Defining Disability - Part I: The Medical Perspective

Whenever we have a discussion with someone, we’re processing the information they are relaying based upon our own experiences and interpretation of what the other person is saying.

It never matters what you think you said -- it’s what the other person heard.

If you asked 20 people to define the word “disability” you’d receive 20 different, albeit somewhat similar, responses.  They’d all most likely focus on comparable aspects of the word, maybe even involve like examples.  There would also be some stark differences.  This is because we’re all defining it based upon our personal experiences and where we sit in the world.

This series of posts will focus on our unique perspectives into the definition of disability – medical, workplace, and regulatory definitions.  I encourage you to ask a sampling of people to define disability to you.  Think about the frameworks they’re using – physical limitations, work situations, developmental limitations, etc.  Consider why someone is using that frame of reference – it’s based upon their experiences.

Medical

When a person sustains an injury or illness, their doctor, or other medical professional, often discusses what types of activities they should avoid and what activities are “safe,” often putting some type of limitation on a particular activity.  An example of this would be no overhead lifting or no lifting over 15 lbs.  These recommendations are based upon past experience, objective reference guides, and individual attributes of the injured or ill patient.  The healthcare provider is often considered the “expert” who is making these determinations.  As you can see, they play an incredibly important role in stating what the injured or ill person can and cannot do based upon their medical (physiological) condition.

The medical definition of disability does not contemplate what the injured worker’s job requirements are – if you cannot lift 15 lbs. at work, it is not safe to lift 15 lbs. at home.  In this respect, we’re focusing on what the injury is, what it has done to your body and what you’re subsequently not capable of safely performing as a result of the injury.

What types of challenges are presented?

In the various arenas that these restrictions are used, the information may not be considered adequate or sufficient from the end-users’ perspective.

Injured worker: 

• What does 15 lbs. really feel like?  I don’t carry a scale around with me, how will I know? The result is general avoidance behavior.  The injured person will avoid lifting things with unknown or uncertain weights.  I know I can lift that  5 lbs. bag of sugar because it says it weighs 5 lbs., but I know I can’t lift my dog because the last time we were at the vet, she weighed 27 lbs.
• There may not be a clear understanding of why the restrictions are in place, i.e., what additional damage could be done by exceeding the restrictions.  Conversely, fear or re-injury and avoidance behavior can result in unintended negative consequences such as “frozen shoulder.”  This can occur in shoulder injuries due to lack of motion.

Employer:

• Similarly to the injured worker, they’re not sure what each aspect of their employee’s position entails.  There’s probably a fear of re-injury as well.  This can lead an employer to say that they don’t have work and that it’s best to let the injured worker recover before returning.
• The employer may not understand fully what work the injured worker can and cannot safely perform. The employer may be trying to complete FMLA, short term disability, and/or workers’ compensation paperwork with the information provided.  Often times a disability note provides the date it was written and the current restrictions.  This is only part of the information needed to complete these forms.

We’re provided with some of the information we need, but not everything we need for every system that the injured worker maybe find themselves in.  This results in follow up paperwork that is generally specific to the employer or insurance carrier.  Each of these parties has their own “definition” of what disability means.

What can injured workers and employers do to navigate these definitions?

• Injured worker
• Understand what information your employer and/or their workers’ compensation insurance carrier needs.
• Ask questions
• How is disability defined?
• In some state workers’ compensation systems it solely depends on earning capacity as a result of your work injury/illness.  In others it may have differing definitions. If you don’t understand, keep asking questions until you do.
• Questions for your doctor:
• Can I safely perform duty x?  How does my activity level impact my recovery?  What are some of the signs that I’ve done too much or too little?  If I feel good can I do more?
• Employer
• Understand what information your company needs to make a determination about modified duty:
• What is the injured workers’ job?  What are the physical requirements?  Are there other jobs that fit these restrictions?
• Ask the physician to approve or comment on the pre-injury or modified duty job description.
• If you aren’t sure what they can safely do, ask!
• Communicate with the injured employee to make sure everyone has the same understanding of the work and the restrictions.  

It may be helpful to explain what framework you’re using when describing or defining disability.  An example of this would be a doctor saying, “From a medical standpoint, your rotator cuff is torn.  At this point in your rehabilitation, you’re able to use your injured arm to lift no more than 2 lbs., no higher than counter/waist-level height.” 

That’s informative for an injured worker to know, but what does that mean in terms of them returning to work? 

Be sure to check out the rest of this series on the different ways disability is defined and why it matters.

 

 

"Wait and see" is never a good approach to claims management, or anything else, really

It sounds obvious, right?  “Wait and see” is the antithesis of “pro-active claims management.”

If you’ve spent any time skimming articles in the workers’ compensation blogosphere, you’re fully aware of the focus on being a proactive employer or carrier, leveraging predictive analytics, and applying all sorts of programs or steps to impact your company’s bottom line.  It goes without saying that having a plan in place prior to a loss or accident occurring is generally accepted as a best practice.

Glad we’re all on the same page.

It begs the question then, as to why employers take the “wait and see” approach when it comes to returning injured workers to modified duty.  Most people agree that proactive claims management is a good thing.  Getting people the right medical treatment and returning them to work as soon as it is safe is also a good thing.  So why is it, time and time again, employers receive a copy of work restrictions and say, we’d like to wait and see what the next appointment tells us. 

