allied health etc.

 Most cost of future care reports assess level of support and assistance needed (Fischer, 2009) Award amounts for "housekeeping" are valued at approx 1/3 of the non pecuniary wary (Kara Naish, TLABC , March 2012)

 We need performance -based functional assessment to determine individuals ADL's , can't just rely on self report AMA Disability - impairment of body function or body structure WHO Presence of disability or disorder is not an accurate predictor of recipt of benefits, workperformance, return to work - diagnosis doesn't alone determine this

Consider two individuals - however activity limitations are quite difference - functional assessment - a tool to measure and verify the objectivity and validity of costly items such as home support services (Fischer 2009)

Best Performance based ADL Assessment of Motor and Prcess Skills (AMPS) -evaluates the quality of performance of personal and instrumental activites of daily living (IADL's) Tests a person in arelevant and family environment as he/she performs meaningful and chosen ADL tasks Has been standardized internationally and cross culturally on 148,000 persons Consists of over 120 standardized ADL tasks Measures 16 ADL Motor and 20 ADL Process Skills --ADL motor observable goal directed actions - walks, lifts, transfers, paces, stabilizes...etc. -ADL process - selecting, interacting, carrying out individual tasks, modifying task, - chooses, gathers tools, sequences, notice and respond, search and locate - how a person accomodates to problems - ie notice and respond, benefit from something that happened minutes earlier, do they accomodate and change with learning

Motor and Process skills are ranked from easier to harder Person chooses minimum of 2 ADL of the 120 potential Each motor and process skill is scored based on: Effort - physical difficulty, clumsiness, or fatigue Efficiency - disorganization or undersirabl use of time, space or objects Safety - risk for perosnal or environmental damage Independence - pysical or verbal assistance AMPS computer software generates an ADL motor and ADL process score for the person - compared to 95% age matched healthy person ADL motor cut off -where people have problems ADL skills are one of best predictors of return to community

Ecological Validity - testing something they've chosen in their environment 25% chance that a process score will differ in laboratory and home OT should evaluate in home Need to balance overprovision and underprovision....

 HOme making costs Frequence of homemaking servciess 2 hours/ week yearlly 3360 10 years 33,600, 20 years $67,200 8 hours / week yearly $13, 440 20 years $268,000 about 

Question and answer

 AMPS - $400 to $500 for report

 What about patients with variability where waxing and waning pain - OT assesses this by saying to them to do it 'the best you can now' not the way you used to.

 Dr. Armstrong - recommended that as a scientist he'd like to see 3 assessments to get mean standard deviation - answer - AMPs can be readministered

 Also question about testing at maximal medical ability when score would likely have more long term validity.