Special Master Appeal Decisions

353. Who determines the appropriate model for predicting premorbid functioning?


During neuropsychological testing, the examining neuropsychologist must estimate the Player's previous level of performance using the ACS Test of Premorbid Functioning ("TOPF"), and the clinician should select a model based on the patient's background and his or her current level of reading or language impairment. The selection between models is a matter of fine clinical judgment and the Settlement Agreement explicitly vests that choice between statistical models with the neuropsychologist. The Claims Administrator defers to the neuropsychologist's choice of models. However, if the particular facts of a claim indicate the neuropsychologist's choice between models is medically unsound, meaning without any articulable medical rationale, the AAPC may question that selection. In that case, the AAPC must provide a detailed explanation why the neuropsychologist's choice of model is inappropriate. Click here for additional information and to read the Special Master's full decision on this topic.