Discharge planning begins upon admission

A very wise nurse once told me they had a saying in the hospital she worked at:  "Discharge planning begins upon admission."  The goal of any admission at a hospital is to discharge the patient, hopefully in a better, healthier state than they were when they arrived.

This same adage applies to workers' compensation claims.  The goal of any claim representative should be to ensure the injured worker receives appropriate medical treatment that will help them recovery, return to work, and hopefully a state of wellness.  This doesn't just miraculously happen!  A well-thought plan is needed to coordinate a successful return to work, but particularly if we're aiming to help the injured worker get better.

What can you do to help plan for success?

Start having the return to work conversation as soon as possible.  Employers should proclaim it to be their goal to return the injured worker to work whenever a claim is reported involving lost time.  That means having return to work discussion in the absence of a modified duty release.  You might be asking, how can we bring someone back to work if they don't have a work note allowing them to come back?  Generally we have an idea as to why type of restrictions correspond with the type and severity of injury.  For example, a rotator cuff strain/sprain may result in no overhead lifting, one handed restrictions, or lifting no greater than 2 lbs. over counter level.  How can you plan for RTW when there is such a variance in possible restrictions?  Plan for the worst, hope for the best.  Anticipate the most restrictive work note and go from there.  If they can lift 2 lbs. with their injured arm and you planned for, and found, one-handed work, then you have work available that fits restrictions!

When you have an injured worker with a note that totally disables them from working, it's never too early to try to identify a modified duty opportunity.  Sending this modified duty option to the treating physician may facilitate an earlier release to return to work, or it may not, but it's worth an attempt.

Communicate your intentions to the injured worker as well.  They are probably very concerned about their job, their income, and how they are going to pay their bills if they are taken out of work.  Letting an injured worker know, at the appropriate time, that you will try to find work available will be one of the best things you can do to reassure them that you value them as an employee.  Just be sure to do it in a sensitive manner at an appropriate time.

Word of the Day: Return

Merriam-Webster defines return as "to restore to a former or to a normal state."

That's the promise we make when we say we're going to return someone to work or return them to wellness.  It's a tall order.  Telling someone you're going to return them to a former state is almost like telling someone to get the wrinkles out of a piece of balled-up aluminum foil.  Even with extreme measures, the likelihood of getting a smooth Hershey Kiss wrapper out of a pea-sized wad is nearly impossible.  I am in no way saying injured workers are like balled up scraps of aluminum -- but we cannot promise everyone the health and ability they may have experienced pre-injury.  Even without an injury my body has aged 24 hours more than it was the same time yesterday.  In the past 24 hour hours deterioration has occurred, plates of the earth's lithosphere have shifted ever so slightly, and maybe an ice cap has melted ever so slightly more today than yesterday. It is very unlikely, if not improbable that we'd be able to easily eliminate the effects of aging, prevent the earth's plates from shifting or restore the polar ice caps. 

The workers' compensation laws are designed to indemnify an injured worker, or to "make them whole."

For a larger proportion of work injuries, that’s likely the case -- the cut finger that doesn't leave a scar, the bee sting, the ankle sprain that has resolved.  We can't make the same promise for many, more severe injuries that require surgery, produce scars, or leave injured workers with permanent restrictions.  The law tries to indemnify injured workers for their loss of income, medical treatment and sometimes permanent impairment.  But the injured worker will never be the same as they were pre-injury -- it's impossible for me to be the same as I was a week ago.  The point is -- we cannot stop change, nor can we go back and prevent the future from happening.  That is, unless of course you're Marty McFly.

It sounds as if this goes against all that we promise -- Return to Wellness?

The Return to Wellness promise is alive and well.  I can't tell you that we can return everyone.  These cases demand a frank and honest discussion about what the injured worker's future looks like.  When there are likely permanent restrictions or impairment, how do we manage that going forward?  I'm not talking about mitigating losses, I'm talking about reconciling who you were before an injury occurred and who you are going to be in the future.  For that logger who is not going back into the woods, it can be devastating.  For the mason who has always taken great pride in their skilled work, it's like losing part of your identity. 

As soon as we recognize that this may be the outcome, the sooner we must discuss what the future looks like for that injured worker.  Yes, it may not involve chopping down trees or building stone walls, but it has to mean something else.   This is reality, albeit sometimes a harsh one.  Life goes on after the work injury and it goes on after the claims settlement.  Medical providers can only take an injured worker so far and they can't, unfortunately and in most cases, return you to where they were before the injury occurred.  All the more reason to work to get an injured worker the best possible outcome -- this is going to be their life and their future long after the claim closes.  We may be stepping out of the realm of statutory benefits, but we can never lose sight of the fact that these are peoples' lives that are impacted by work injuries.  We must do all that we can to minimize that impact.