It’s like driving down a highway with your fuel light on, and having no certain way of knowing if the next gas station is 6 or 65 miles away.  Sure, the sign said fuel - 6 miles ahead, but it may be closed for service.  The doctor’s notes said that the injured worker would likely reach full duty status in 6 weeks.  In cases of a cut finger or even a clean fracture, maybe the prognostications are accurate.  These projections are based on many factors – most of which are subjective and can be difficult to quantify.  Does the injured worker smoke?  Have they had an injury like this before?  Are they considered obese?  How old are they?  Do they have other co-morbidities or conditions that may delay recovery?  Do they have a support system at home to help them get to their therapy appointments or change wound dressings?  Are they compliant with their home exercise program? 

It's a well-known joke that the best occupation in the world is to be a meteorologist because you can be wrong every day of the week and still have a job.  Well, predicting recovery times can sometimes be a lot like predicting the weather.  There is plenty of data that has been aggregated and put into a model to predict when we think this person will come back to work, but the factors that we cannot measure with great precision are those specific to that injured worker – the psychological and social factors.  How motivated is the injured worker? What’s going on in their personal lives that may impede or speed up recovery?

So, like predicting the weather or mentally calculating your vehicle’s MPG vs. distance to the next gas station, use the information that you know.  Base your next steps on the given work restrictions and find something the injured worker can do within those restrictions.  You don’t know what you’re going to get in the future, so make an informed decision rather than “hoping” or taking a “wait and see” approach.

Think about the last time someone told you that they would “wait and see how things go."  How did that make you feel?  Most likely, it made you feel pretty uneasy. 

We’ll wait and see how that tire holds up.  We’ll wait and see how this year goes for your first year freshman son or daughter.  We’ll wait and see how this prescription medication works for your cardiac problems or blood sugar.  We’ll wait and see if that health problem worsens before we decide to do anything about it.

Would you accept any of those things with ease?  Probably not.  You would likely ask the doctor if there was anything you could do to improve or influence the outcome.  Would diet and exercise help?  Are there tutors available to help my son rather than having to  “wait and see” if he passes or fails his mid-term?  Waiting and seeing is basically relinquishing all control and influence over a situation.  Sure, you cannot control everything but there’s always something you could be doing now to positively impact the outcome.

 

Eliminating uncertainty does wonders for peoples’ confidence in their future, as well as their workers’ compensation claims.

If you find yourself saying that you'll wait and see if the injured worker is released to full duty at their next appointment, you should probably not wait and see how that approach works out -- do something now.

Uncovering commonly overlooked RTW options by inspecting the way we view inspections

Sometimes it may seem as if there is a bureau or a department to regulate just about every business these days.  In all fairness, these regulations are for good reason and we're thankful that there's someone there to do it.  With regulation come rules.  With rules come inspections.  The good news is that these inspections can be a fantastic source for productive and meaningful return to work (modified duty) opportunities.

Restaurant Inspections

Hopefully your restaurant is not worthy of Chef Ramsey and his camera crew.  If it is, well, you’re dealing with more than just RTW problems and I’m afraid our blog can only address so many issues in 500 words or less.

Restaurant inspections are conducted by various regulatory bodies at the state level to determine if a restaurant is operating within approved food-safety guidelines, has appropriately trained staff, among other requirements.  Many newspapers, as well as online sources, publish the health inspections of restaurants and other food service locations.  Copies of inspection reports are available by request from the agency responsible for completing the inspection.  The point is, this information is, for the most part, easily accessible and can have an incredibly positive or negative impact on your restaurant’s reputation (and subsequent sales).

Common injuries in the restaurant industry include cuts and lacerations, slips/trips/falls, and lifting injuries to the back.  The resulting work restrictions can include limited use of the involved body part such as:  no use of the right hand, no lifting greater than 10 pounds, must be able to sit most of the shift.  The old adage goes, “If there’s time to lean, there’s time to clean.”  Meaning, if you’ve got time to lean on the counter, you’ve got time to wipe said counter, polish said glasses on the counter, or refill said condiment containers under said counter – it’s like the military – there’s always something that needs to be polished, painted, or wiped down.

Restaurant inspections are based off of the codes in place.  Check with your local health department or state agency to see if they have any check list resources to help ensure your restaurant’s operations meet or exceed the standards.  Not only is it a good business practice, but it’s a great resource for modified duty.  A clipboard allows for ease of use.  Even if it is the injured worker’s dominant hand, they can probably check a box under “yes” or “no” with their non-dominant hand.  Most importantly, the work is meaningful, productive, and serves a legitimate business purpose.  This is the best kind of modified duty you can find!

Other types of inspections

 

Long term care facilities have many requirements to meet when it comes to Medicare compliance.  OSHA has numerous requirements related to various aspects of your business.  These include material safety sheets (are yours updated to meet the Globally Harmonized standards/hazardous communications documentation requirements).  Are your eyewash stations up to par?  (More importantly, does everyone know what the standards for an eyewash station are?)  When was the last time your fire extinguishers were inspected?  Are all of your crew members’ step ladders safe and free of cracks or damage?  Are your company vehicles properly maintained for safe operation?  Ask your Risk Management Consultant to help you identify some issues that OSHA may be concerned with and implement a checklist/maintenance system for compliance.  Use that checklist system as part of your modified duty options.  While it may not yield months of modified duty options, it will help you get an injured worker working and hopefully help prevent future injuries or citations.  The goal of course is to make your workplace safer, not just to avoid the citations.

