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.