 

References:

Return. (n.d.). Retrieved November 21, 2014, from http://www.merriam-webster.com/dictionary/return

One more reason to offer RTW: Stop giving injured workers a bad rap

So much for the 80/20 rule.

According to a study conducted by Harris Poll on behalf of Summit Pharmacy, Inc., 2 out of 5 Americans believe that people who are collecting workers' compensation benefit don't want to work.  Not surprisingly, roughly 35% of respondents agreed that "You need a PhD to complete all the necessary paperwork associated with a workers' compensation claim."  That last question was a bit leading, and a tad dramatic for my liking, but I digress.

You can read more about the survey here.

While the survey may not be free of bias, I think there are some opportunities for further discussion.  The survey fails to consider whether or not the employer offered modified work to the injured worker.  If someone is offered suitable work and refuses it, that's a different story.  If the employer has done nothing to offer an injured worker modified duty, or if the injured worker remains totally disabled, then they are likely justified in remaining out of work.  I understand I'm arguing against a stereotype, but the stigma and stereotypes cannot be ignored.

In previous posts, I've written about injured workers who start to feel that they have to prove how disabled they are to justify their injury to people.  In an environment where a good portion of the American population thinks injured workers are just lazy, I can't imagine that makes anyone feel too good about being out of work.  It may even lead to them citing limitations and disabilities to demonstrate that they're not "faking" their injury. 

Conversely, when an injured worker is in a supported environment where they can trust that people surrounding them (including their employer and coworkers) believe their injury occurred and the subsequent pain is real, I'd venture to guess that they'd be less likely to point to their inabilities as they have nothing to "prove."

One thing we can do to fight this stigma (aside from preventing injuries from happening in the first place), is to offer modified duty to injured workers.  If they unjustifiably refuse the work, i.e., they really don't "want to work," then their benefits may be suspended and everyone can loosely conclude that they really don't want to work.  I'd like to see a survey that focuses on that.

We can also do a better job of helping injured workers fill out claim paperwork.  It may not require a PhD, but it is filled with jargon and legalese that those outside the WC industry have a difficult time understanding. A word of advice -- if you know the form you're about to mail out causes outrage or panic in injured workers -- give them a head's up that it's coming and what it means.  The wording on the forms typically makes it sound worse than it really is.

The Importance of an Ordinary Day at Work

In a recent meeting, I was encouraged, as I'm sure many others were, by a very simple, poignant observation.

We often wish away the ordinary days -- we pine to be on vacation, experiencing something exciting or adventurous, but when something happens to us or one of our loved ones, someone gets sick or injured, the one thing that we all long for are the ordinary days. We'd give nearly anything to have an ordinary day.

I've always believed that every day is a gift, and your health is a gift -- both of which we shouldn't take for granted.  It's unrealistic to spend every minute of every day focusing on how lucky we are to be alive and well, but as soon as something impedes our health or normal lives, we realize how fortunate we were.

I believe this is the case for most of us.  I also believe that is the case for most injured workers and employers of injured workers -- we all want the same thing.  We want to get back to the way things were.  We want things to be "normal" again.  Yesterday (Tuesday after Labor Day) was probably tough for most people -- getting back to work after a long weekend can be challenging.  Many people probably thought, why can't I win the lottery and get to stay home forever?! 

Work plays such an important role in our lives -- how we define ourselves, it is from what we derive our value, it shows what we can contribute to the world.  Think about the last time you met someone new.  After introducing yourself, the next thing you probably moved on to discuss was where you worked or what you did for a living.

Our job as workers' compensation professionals is to do what we can to restore injured workers to wellness.  To provide the appropriate medical treatment, guidance, and assistance to help achieve that sense of normalcy.  While it is true that not everyone will return to that old "normal," getting back to a state of wellness and productivity is our aim. 

We are creatures of habit.  We crave consistency.  We like routine and predictability.  Any disruption can cause us a great deal of strain and stress.  Think about the last unanticipated road construction detour you were faced with on your way to an appointment? 

Think about your morning routine.  You wake up, maybe you stop at the usual place to grab your coffee on your way to work, exchange some daily banter with the cashier, and continue on your way to work.  The average person spends 90,000 hours at work during their lifetime.  That's over 10 years, 24 hours per day.

Sure we all have our days we wish we'd win the lottery -- some more than others.  Those things that we'd rather be doing than working are probably also the same reasons we go to work.  There are probably aspects of everyone's job that would rather not have to do-- but that's why it's called work, right? 