I’m sure there are various other types of inspections that your business may face – be prepared and help return an injured worker to meaningful, productive modified duty.

A must watch - "GOLD" - You can do more than you think

Two years ago I had the privilege of watching this film in its entirety at a seminar on the importance of return to work and disability management.  Those of us in the audience were also fortunate enough to hear Kirsten Bruhn speak about her experiences after her accident, and how swimming (and her family) helped her see a future in a new way.  She is an inspiration to many and I invite you learn more about her story.  In her words, "You are what you are thinking. I have learned that I need to step away from my handicap and reinvent myself for what I am capable of doing. And action follows the thought."

I encourage you to watch this short movie trailer and read about the two other Paralympic athletes, Kurt Fearnley and Henry Wanyoike.

There is a movement to change the way we talk about people with disabilities, how they are integrated in our society and workplaces, and a general understanding and appreciation for what it means to live and contribute when you have a disability.  It is a matter of changing the conversation and changing peoples' perspectives -- this video is a great starting point. 

In workers' compensation, we don't typically work with professional athletes, but we do work with industrial athletes.  When an accident occurs, whether it results in permanent impairment or not, that can be a life-changing event.  The impact it has on a person's life may vary, but never doubt that it has an impact.  We are in a position that requires us to understand that impact it has on an individual physically, psychologically, economically and socially -- and help them return to wellness.

Watch it, share it, keep the conversation going.

It's Kids' Chance Awareness Week! Please help spread the word by reading and sharing this post!

What is Kids’ Chance of America?
Kids’ Chance of America is a 501 (c)(3) organization that represents a collection of state-level non-profit Kids' Chance organizations that provide scholarship opportunities to children who need financial assistance due to a parent’s work-related injury or fatality. Cumulatively, since their inception in 1988, Kids' Chance organizations have awarded 5,479 scholarships totaling almost 14 million dollars.

There are currently 29 Kids’ Chance state organizations with several additional states in the planning stages. The goal is to establish a Kids’ Chance presence in every state so that all eligible students are made aware of their assistance. Find out if there’s a Kids’ Chance in your state.

What Makes Kids’ Chance Awareness Week Special?

Today marks the inaugural Kids’ Chance Awareness Week. Eastern Alliance Insurance Group is proud to provide financial support to many Kids’ Chance organizations, and sponsors the “fresh outlooks. better outcomes.” scholarship through Kids’ Chance of Pennsylvania. Our employees also embrace this terrific cause, raising thousands of dollars every year for Kids’ Chance scholarships, and serving on the boards of several Kids’ Chance organizations.

In 2015, scholarship applications increased significantly but we know there are more students in need of assistance. Kids’ Chance Awareness Week is designed to increase visibility through special outreach events in each state that will spread the word about Kids’ Chance scholarship opportunities.

Planning for College Initiative

In order to help achieve the goal of creating a Kids’ Chance presence in every state, Kids’ Chance established the national Planning for College initiative. For a family who has lost a parent’s income due to a serious or fatal work-related accident, planning for college can become a real challenge. Through the Planning for College Initiative, Kids’ Chance is here to help those families with children of all ages stay in contact so, when the time is right, they’re prepared to apply for our scholarships.  If you or someone you know is eligible for a Kids’ Chance scholarship, enter your contact information in the Planning for College form.

How Can I Get Involved with Kids’ Chance?

• Contact the Kids’ Chance organization in your state to find out what special Awareness Week events are planned.
• Spread the word about Kids’ Chance Awareness Week through social media, tagging Kids’ Chance: @KidsChanceInc.
• Talk to your colleagues who may come in contact with injured workers and/or their families that may have children who could be eligible for a college scholarship -- now or in the future.
• Planning for College materials can be found here or to request Planning for College Cards, please contact the Kids' Chance office at admin@kidschance.org or call 484-945-9903.
• Share this blog post!  You can do so by using the sharing icons below. 

 

Don't wait until you have a RTW note to start thinking about RTW

As an employer, when you have an injured worker who is out of work with restrictions, there should be no delay in having serious return to work (RTW) conversations.   Even if you don't have restrictions yet, there should be a return to work discussion taking place. 

How can I plan for RTW if I don't know what the injured worker can do?

Your claim representative and nurse case manager (if assigned) will be able to project roughly what the restrictions will involve.  There also other resources available to help, such as Occupational Disability Guidelines (ODG) and the Medical Disability Advisor (please note, we don't endorse either of these, but they are available).  A free, simple, and more accurate resource would be to ask the treating physician!  Most injuries do not require total disability for more than a few days so it is not unreasonable for an employer to make an inquiry as to when the injured worker will be released to return to any type of work and what type of work capabilities are likely.

Make sure the injured worker and their physician know that you have modified duty available?

Do not delay in communicating your intentions to bring an injured worker back to work.  From an injured worker's perspective, there is a great deal of uncertainty about their physical well-being, their financial stability and their future employment situation.  Reducing this uncertainty will help the injured worker focus on the recovery and return to normal activities, including work.  Physicians may not see the point in giving an injured worker a release to return to work if there is not modified work available. 

Are you unsure what type of work to offer?  There are several ways to identify meaningful, productive work.

