What is a SIMP?
A SIMP is a structured intensive multidisciplinary program used to treat chronic pain. It is typically performed at a multidisciplinary rehabilitation center that evaluates and treats injured workers. They have lots of different programs to help L&I with difficult and complex cases. They help L&I more than they help the injured workers.
Do I Have to Go? Recommendation vs Referral
A SIMP can be recommended by an occupational nurse consultant, Office of the Medical Director, independent medical examiner (IME), claims manager or vocational rehabilitation counselor.
The attending physician must be the one to make the referral. L&I will suggest to and sometimes pressure your attending physician into making the referral. If your attending physician does not think a SIMP program would benefit you and your claim they need to say so in writing to L&I. Your doctor will then need to propose a curative treatment plan.
The Harsh Reality of a Serious Injury
Not everybody gets better after a serious injury. Significant problems sometimes last forever. This is the real tragedy of an L&I claim.
L&I is not going to keep a case open forever. When L&I thinks your time is up, they will use a SIMP or an IME to help them close your claim.
Claim Closure Rules to Think About
- The legal system has some interesting rules about what it take to close an L&I claim.
- Rule #1 – L&I can’t close your claim until you either return to work or some doctor says you can work.
- Think about this: SIMP have doctors and specialists ready to see you today and say you can work tomorrow.
- Rule #2 – You are not an expert about your ability to work. Doctors are the experts in the courtroom. It is their opinion about your ability to work that counts. The opinions of medical experts win or lose cases. Doctors who are willing and able to write reports and testify will help decide how an L&I claim turns out.
- Think about this: If the SIMP doctor has become an expert in your case, that makes claim closure easy. L&I will close your case based on the opinions of SIMP doctors. Depending on who the SIMP doctor is and what they say, that may or may not be a good thing. If you don’t agree with the opinion of the SIMP doctor, you may need your attending physician to help. Your doctor is going to be asked if you can work. This is where your doctor, the attending physician needs to step up and write a helpful report. If your doctor won’t help you, the SIMP doctor or the IME will play a leading role in helping L&I close your case.
- Rule #3 – Ability to work is an opinion. There is no bright line between can work and can’t work. It is a vast grey area. Many seriously injured workers end up in this vast grey area. Their ability to work is uncertain. The facts are not obvious. Ability to work is therefore probably going to be decided by the opinions of doctors. Often it becomes a fight between L&I’s doctors and the injured workers attending physician.
- Think about this: SIMP exists to help L&I. SIMP offers a lot of programs. In the end if you go through any of these programs , then the SIMP doctors and therapists become the experts who are likely to say you can work.
What is Offered in a SIMP Program?
Pain Management Program
The Pain Management Program is a rehabilitation program for injured workers and others with disabling conditions and pain. The functional restoration program includes medical treatment cutting off or reducing drugs, physical conditioning, treatment of mental health concerns, and vocational counseling.
This program anticipates return to a specific job. It consists of simulated work tasks of the specific job with the goal of increasing conditioning and work capacity to tolerate a safe return to full time work.
Work conditioning treatment is meant to improve strength and endurance to safely progress to work hardeing or return to work.
Physical Capacity Evaluations
A Physical Capacity Evaluation (PCE) is a controlled physical assessment over a sustained period of time. It is a test, often times not so obvious, of an injured workers ability to work. The PCE is used to consider return to work in the job of injury, return to prior jobs performed by the injured worker, or in consideration of a retraining goal. The PCE may be used to determine the need for specific work restrictions. It may also be used to close the L&I claim.
SIMP Doctors, SIMP Therapy and SIMP Rehabilitation programs help some injured workers and they hurt others.
- Workers who respond well to a program are helped. They get back to work and for the most part everybody wins.
- Workers who do not improve may be hurt by this process. Their insignificant gains seem to be enough for their SIMP doctors to OK a job analysis and put an end to additional services including vocational training. This often results in a quick claim closure.