When the ability to participate in work every day is taken from someone due to an injury or illness I'm confident in saying that what that person would like most is an ordinary day at work.  Employers have an opportunity to give the gift of ordinary days. 

Nurse Case Managers are NOT the Claims Police

This week's post comes to us from Eastern's own Director of Medical Cost Management, Nancy Crago, RN, BS, CCIM, AIC.  Nancy has over 35 years of nursing experience as well as 16 years of insurance experience.  She has had the opportunity to work directly in many areas of workers' compensation claims ranging from telephonic case management, claims adjusting, and supervision of adjusters and case management teams.  

What is a case manager?

The Case Management Society of America defines a case manager as a health care professional who is responsible for utilizing the case management process for individuals with health-related needs, with the goal of maximizing their wellness, autonomy and appropriate use of resources.  

What experience do case managers have?
Nurse Case Managers are registered nurses with at least 10 years of nursing experience.  Many nurses have advanced degrees and have specialized clinical skills and knowledge.  In addition, many nurses have national certification from organizations which focus on case management.  These include CCM, CRRN, and CDMS.  Continuing education is required to maintain professional licenses and national certifications.

Nurse Case Managers who work in the workers’ compensation environment generally have backgrounds in orthopedics, neurology, critical care, emergency trauma, general surgery, rehabilitation, or occupational health.  

Exactly what is it that nurse case managers do?
Case Managers have several roles – they are advocates, facilitators, coordinators and educators.  The foremost role is advocate.  Whenever a case manager works with an injured worker, the nurse establishes a relationship with that person.  The case manager and injured worker establish goals and plans to meet those goals.  While working as a case manager in workers’ comp it is essential that the case manager inform the injured workers that any information related to the claim and its outcome will be shared with the physician(s), claims representative, and employer.

How can employers maximize the benefits of case managers?
Collaboration is the key to a successful outcome with a case manager.  Case managers are looking for a win-win situation – the injured workers returns to wellness and the employer regains a productive employee.  Although the case manager will be an expert about the injury and treatment, he or she may not be an expert about the injured worker’s job and specific requirements.  Share a detailed job description with the case manager.  This will foster understanding about your business.  This knowledge and a written job description helps the case manager to clearly discuss how the injured worker can safely return to work during recovery from the work injury.   Use the case manager’s medical knowledge to help design a job around any restrictions the physician may order.  Ask questions about the treatment plan – how long will treatment last, are there other effective treatments. 

Case managers are NOT the "claims police"
Injured workers (and some mistaken employers) may think that the case manager is assigned as a policeman.  Nothing can be further from the truth.  Medical care is becoming more and more complex.  The case manager will assist the injured worker to understand the treatment plan, medications, and why early return to work is essential for a full recovery. 

Because the case manager brings medical expertise to the claim, he or she will always be pushing toward the next outcome and goal.  Expect the case manager to provide suggestions and recommendations for next steps.

Through education and experience, a case manager brings medical expertise to the claim.  A case manager also helps to coordinate care with a variety of healthcare providers—physicians, therapists, pharmacists, etc.   Case Managers are not “claims police”.  Their only focus is on returning injured workers to wellness through appropriate medical care.  As nurses, case managers are advocates for the injured worker, which benefits the injured worker and the employer. 

Thank you to Nancy for sharing her experience and insight on some of the many aspects of case management!

 

Vocational Rehabilitation: Who has the best outcomes and why it matters

When an injured worker receives permanent restrictions that prevents them from returning to his/her pre-injury position a few things may happen.  The employer may modify the injured worker's pre-injury job to accommodate the restrictions.  The employer may offer the injured worker a different position within the organization.  Unfortunately, sometimes an employer is either unable or refuses to do so and the injured worker is without a job to return to.  While many of us would say, well I'd just go out and find another job.  As research has shown, if you're a married male, younger than 50 years in age, who has a solid education, not attorney represented for your claim, and who participates in a vocational rehabilitation program -- yes, you most likely will (Blackwell, Leierer, Haupt & Kampitsi, 2003).  That's because individuals who fit this demographic profile have been found to have the best return to work outcomes after a claim.  That is not to say that other injured workers won't benefit from vocational rehabilitation services such as retraining or on-the-job-training.  Generally speaking, the more transferrable skills and individual possesses, the more likely they are to find work in another setting.  A lower education level and being over the age of 50 may limit an individual in their job search.

It also makes sense that the less "employable" an injured worker is, the more it increases the exposure of the claim -- thereby increasing the value of the claim. The goal of any vocational rehabilitation plan is to assess an injured worker's employment history, transferrable skills, education, and provide services (re-training, job search tools) to identify employment opportunities.  The more dismal the re-employment picture is, the greater the challenge it is to return the injured worker to gainful employment.