We've all heard the stories of employers who bring injured workers back to count paperclips, separate nuts and bolts, or count cars in the parking lot.  What's the point?  How does that help anyone?  It damages the employer/employee relationship and makes an employer look unreasonable.

Instead, employers should review the injured worker's job description for less physically demanding tasks that fit within the injured worker's current or future restrictions.  Still can't find anything?  Look at other job descriptions or departments for work.  Before you dismiss this option, consider a few hours of cross training and what it could yield.  The benefits of training employees in various departments benefits everyone in the short term (as a modified duty solution) and in the long term.  Having skilled employees who are trained in various areas can go a long way to help reduce the time an injured worker is away from work and help your business. 

One of the most overlooked options is to ask the injured worker if they have any ideas.  Far too often decisions are made without involving the injured worker.  After all, they are the one who is going to push them to get better, to return to work, and to recover.  What are you doing to make sure your employees want to return to work?  Once you've identified return to work options, discuss the job with them and address any concerns up front.  Problems don't resolve on their own, they snowball.

If you have questions, find answers!

Rather than putting things off until someone contacts you, handle all workers' compensation issues proactively.  If you have questions about the job offer letter, call your claim representative.  If you are unsure if the work you’ve identified is suitable, check with the doctor.

There are few things in life that we can safely and confidently place on "auto-pilot."  Workers' compensation claims management is not one of them.  Put the time in up front and you'll be amazed at the outcomes.

You've hear of Undercover Boss, what about Undercover Injured Worker?

Most of us are probably familiar with the concept behind the show, "Undercover Boss."  The removed CEO or owner of a large corporation changes their identity and goes "undercover" working as a new hire that needs to learn the ropes of the less than glamorous positions in the company.  They're stripped of the everyday luxuries and live in a motel room, etc. to experience what their lowest paid employees make -- all in an attempt to understand what it's like to work for their company.  The show is usually very emotionally charged, and ends with the CEO having a revelation that changes need to be implemented, improvements need to be made, and sometimes they even shell out thousands of dollars to help an employee pay for overwhelming medical bills or something of the sort. 

I propose that employers go to work as an undercover injured worker.

Before you diminish the value of a safety measure, process improvement, or a return to work (RTW) program -- put on a pair of the proverbial "someone else's shoes" or work boots and see what the experience is like to have a workers' compensation claim.

I guarantee the experience will be eye-opening.  It will open your eyes first hand to a system that is riddled with challenges, confusion, complexity and bureaucracy -- a system that was designed to be a no-fault system to promptly provide benefits to any person injured on the job.  What does your accident investigation feel like?  How well does your injury reporting process work?  How does it treat injured workers?  How do our employees treat injured workers?  How does RTW impact the injured worker?

You'll learn how coworkers and supervisors treat you -- maybe with respect, maybe with pity, or maybe with anger or suspicion.  You'll learn what it's like to receive confusing forms in the mail, feel the uncertainty of whether or not you'll get a check in time to pay your bills, and realize that life does not stop simply because you got injured.  You may be limited in returning to work but your supervisor determines that there's "no light duty" in your company.  You'll feel the isolation and detachment within a few weeks of being out of work.  The attorney commercials will get old quickly; the resentment may build between you and your employer because you want to come back to work, but aren't being offered work.  You'll feel that people don't believe that you're really injured.  You might even see a weird car parked outside of your house that you soon discover is a surveillance company hired to see if you're doing anything outside of your restrictions. 

Now, in this scenario, you're not truly injured -- as an undercover injured worker, you're lucky that you don't have to go through the physical pain that results from an injury.  You won't have to worry about how you're going to button your own shirt, make yourself dinner, find a position to sleep comfortably because you can't use your arm due to a shoulder injury.  Fortunately, you won't have to feel how tiring and exhausting constant, throbbing pain can be and how it takes a toll on your ability to cope with stress.  Luckily, you also won't have to experience the strain that it puts on your relationship with your spouse and/or children now that you can't fulfill all of the requests you used to, cooking a meal, doing the laundry, driving the manual transmission car-- you won't have to experience what it's like to give up a good bit of independence nor will you realize how much that impacts your psychological state.

When someone has an injury, it doesn't stop at the physical level.  It impacts the injured worker from a financial, social, psychological and physical level.  It impacts their relationships, their confidence in their ability to provide for themselves or their family, and their place in this world.

Thankfully, I've never experienced a work injury.  How do I know to write about all of this stuff?  It's called empathy.  I took the time to imagine what it must be like to go through this process.  We all like to say that "if it were me in that position I'd do X, Y, and Z" but you never know until you've experienced it firsthand.

I encourage all employers who are in the position to make decisions related to the safety and well-being of their employees to take 10 minutes out of their day, at least once a month, to consider the "other side of the coin" when making a decision, not just the coins associated with implementing a change or offering modified duty.

Can we agree on one thing...? Variance between providers' RTW recommendations

In a 2010 study of healthcare providers’ agreement related to return to work (RTW) capabilities, researchers found some areas of consistency and some, well, not so consistent (Ikezawa, Battie, Beach & Gross, 2010).  The aim of the study was to determine if there are differences between providers as it relates to the information providers use to make RTW determinations, and what their RTW determinations were for three different case scenarios:  fracture, dislocation, and low back pain.  The survey focused on collecting three types of information.  Participants were asked to determine the following:  if the person was fit to return to work, assess the physical demands of their job, address any restrictions due to injury, determine the injured workers’ work capacity, and make any other recommendations if they were deemed unfit to work.  The second part of the survey focused on what type of information the participants used to make their decision, as well as commentary on what type of information would have improved their ability to make these determinations.  The final section of the survey focused on demographic information about the participants (specialty, gender, age, years of practice, etc.).

