I am often asked many questions about the profession of vocational and rehabilitation counseling/consulting, and what makes a vocational specialist, or expert, and what does a life care planner do.  These are specialty areas that are not as familiar a line of work as that of a social worker, psychologist or economist. It usually takes some time to explain the field and the role of the specialist within.  This section will briefly introduce the reader to the uniqueness of the field, the focus and objectives in the industry, and discuss the role of the specialist.  With this information, the reader will ascertain an understanding of the profession and of its usefulness.  

The Field, The Purpose, The Specialist

The field of rehabilitation involves working with a disabled individual who sustained either a work injury or motor vehicle injury and the provider of benefits is the insurance company, via worker’s compensation or motor vehicle insurance.  Through the insurance company network, a vocational rehabilitation counselor or case manager is hired to direct and mange the disability claim to the point of closure. The vocational rehabilitation counselor’s purpose is to return the injured party back to gainful employment within the parameters of the person’s disability.  The vocational rehabilitation counselor may utilize vocational tools to accomplish this, some of which include counseling, testing and skills assessment. The case manager coordinates the medical care of the disabled individual to the point that the person has obtained and completed treatment, is at a point of maximum medical improvement, or is able to return to work.  Vocational rehabilitation services are provided through state and private agencies such as the Division of Vocational Rehabilitation (DVR) or private case management companies such as Diversified Rehabilitation & Consulting, Inc.  Rehabilitation case management services are provided through private rehabilitation companies such as Diversified Rehabilitation & Consulting,

The roles and functions of both vocational rehabilitation counselors and case managers have grown and expanded into sub-specialty areas that are useful to insurance companies, attorneys, employers and Federal Agencies. Other professional titles include “Vocational Expert” and “Life Care Planner,” which are involved in the forensics of rehabilitation. In this area of rehabilitation, the disability is taken to the “courtroom” and viewed in economic terms to assess disability-related damages.

By way of history, the Federal Social Security Administration (SSA) in the 1970’s was the first entity to use Vocational Rehabilitation Counselors in the courtroom. The counselors were called “vocational experts” after qualifying from review of their credentials. The title and role remain in use today. The expert is called upon as an impartial witness to provide vocational testimony in a hearing to assist the Judge in determining a claimant’s application for disability benefits.  The expert will provide an opinion on the claimant’s past work and ability to perform it, describe the work history according to skill and exertional level, and provide an opinion on whether the claimant can perform the functions of the job adequately, and if not, whether there are other jobs available.  The role of the vocational specialist has continued to expand as this country has become more litigious. With the millions of civil suits filed each year (Garske & Havranek, 1999), the incorporation of vocational expert testimony in civil litigation was inevitable. Hence, in addition to functioning as experts in SSA cases, vocational specialists provide testimony for cases involving worker's compensation, personal injury, catastrophic personal injury, wrongful termination, employment issues and divorce (Sleister, 2000). Pension and disability funds also use Vocational Experts to determine the extent of disability. 

The Social Security Administration is the only legal setting that assigns the title of "Vocational Expert" to the vocational rehabilitation specialist. Outside of this arena, the vocational specialist must "qualify" as a vocational expert prior to giving testimony, based on credentials. A Vocational Expert is “an individual who has received an academic degree from an accredited educational program accepted by the rehabilitation  profession as denoting professional status; is certified and/or licensed to practice in accordance with the rehabilitation profession’s national certification board or commission and/or the state’s licensing board; maintains his or her certification and/or licensure by completing continuation education units approved by the certification /licensure boards for renewal of certification/licensure; and has completed the amount of time on the job specified by the profession" ( Vander Kolk, (1993). 

A Vocational Expert is a professional who has studied and understands the relationship between the functional limitations of illness and/or disability, and the physical and mental demands of work.  A physical or psychological injury in an accident must now be translated into the loss of specific vocational opportunity, the work done by a Vocational Expert.  Vocational loss can be evaluated in a variety of ways dependent on the case. This may include the availability of jobs in geographical areas, the average wage of post injury employment, and/or diminishment in earnings pre and post injury.  A vocational expert is retained to provide a vocational analysis of a case that serves to address the overall employability of an individual, taking into account medical limitations, residual functional capacities, age, education and work experience.  An analysis of pre-injury and post injury wages is performed to determine the disabled person's earning capacity and/or loss earning capacity over his/her work life expectancy. Dependent upon the case, this information is provided to an economist for further economic analysis to determine present day value, earnings growth rate, interest rate, inflation, etc.

Disability can no longer be determined solely by the medical status of the individual.  Age, education, past work experiences, and access to the labor market are now all factors that must be considered before one can claim disability.  Providing a person possesses enough residual functional capacity and work-related skills to perform a job adequately, disability is not likely.  Likewise, if a disability precludes returning the injured party to work, and due to the same factors for age, education and work history, a finding for disability may be indicated. Today, a Doctor’s word is not the sole influence in a decision of disability, but a Vocational Expert is also called upon to give an opinion on whether a vocational disability is present.
 
The role of the Vocational Expert in the legal arena has increased as attorneys realize that a Vocational Expert can "bridge the gap" between medical and vocational limitations, via identifying residual functional capacities and remaining functional skills, to alternative work settings (Weikel, 1986).  

Facts in this section were adapted from the article, "Use of Vocational Experts in Disability Determination" by Dr. Bruce Growick, Ph.D., which was printed in the Spring 2004 Issue of The Rehabilitation Professional.

A Life Care Planner is the author of a life care plan (LCP), who can also critique and review the plans of other Life Care Planners. "A LCP is the dynamic mechanism that provides appropriate, specific, accurate, individualized information for lifetime medical rehabilitation and other care related needs of an injured or disabled individual to, at least, attempt to restore or accommodate a return to the individual's life condition prior to the injury or disability. The primary goal is to allow the individual to participate in life as completely as possible. The resulting document, the life care plan, is created from relevant care providers and research. The treatment and care data is later analyzed by an economist to determine the lifetime expenses, documented in present value dollars (Toppino, Reed, Agrusa, 1998).

A LCP is reserved for use in cases, usually personal injury, where the individual has sustained a catastrophic injury, i.e., traumatic brain injury, spinal cord injury, and current and future medical care and treatment is deemed necessary. A LCP is usually developed on behalf of the plaintiff in a personal injury case. On the defense side, the attorney may retain the services of a Life Care Planner to review and critique the plaintiff's LCP for accuracy and necessity. A LCP in a catastrophic injury puts a value on the case for settlement or trial purposes.

A Life Care Planner is usually certified in one or more areas within the rehabilitation field and has completed training in life care planning. Most Life Care Planners have transitioned from providing case management services in the private sector, to catastrophic case management in a forensic setting.