Employers can take steps to avoid this process by identifying employment opportunities within their company, looking at potential modifications (see our post on AskJAN.org) or any cross-training opportunities within their organization.  When you can control or influence the outcome, your results will usually be better than when you let an injured worker's future be subject to the employment market.

Employers who have injured workers that are given permanent restrictions should think long and hard about providing modified duty, on a permanent basis to their injured workers.  It is not a decision to be taken lightly.  An unrestricted person may have a difficult time finding work, let alone adding in physical restrictions and a period of unemployment due to a work injury. 

References:  Blackwell, T. L., Leierer, S. J., Haupt, S. & Kampitsis, A. (2003).  Predictors of vocational rehabilitation return-to-work outcomes in workers' compensation. Rehabilitation Counseling Bulletin, 46(2), 108.

Concurrent employment conundrum: Return to Work for those who work more than one job

Some states provide benefits for concurrent employment if the injured worker is unable to work one or both (or more, I suppose) of their pre-injury jobs.  The workers' compensation policy covering the injury pays for the lost wages the injured worker sustains due to the work injury, which includes wages lost at another job.

Here's the scenario:

Steve works for No Leaks Plumbing as a plumber.  He also works part time as a bartender at Ps and Qs,Pub on the weekends.  While Steve is working to loosen a pipe under a sink at a customer's home (working for No Leaks Plumbing), he injures his right shoulder.  After going for treatment, he is given one-handed restrictions.  The good news is, No Leaks Plumbing is insured with Eastern Alliance and has a solid return to wellness program.  No Leaks Plumbing can bring Steve back the following day to work within his restrictions.  Unfortunately, Ps and Qs Pub cannot. 

What's the big deal, right?

Well, if the state that Steve files a claim in considers concurrent employment wages as part of the claim, then it can have implications for No Leaks Plumbing.

When calculating the compensation Steve is due as part of his injury, the claim representative would obtain wage information from No Leaks Plumbing and Ps and Qs Pub.  These wages would be combined to determine Steve's pre-injury average weekly wage (AWW).  Based upon the AWW, Steve's compensation rate, or temporary total disability rate, would be roughly 66 2/3% of the average weekly wage.

Let's say Steve makes $1000 per week at No Leaks.  He makes $200 working at Ps and Qs Pub.  One may think that since Steve is working for No Leaks without a loss of earnings, his wages from Ps and Qs Pub wouldn't matter. That is incorrect.

Steve's AWW would be $1200.  If Steve is able to earn his pre-injury hours, earning his pre-injury wages on modified duty, the compensation carrier would still owe Steve 2/3s of the difference between his post-injury earnings and his pre-injury average weekly wage.  In this example, it would be $1200 (AWW) - $1000 (wages working modified duty) = $200.  66 2/3% of $200 = $133.33.  Steve would receive a paycheck from No Leaks, and a temporary partial disability (TPD) check for a percentage of his lost wages from Ps and Qs Pub, in the amount of $133.33.

This puts No Leaks in a difficult position.  They support modified duty but Ps and Qs Pub does not.  The claim representative can attempt to work with Ps and Qs to bring the injured worker back to modified duty, but the pub really has no reason to, other than to have an employee performing some type of work. 

Keep in mind, as long as an injured worker's earning capacity is reduced, due to the work injury, then there is likely going to be benefits due to that worker.

What can be done in this situation?

• The claim representative can encourage the injured worker to discuss modified duty with their concurrent employer
• Obtain a job description from the other employer to help the treating physician determine what the injured worker can safely do at the pub.
• The primary employer (No Leaks) could consider placing the injured worker at a local not-for-profit organization through transitional duty to reduce exposure under the claim, rather than simply paying the injured worker their pre-injury wages.
• If all attempts fail to bring the injured worker back to work at the other employer, the primary employer (No Leaks) may be forced to cover the secondary employer's wages until the injured worker is recovered to perform the work at the pub.

Concurrent employment creates a unique challenge for employers and insurance carriers.  An effective RTW program can help control workers' compensation costs, and can help employers control the aspects of their claims that are within their control.  Sharing expertise and experience with the secondary employer may help them understand why it is a good idea to bring an injured worker back to modified duty.

You've heard of early RTW, but what about late RTW?