Inquiring minds want to know! 

The results indicate that 97% of the providers were in agreement with each other regarding the RTW readiness case of the fracture (p. 370).  This is likely due to fractures being of clear cut pathology.  Similarly, 94% of the providers agreed with each other related to RTW readiness for the dislocation scenario (p. 370).  For the low back pain case (a nurse who had back pain for eleven months), providers were basically split as to whether the injured worker should return to work or not – 55.6%.  Of note, however, with regards to the back pain case, 56% agreed that RTW with restrictions was appropriate; whereas 44% believed RTW full duty was appropriate. 

What did the providers rely upon to make these determinations?

Not surprisingly, experience and training will influence a provider’s recommendations.  In this study, researchers found the providers relying mostly upon physical examination, current functional status, and occupational status (pp. 370-371).  Providers stated that functional capacity exam (FCE) results, information on availability of modified duties, and patient participation in an occupational rehabilitation program would help improve their ability to accurately address RTW opportunities (p. 371).

Another interesting point made in this study is that only a small percentage of providers considered the sustainability of RTW, motivation to RTW, recovery expectations, and guarding movements.  Not until more recently are practitioners focusing on the biopsychosocial, or multi-dimensional, aspects of RTW.  These differences in approach will more than likely yield differing RTW recommendations and should be considered when evaluating a provider’s recommendations for RTW (p. 372).

 Regardless of their agreement, the majority of providers gave some type of RTW recommendation involving restrictions –so no matter their perspective (biomedical vs. biopsychosocial), we can expect some type of restrictions from an injury and prepare for them accordingly. 

 As noted above, the availability of modified duty was emphasized as being one of the factors providers are looking at when determining the injured worker’s release to RTW.  If you have modified duty, be sure that the providers are aware of it!  For those employers that utilized a panel of physicians or a providers list, send them copies of your modified duty jobs to keep on file in the event one of your employers visits there.  If that’s not the case, it would behoove you to provide the treating physician with a pre-injury job description and/or a modified duty job description to keep in the injured worker’s file.  The more informed provider will more than likely make a more accurate RTW recommendation.

References:

Ikezawa, Y., Battie, M. C., Beach, J., & Gross, D. (2010).  Do clinicians working within the same context make consistent return-to-work recommendations?.  Journal of Occupational Rehabilitation, 20, 367-377. doi:10.1007/s10926-010-9230-z

Upset About your Workers' Compensation costs? What are you going to do about it?

There's ample research and discussion about factors that may lead to delayed recovery or poorer outcomes for workers' compensation claims.  We're all really good at pointing the finger and saying that it's because of the doctor, the unmotivated injured worker, or the employer who just doesn't get it.  I'd like to ask one simple question to those who are frustrated or angry about workers' compensation outcomes.  What are you going to do about it?

In the extreme case, an employer could shut down the business, throw in the towel.  Highly unlikely.  Realistically there are several steps employers and other stakeholders can take to GET INVOLVED in their claim management programs.  Here's just a few of my favorite.

• Report all injuries as soon as possible.  It's fairly common knowledge that the sooner everyone knows about an injury, the sooner it can be managed.  This leads to the next important point.
• Get the injured worker prompt appropriate medical care.  Get them the best care a workers' compensation dollar can buy.  If you want the best outcome, why would you skimp here?  Who would you want to see if it were your injury -- the doctor who just processes injuries and prescribes anti-inflammatories, tells you to follow up with your family physician if not better in a week or the occupational health physician who understands how to approach work injuries, what is necessary to help you get better and back to work, and what the signs of trouble may be?  Do you want a physician who follows what massive amounts of research says provides the best outcome, or the doctor who disregards evidence-based medicine in exchange for their anecdotal, 30 year old medical school training.  I wouldn't want a mechanic who only worked on cars from the 1970s to work on my 21st century car that's basically a computer running on gasoline (or electric, for that matter).  Get your employees to the best providers who are on top of the most current medical practices, and follow evidence-based treatment guidelines.
• Reduce delays in care by getting treatment approved, appointments scheduled, and referrals made TIMELY.  The sooner we can help that injured worker get the care they need, the sooner everyone can learn what the true injury is, what the treatment plan will look like and assess the RTW opportunities.  Nurse case managers can help with this process.
• Communicate effectively!  Communication is often the cause and the solution to all problems in a claim.  Keep everyone in the loop -- find a way to do it. Maybe it's a list of everyone who you need to update, written down on a sheet of paper.  Maybe it's an email distribution list that you create for each employee's claim.  Whatever your strategy is, keep everyone up to date.  As the saying goes, communicate by a factor of 10, and then say it one more time.  This group includes the injured worker, the employee's supervisor, the claim representative, nurse case manager, medical providers, and whoever else may be involved in the claim.  Documentation will be key in communicating technical, detailed information.  One example of this is the injured worker's pre-injury job description.  Document it, send it around for review and approval (including the injured worker) and then send it to the treating physician, physical therapist, and nurse case manager.  After all, how can you plan to get an injured worker back to work if you don't know what they need to do?  Identify barriers to return to work early on and develop a plan to address them.

These suggestions are based upon evidence.  Researchers from the Department of Physiotherapy and the Department of Epidemiology and Preventative Medicine at Monash University in Melbourne, Australia conducted a study involving the aforementioned interventions.  The results?  In their study, their intervention reduced costs associated with RTW claims by 34% and cut the days away from work by 58% (Iles & Wyatt, 2013).

References:
Iles, R. A., & Wyatt, M. (2013). Applying the evidence: a real-world example of an intervention to reduce workers' compensation costs. Physical Therapy Reviews, 18(5), 395-402.

RTW in the Health Care Setting - it can be done

Identifying modified duty options is incredibly important for those employers in the health care industry.  According to the Bureau of Labor Statistics, in 2012, employees in health care support occupations lost time from work due to a workplace injury or illness more than 2 times more often than all other occupations reported (U.S. Bureau of Labor Statistics, 2014).  

Barriers to RTW in hospitals and health care settings

While the incidence rate alone is a challenge, the usual 24/7 operations of hospitals can also be a barrier.  Employers are concerned about patient safety and cite this as a reason for not returning nurses with restrictions.  One of the most frequent obstacles is how hospital employers budget and account for wages paid while an injured worker is working on restricted or transitional duty.
 
Opportunities for RTW in hospitals and health care settings
Every industry has its unique challenges.  Generally speaking, there are always options for modified duty if one looks hard enough and thinks outside the box.  Recently, the Office of Disability Employment Policy (U.S. Department of Labor) funded a study to “identify promising practices and success stories related to RTW efforts and outcomes in the health care industry” (p. vi, 2015).  The following is a high level summary of some of their findings.  You are encouraged to read the full report here.

Health care employers and subject matter experts relayed several “best practices” that may benefit other employers:

·         Communication and training regarding RTW

o   Ensure that management and supervisors fully understand RTW, its benefits, and best practices 

·         Working with physicians  

o   Provide doctors with RTW plans or RTW options for the injured worker they are treating

·         Consider the utilization of occupational health providers and/or vocational rehabilitation  providers to assist with RTW

·         Identify outside sources for transitional work if no work can be found in-house

·         Support the case for RTW with financial figures

·         Create a system that pays for the transitional duty/modified duty work that ensures accountability for to motivate managers

o   Return injured workers to their department

o   Reduce injury rates

o   Employers may want to consider excluding injured workers on modified duty from productivity rates/counts

Some other highlights of the article include suggestions regarding a modified duty/transitional duty job bank.  We’ve always recommended employers maintain a list of tasks that need to be done in the event they have an injured worker on modified duty but these suggestions take it a step further.

Creating and maintaining a “living” job bank

The participants in the interview reported that they train supervisors and managers to find and share any modified duty positions prior to posting them.  These are often short-term jobs that need to be filled.  The respondents also reported that they contact the central staffing unit when looking for potential RTW opportunities within the hospital.  When long term or permanent restrictions are likely, the employers work with the injured worker, and sometimes a vocational counselor, to identify interests of the injured worker and their knowledge, skills and abilities.  If the injured worker would like to work in a different position that suits his/her restrictions, but requires training, the employer works to implement that training or provides unpaid volunteering in a particular department to train and trial the injured worker in that role.  The focus is upon retaining current employees.

 
Here is a link to the report for your own reading pleasure. The report also highlights seven very interesting and creative RTW success stories.

References:

 

U.S. Bureau of Labor Statistics. (2014) Number, incidence rate, and median days away from work for nonfatal occupational injuries and illnesses involving days away from work by summary occupational groups and ownership.  Available at:  http://www.bls.gov/new.release/osh2.t03.htm.  Accessed May 14, 2015.

 

Denne, J., Kettner, G., and Ben-Shalom, Y. (March, 2015).  Return to Work in the health care sector:  Promising practices and success stories.  Washington, D.C.:  Mathematica Policy Research.  Retrieved from Mathematica Policy Research  at http://www.mathematica-mpr.com/~/media/publications/pdfs/disability/rtw_health_care_sector.pdf

Workers' Memorial Day - April 28, 2015

Tuesday, April 28th is Workers' Memorial Day.  On this date in 1971, OSHA was established.    Since 1970, workplace fatality rates have dropped by more than 66% with U.S. employment nearly doubling (www.osha.gov).  While statistics indicate improving trends, each year there are still thousands of people who go to work but don't return home at the end of the day.  According to the U.S. Department of labor, every two hours someone is killed on the job.

So, tomorrow, take a few moments to reflect or participate in a local event to honor those and their families who have experienced the loss of a loved one due to a workplace fatality.  Think about what your organization can do to ensure that each and every one of your employees returns to their families at the end of every day. 

 

 

This is also an excellent time to share the work of Kids' Chance.  Throughout the country, Kids’ Chance state organizations provide scholarship grants to children where a parent has been seriously or fatally injured in a work-related accident.  If you or someone you know is the child of a parent who was seriously or fatally injured, please visit www.kidschance.org to learn more about the scholarship opportunities available and the application process.

Returning Starfish to Wellness

“Once upon a time, there was a wise man who used to go to the ocean to do his writing. He had a habit of walking on the beach before he began his work.