So much of what we hear about return to work focuses on early return to work. The majority of injured workers receive medical care, return to modified duty and then eventually their pre-injury jobs. But there's also a group of injured workers who receive medical care, and are given restrictions that are ultimately deemed permanent.  The injuries are typically more severe, or require more than conservative treatment.  Eventually, disability persists so long that we lose focus on return to work as a treatment goal. As Sullivan and Hyman (p. 1, 2014) put it,

     "Evidence-based clinical guidelines emphasize early return-to-work as a critical          
     treatment objective in the management of recent onset pain conditions.  However, 
     something changes when a pain condition becomes chronic.  For chronic pain        
     conditions, return-to-work is rarely put forward as a primary treatment objective.  
     Consequently, successful return to work is rarely an outcome in the treatment of chronic 
     pain conditions."

In their editorial, the authors emphasize the importance of remaining active in ALL phases of recovery, even after an individual's pain becomes "chronic."  If all the treatment that is provided (primarily prescription pain medications) does nothing to improve the individual's level of function, then they aren't really working, are they?  One can argue that pain medication alleviates the individual's pain, but if that doesn't result in an increase in function, is it worth it?  Why aren't we focusing on function?

There's also an assumption that individuals with chronic pain cannot work.  The authors cite a study in which 40% of chronic pain patients who underwent a return-to-work intervention program were successful in their return to work.  If you don't think it is an option, you will never look for information to prove yourself wrong.  Employers who adamantly proclaim that they don't have modified duty will not then go look for modified duty options.  Injured workers who believe that they will never return to work will most likely not look for opportunities to go back to work. 

"Beliefs are the roadmaps of behavior" (p. 2, 2014).  We must keep return to work on the table.  When I say "we," I mean insurance professionals, case managers, medical providers, employers, and injured workers.  The return to work may not be a pre-injury position, but there is work out there for those who want it.  Take workers' compensation, or any other type of benefits, out of the equation, and focus on the individual.  This is their life, for the rest of their life, not just until their benefits expire or their claims settle.  What are "we" doing to provide the best outcome and what are we doing to return them to wellness via return to work?  Can we really expect an injured worker to stay motivated if their physician has thrown in the RTW towel?

To read the editorial, click here.

References:
Sullivan, M. J. L., Hyman, M. H. (2014).  Return to work as a treatment objective for patients with chronic pain?  Journal of Pain Relief, 3(1).  doi:  10.4172/2167-0846.1000130 







Why employers should support employees before and after a work injury

When employees are treated fairly, they are more likely to have a stronger commitment to their workplace.  When employees feel they are not being treated fairly, they will be less motivated to return to work or put in extra effort to overcome even minor obstacles. 

In a 2006 study of social support as a factor in the return-to-work process, researchers found that social support was reported as a key contributor to a successful work re-integration (Lysaght & Larmour-Trode).  The authors of this study found that the so-called "soft" aspects of the RTW process were relevant to RTW and important to injured workers and supervisors alike. 

Relationships, in and out of the workplace, help us deal with stress.  When you have a work issue, you may confide in someone outside of work, or maybe a co-worker who understands the situation.  When you have an issue at home, a co-worker can be an objective third party to help make sense of things.  These forms of social support also apply to work-related injuries and the RTW process. 

Previous research has identified four sources of support in the workplace (p. 256):

• Informational:  information, suggestions, recommendations

In the RTW context, injured workers need information about how to complete paperwork, what the RTW process involves, as well as advice on what they can and cannot safely do within their work limitations.  While it would appear some that the onus to obtain this information is on the injured worker, supervisors or other parties, can assist injured workers by providing them with information or assisting them with obtaining that information.  Sometimes it just takes a simple conversation to alleviate mounting concerns.

• Instrumental:  compensation/wages, hours, work

Employers can provide instrumental support by providing ergonomic assessments, modifications of job duties, or work schedule accommodations.  Any step that an employer can take to increase an injured worker's sense of autonomy and contribution will aid in their re-integration into the workplace.  Meaningful work duties with a clear business purpose are ideal options for RTW.

• Emotional:  listening, genuine concern and caring about employees

Employees want to know that their employer genuinely cares.  The aforementioned study found that co-worker support was also repeatedly mentioned by the interviewees.  Some reported their coworkers worked to assist them, asked how they were doing, and included them in social activities outside of work before they returned to modified duty.  Others recalled negative experiences of co-workers making hostile comments, or ignoring the injured worker.  Management has a key role to play in addressing negative treatment of co-workers who return to modified duty after a work injury.

• Appraisal:  feedback regarding performance, social comparisons

While this can be a delicate topic, it's important for supervisors to understand an injured worker's need for feedback once they return to work.  This allows for open communication about the injured worker's recovery, the appropriateness of the duties assigned to them, and their overall experience back at work.  Treating employees fairly, whether on restrictions or not is key and should not be overlooked.