One day, as he was walking along the shore, he looked down the beach and saw a human figure moving like a dancer. He smiled to himself at the thought of someone who would dance to the day, and so, he walked faster to catch up.

As he got closer, he noticed that the figure was that of a young man, and that what he was doing was not dancing at all. The young man was reaching down to the shore, picking up small objects, and throwing them into the ocean.

He came closer still and called out, "Good morning! May I ask what it is that you are doing?"

The young man paused, looked up, and replied, "Throwing starfish into the ocean."

"I must ask, then, why are you throwing starfish into the ocean?" asked the somewhat startled wise man.

To this, the young man replied, "The sun is up and the tide is going out. If I don't throw them in, they'll die."

Upon hearing this, the wise man commented, "But, young man, do you not realize that there are miles and miles of beach and there are starfish all along every mile? You can't possibly make a difference!"

At this, the young man bent down, picked up yet another starfish, and threw it into the ocean. As it met the water, he said, "It made a difference for that one.”
― Loren Eiseley


In an industry riddled with challenges, competing interests and seemingly endless uphill battles, we should always remember "the starfish story."  As insurance professionals, we are given the opportunity to apply our expertise and experience to  positively influence the lives of others-- to help an employer retain an employee despite their work restrictions, to help an injured worker return to wellness through productive, meaningful work, to prevent injuries from occurring.  We have the knowledge and skills to help guide our insured employers and their injured workers through the workers' compensation system.  A system that is rife with black holes -- one in which an injured worker can, far too easily, slip through the cracks.  We can't convince every employer to offer modified duty work, nor can we convince every injured worker to take the steps to get off of their narcotic pain medications, nor prevent every injury from happening, but we can help in this case...and the next one...and the next one...

It may not always feel like it, but everyday we are presented with a unique opportunity to make a difference in our employers' worlds, our injured workers' worlds, and our own.  What we do on a day to day basis may prevent us from seeing the impact we can have on the lives of thousands of injured workers and employers each year.  Within the confines of our system, we can have a positive impact and successfully fulfill our promise to deliver a better outcome. 

There will always be another starfish to toss back into the water, and with each one we have the responsibility to help them get back into the ocean.

It's a good thing Punxsutawney Phil isn't a doctor...

Punxsutawney Phil has prognosticated that there will be six more weeks of winter.  Apparently, this is not just a Pennsylvania thing -- we must give a shout out to Birmingham Bill in Alabama, who apparently this year has deferred his recommendation to Phil.

You're probably wondering where we're going with this.  This annual tradition is not unlike the course of a workers' compensation claim -- hear me out.

An injured worker and their employer are often left to wait and see what the doctor says at the next appointment.  We're left waiting to learn if the injured worker will be out of work for another six weeks or if they will be release to modified duty.

Sometimes, as in the case of Birmingham Bill, the doctor defers the disability determination to another physician (enter Punxsutawney Phil).  This can lead to more frustration for the injured worker and employer who simply want to know what is going to happen next. 

Sometimes attorneys get involved (as evidenced in the Washington Post article I referenced earlier).
This can cause additional delays and confusion if all parties are not on the same page.

Alas, the injured worker is left to sit at home and watch re-runs of Groundhog Day. Not that Bill Murray isn't entertaining, but like the movie depicts -- the same old, day in, day out routine can wear on a person.

Aside from getting someone else to press the "snooze button," there are some simple things employers and injured workers can do to avoid the repetitiveness and delay associated with the quest for a release to return to work (restricted or otherwise).

• Provide a modified and pre-injury job description or list of tasks at the first doctors visit.
• Clarify early on who will be addressing the injured worker's ability to return to work (the surgeon or the treating physician?)
• Request treatment and recovery projections at each office visit.  Additionally, clarify some of the things that may delay recovery so that everyone can plan accordingly.
• Communicate the availability of modified work often!  Don't leave it up to the doctor's office to remember that you're an employer who can offer modified duty restrictions.
• If the delays seem unreasonable, consider obtaining a second opinion (if that option is available).  Like Birmingham Bill, sometimes you must consult with another colleague.

More tips to ensure your RTW program is worth more than the paper on which it's written

Last week we wrote a post about ways to measure the effectiveness of your return to work (RTW) program.  As you may recall, the prior week's post gave some tips to measure the effectiveness of a newly implemented RTW program.

Let's discuss the more mature RTW program.
For employers who have had more experience with modified duty and lost time claims, the methods to evaluate the effectiveness mentioned in the prior post will also apply.  If you're looking for more targeted or "next level" metrics, there are some simple ways to accomplish this.