An employer's relationship with their employees should provide support in these four areas before an injury occurs.  Work to strengthen these relationships today and it will undoubtedly help when you are working with an injured worker on modified duty.

Source:  Lysaught, R. M., & Larmour-Trode, S. (2006).  An exploration of social support as a factor in the return-to-work process.  Work, 30, 255-266. 

Upcoming Blair County (PA) Chamber of Commerce Event: Developing RTW Programs 3/21/14

This Friday, March 21st Eastern Alliance Insurance Group's RTW Specialist, Sarah Tayts, will be a co-panelist at the Blair County Chamber of Commerce's March Safety Meeting.

The panel will be discussing the development of RTW programs and how employers can successfully gain support for RTW in their organization.  

If you're interested in attending, click here to register for the event.  You can also visit the Chamber's website at www.blairchamber.com

When:              3/21/14 7:30-10 am

Where:            Hampton Inn

180 Charlotte Drive
Altoona, PA 16601

Cost:               $15 – Chamber Members
                        $30 – Non members

Join us for a complimentary webinar: Communicating with Injured Workers for Successful RTW Outcomes

Who: EAIG's Return to Wellness Specialist, Sarah Tayts, AIC, ARM is presenting this webinar which is open ALL Eastern Alliance Insurance Group Agency partners and clients

What: A complimentary webinar that will provide information on the importance of communication between the injured worker and the employer, tips for managing claims and RTW through effective communication, and ecovery resources to faciliate more effective communication and better RTW results.

When:  Thursday, March 13th from 10-11 AM (EDT)

Where: Via webinar

How: Click here to register!  Feel free to forward this post via email to your EAIG clients as an invitation.

Industrial athletes: Dip your toe in the pool before diving in to RTW

In his blog post, Dr. James Butler of Orthopedic Associates of Evansville, Indiana, writes: 

“30 years ago, as a young physician I was taught, as many of our parents were, that if you have an injury you must have complete rest.  We have discovered over the years that that is a fallacy and leads to other problems.  I often joke with patients that as a young doc we used to hospitalize patients with back pain and put them in bed for a week or two at a time, and many of them are still there.  The sports medicine specialists were in the forefront of changing that idea.  They began treating their athletes by resting only the injured part while continuing to actively use the rest of the body.  They found that people healed quicker, and were back in the game sooner.  Well, we have finally realized that workers are just a different type of athlete, an “Industrial Athlete” and they also need to be kept with their team while healing so they can get back up to bat again sooner.” 

Work must be a component of any injured worker’s recovery. 

Maybe you are an employer who wants a healthy, productive employee back to work or you're the spouse of an injured worker who wants things at home to return to the way things used to be. Maybe you’re a physician who wants to help your patient recover and achieve the best possible outcome.  Graded work exposure may help you attain these goals by making work a part of the recovery process.

What is graded work exposure?

It’s a predetermined plan agreed upon by an injured worker’s occupational therapist and the injured worker’s supervisor that returns injured workers to job duties in which the hours and duties are gradually increased until the injured worker can return to their pre-injury duties. 

An example is when an injured worker returns to work four hours per day, five days per week for two weeks.  After two weeks, the injured worker’s hours are increased to 6 hours per day for two weeks, and then eventually eight hours per day.  Graded work exposure may involve the injured worker only performing certain aspects of their job that are more physically challenging for just a portion of their day.  Graded work exposure can be particularly helpful for injured workers who question their ability to return to their pre-injury job, or are fearful of getting injured again.  Making progress toward goals through graded work exposure can help both employers and injured workers restore their confidence in the injured worker’s physical abilities. 

In a 2000 study conducted on therapeutic return to work (TRTW), researchers found that work rehabilitation programs that linked graded work exposure with traditional physical therapy for chronic low back pain resulted in 93% of participants working at two-year follow up.  More telling of the success of this program is that none of the participants reported back pain recurrence from working during the period of the study (p. 59, 2000). Of those participants who underwent traditional functional restorative therapy, 73% of participants were working at two-year follow up.  Participants in the TRTW group also indicated lower average disability scores, lower average pain intensity scores, and lower scores on fear avoidance beliefs measures (p. 60, 2000).

Speaking of industrial athletes…

Do you remember the first time you jumped off the diving board?  Your thoughts preceding that jump probably focused on every time you nearly drowned before that.  You’re teetering at the edge of the fiberglass board hoping that you won’t sink like a rock, hoping that someone will come to your aid if you suddenly swallow half the contents of the pool, and hoping that it will all be worth it.  The people on the side of the pool are telling you to just do it already, to trust them -- they’ve done it a hundred times before and it will be great.  Something tells you to linger on the board just a little longer, inch a little closer to the edge, and that you’ll decide when you’re ready.

Returning injured workers to modified duty requires trust.  Employers and injured workers are concerned about re-injury.  There may be doubts in either party’s minds about whether or not the return to work will, well, work.  These feelings of anxiety, uncertainty and doubt are also experienced by employers and injured workers who are contemplating a return to work after a work injury.  No matter how many times a doctor tells an injured worker or an employer they can do x, y and z, they haven’t seen it done yet and they aren’t really sure of the outcome. Without an attempt no one will ever know. 

When planning the return of an injured worker, focus on setting it up for success and consider graded work exposure as an option. 

References:

Durand, M. J., & Loisel, P. (2001). Therapeutic return to work:  Rehabilitation in the workplace. Work, (17), 57-63.

Where in the PA WC Act does it say employers have to offer work to an injured worker? Right here...

I once had an employer ask me to show them where in the Pennsylvania Workers' Compensation Act it states that they have to bring an injured worker back to work.  I kindly directed them to Rules and Regs --  Title 34. Labor and Industry, Part VII. Bureau of Workers’ Compensation, Chapter 123. General Provisions Part II,  Subchapter D. Earning Power Determination, section 123.301 Employer job offer obligation.  Here’s a link to this particular subchapter.

The Rules and Regulations state that if a job is open with the liable employer, that the injured worker is capable of performing, “…the employer shall offer that job to the employee prior to seeking a modification or suspension of benefits based upon earning power.”  Basically, if you’re a Pennsylvania employer who is currently hiring for a position that an injured worker is vocationally and physically suited to perform, then the employer has an obligation to offer that job to the employee. 

If the employer offers the job and the injured worker fails to respond to it or refuses it, then the employer’s duty has been satisfied and they can seek relief for refusal of a valid job offer and/or pursue evidence of earning power through a labor market survey/earning power assessment.  If the employer has more than one opening that the injured worker could perform, the employer has the right to choose which job to offer.

Just for clarification – “…prior to seeking a modification or suspension of benefits based upon earning power” means that the employer/insurance carrier cannot seek relief through an earning power assessment/labor market survey if there is suitable job available to the injured worker at their pre-injury place of employment.  Proving earning power basically means that an employer/insurance carrier utilizes the services of a vocational counselor to provide proof that there is work that exists in the usual employment area of the injured worker that he/she is vocationally and physically suited to perform.

This earning power assessment consists of a vocational interview with the injured worker to review his/her work history, vocational skills and any other relevant attributes pertaining to their employability.  Some examples are military experience, education level, prior jobs held, or any certifications that the injured worker may possess.  The vocational counselor then conducts a labor market survey to see what types of jobs exist in the market that the injured worker could perform, taking into consideration their work abilities.  Once the survey is completed, the vocational counselor determines realistic earnings for these jobs for the injured worker. 

Once the labor market survey/earning power assessment has been completed, the report is provided to all parties involved and the employer/insurance carrier may decide to file a Petition to Suspend or Modify the injured worker’s wage benefits based upon this projected earning capacity.  The purpose of this evidence is to demonstrate that there is work available to the injured worker and based upon their responsibility to find work within their restrictions, the employer/insurance carrier should be relieved of some or all of their ongoing wage benefits (depending on the amount the injured worker is deemed capable of performing).

Many employers are unaware of how their ability to offer modified duty impacts their claims.  If the earning capacity identified by the vocational counselor is less than what the injured worker previously earned (their average weekly wage for their WC claim), then the employer/carrier is responsible for 66 2/3% of the difference, which is called Temporary Partial Disability Benefits, or TPD.  In Pennsylvania, an injured worker is entitled to 500 weeks of TPD benefits.  If 2/3’s of the gap in earning capacity is equal to $150 x 500 weeks, the employer/carriers is still responsible for nearly $75,000 in wage benefits.

The intention of this post is not to make readers experts on any aspect of the Pennsylvania Workers’ compensation Act, nor is it to be construed or utilized as legal advice.  The intent of this post is to make employers aware of the potential avenues that they may have to travel, if they are unable to bring an injured worker back to their pre-injury earning capacity in Pennsylvania.  As with everything in insurance, each case is fact-specific and any decisions should be reviewed with an experience claim representative and/or legal counsel.

The Snowball Effect of Employee Satisfaction

If the words “employee satisfaction” incites eye rolls from your management staff, then share this post with them next time you discuss your workers’ compensation program. 

A 2011 prospective study of work-related low back injuries indicates that what employers do after a work injury can have a significant impact on the injured worker’s recovery level.

Loss reduction efforts that improve employee satisfaction may also improve the injured worker’s outcome.  This study found that injured workers who were both satisfied with their employer’s response to the injury and their doctor’s treatment experienced better scores on leg and back pain scales, tests of function, and quality of life scales.  It’s important to point out that it wasn’t because the doctor wrote them out of work or gave them a warm and fuzzy feeling – the study indicates that satisfaction regarding the effectiveness of treatment is what contributed to the reduction in symptoms and functional limitations. 

The effect of the employer’s treatment of the claim was just as important as the medical provider’s treatment of the injured worker at 6 months post-injury.  Even more interesting is that at 1 year post-injury, the importance of employer’s treatment of the injured worker continued to grow.

In practical terms, this makes sense.  Think about an injured worker who has been disabled from working for a period of 3 months as the result of a significant injury.  If an employer responds negatively, or fails to stay in contact with the injured worker, the relationship begins to deteriorate.  How would you feel if you were out of work for a significant duration and no one seemed to care?  An understanding employer who is willing to work with an injured worker will gain the reputation of an employer who cares about the well-being of their employees.  This reputation travels faster than the speed of light.  I’m sure you could name three places right now that you swear you’d never work – and not just because of the type of work, but because of how they reportedly treat their employees.  Fact or fiction, it doesn’t matter if potential, future job applicants hear this.

Using deductive reasoning, one could conclude that what is good for the injured worker’s recovery is also good for reduction of claim costs (and good for the company).  The authors report a 30 percent reduction in claim costs attributable to higher satisfaction with claim treatment and likely due to a reduction in lost time claims.

Reference:  Butler, R. J., & Johnson, W. G. (2011).  Loss reduction through worker satisfaction:  The Case of workers' compensation. Risk Management and Insurance Review, 14(1), 1-26.  doi: 10.1111/j.1540-6296.2010.01188.x

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New Year, new approach to RTW

Hopefully you found the holidays to be enjoyable, now it’s back to work!  If you’re one of the many resolution-ers out there, you may want to read this before going public with your resolution.  According to a study cited in a Forbes.com article, about 40% of Americans make resolutions and only 8% of them keep them. 

Resolve to improve your company’s workers’ compensation program.  Why? Because unlike a short stint at the gym or week or two on the South Beach Diet, improving your workers’ compensation program doesn’t require any special diets or new clothing.  Nope, you simply need some groundwork and a good team of people to support you.

The process of setting your goals has a direct impact on the likelihood of successfully attaining them.  Some simple considerations can go a long way.  Goals should be simple, attainable and measurable.

Simple

Stick to one or two goals for your RTW program.  A simple starting point for employers without a RTW program could be to identify 10 modified duty tasks for each department in your organization.  Creating a modified duty job bank is an essential step in achieving successful RTW outcomes.  Review your loss history to decide where to start if it seems overwhelming.  Try not to reinvent the wheel – use existing job descriptions for ideas. 

Attainable

Sure, every organization would like to eliminate all injuries or all lost time days, but that might not be very realistic.  You can’t prevent everything, so make sure you have a plan to deal with an accident when it occurs.  Review your past loss histories to identify trends and to set reasonable goals.  You can also look to the Bureau of Labor Statistics (BLS) for comparison data.  Periodically re-assess the goals to determine where you are and if they need to be adjusted.

Measurable

As the old adage goes, you manage what you measure.  Once you’ve determined your simple, attainable goal, you must be able to measure it.  Some examples include:  reducing lost time days by 20%, reducing the number of lost time claims by 80%, getting every injured worker who has restrictions back to work within 7 days of their release to return to work.  If part of your goal focuses on providing training for supervisory and management staff on the importance and benefits of modified duty, consider setting a goal to require each staff member to attend training.  You could go the extra step and require them to score a 95% or higher on a post-training quiz.

Other considerations

Announce your goal to the organization.  Divulge your plans and then demonstrate the progress you make toward those goals.   Make it extremely clear how each employee contributes to this goal as well as how your workers’ compensation premiums impact the financial results of the company.  If your company has quarterly meetings, add this to the agenda.  Regularly post your progress in a visible area such as your mandatory postings board or break room.  If you don’t reach your goal, determine an objective reason why.  Use this information to realign your goals for the following year. 

We’re here to help you successfully implement a return to wellness program.  Check out our resources on www.eains.com/ecovery or contact us directly.

Best of luck in whatever resolution you take on this year, and if you’re one of the nearly 60% of Americans who don’t make New Year’s resolutions, we still wish you all the best for 2014.