• The window of opportunity to positively impact the outcome of a workers' compensation claim is very short and it begins closing the day the injured worker is taken out of work. Employers must create a sense of urgency with regards to RTW.  Most of our insured employers feel that they are "pretty good" "in most cases" at identifying modified duty.  Assuming this is how you perceive your company, and this judgment is factually substantiated, you may want to start measuring the days until a RTW opportunity is found/offered.  Measure the days that pass between the time the claim representative or injured worker provided a RTW note and the date they received an offer to RTW.  Employers can be even more aggressive in their standards and measure from the actual date the injured worker was released to modified duty until the day they returned.  This would assume that the expectation is for any release to modified duty to be reported to the employer as soon as possible, likely by the injured worker.  These "lag time" days are wasted days of productive, meaningful work -- and days where temporary total disability are unnecessarily being paid.  Setting a goal and starting the clock will create that sense of urgency that is essential in an effective RTW program, and give you something to measure against.
• If you're an employer who really wants to challenge themselves, take a look at the Occupational Disability Guidelines (ODG) return to work recommendations. These are evidence-based guidelines for expected RTW targets based on diagnosis and categories of work (light, heavy, very heavy, etc.).  Holding your RTW outcomes to these standards gives you a benchmark to measure against.  Obviously there are going to be scenarios that don't comport to a set of guidelines, but it gives you an opportunity to look at a benchmark and investigate what the deviation stemmed from -- was it due to complications with treatment, or lack of a modified duty offer?  Another benefit of using guidelines is that it gives realistic projections for various timeframes of when an injured worker reaches different levels of work.  The guidelines also consider certain comorbidities (things that will impact recovery times).  Here's an example:
• ODG Treatment and Return to Wellness guidelines: 724.2  Lumbago
• Severe, manual work:  14-17 days
• Severe, heavy manual work:  35 days
• Obesity comorbidity (BMI >= 30), multiply by 1.31
• Because this particular injured worker was considered obese, ODG projects their recovery time to take about 31% longer than an injured worker who has a BMI of 29 or lower.

While it is sometime difficult to measure results, it's best to measure something -- and be sure to do it consistently.  Put some thought into what your goals are and how you're going to measure them.  Communicate these goals (repeatedly -- we mean it, every chance you get!) and share your progress.  The gold standard would be to find a way to make managers/supervisors accountable for their results.  As "they" say, you manage what you measure.

Tips to ensure your RTW program is worth more than the paper on which it's written

A recent survey found that 90% of healthcare employers had a RTW program, but only 65% actually had metrics in place to monitor its effectiveness.  What's the point of putting something in to place if you have no way of knowing how it's working?

This is a common occurrence -- safety committees that are created to obtain a premium discount, a customer satisfaction survey conducted so that companies can say that they did it, or a declaration that a company is going to implement a wellness program to say that they're a healthy workplace.  These are all great things to talk about, but if you don't measure and monitor your results, what's the point?  You may have a safety committee, but if they don't perform or impact safety in the workplace, other employees will see it as a waste or worse yet, not take their recommendations seriously.  This can sometimes have a more harmful effect than not having one at all.  Any wise employer would prefer a highly performing, informal return to work program over a formalized, ineffective program any day.  Results are what matter.

'Tis the season for resolutions to lose weight, eat better, save more money, etc.   If you're trying to lose weight, you're probably weighing yourself at frequent intervals to track your progress and monitor the need for modifications to your routine.  If you're trying to save money, you've probably gotten into the habit of shaking your piggy bank to verify it's heft on a regular basis.  The old adage is, "you manage what you measure."  Why should RTW programs be treated differently?

Your company went through the efforts of putting together a RTW program, so why not measure its progress and make it as effective as it can be?  If you're not measuring your RTW results, then your program is worth about as much as the paper on which it's printed.

As with any goal, you have to decide what a realistic, measureable goal is.  Here are some tips on how to set realistic goals with respect to your shiny new RTW program.

For the fledgling RTW program:
You may need some data to timely demonstrate your program's return on investment.  Money is probably the biggest pressure point.  You can track this in a few ways. 

• Obtain a copy of your loss runs for the prior year.  Record how many lost time claims you had and how much was paid in indemnity (wage loss) benefits per claim.  Your target may be to reduce average indemnity payments per claim by 10%, or something along those lines. 
• Look at the frequency of RTW offers being made compared to the claims where no modified duty was offered. Separate the offers by modified duty offers and full duty RTW offers.  This is a good measure of the success or comprehensiveness of your program.  Sometimes your missed opportunities (and related costs) are more impactful than demonstrating savings, particularly if your program is very new and successes are rare.
• If your program is still getting off the ground, look for very basic areas of opportunity. Is someone at your company following up with the injured worker on a regular basis to check in and discuss potential modified duty options? What is the lag time between the injured worker getting restrictions and the employer finding work? 

Stay tuned for the next post with more tips on how to measure your RTW program's effectiveness.

Injured Workers asking to RTW likely as a Blue Moon?

When an injured worker is out of work for a period of time, more often than not the reason is inaccurately attributed to the injured worker's motives.  They don't want to work.  It's easier to sit at home and "collect a check."  They could work, but they're not.  Please realize this is not always the case.  I've seen injured workers' calls to discuss return to work go unanswered by their employers.  The injured worker may call to update them on the work abilities, or just touch base with them regarding their recovery.

So, what happens when an injured worker doesn't get a call back?

It's no mystery...think about how you would feel.  You'd probably ask yourself some or all of these questions:  Do I have a job to return to?  Did I do something wrong?  Don't they believe that my injury is real?  What happens if I lose my job?  How am I going to pay my bills?  Why won't they even talk to me?

Do these questions sound familiar?

They should, thanks to the ubiquitous attorney commercials.  They promise to answer these questions (along with getting the injured worker the money THEY deserve, which may or may not include atypical financial results). 

This post isn't about how to prevent injured workers from getting attorneys...it's about helping employers understand that returning an injured worker's call (particularly one who is asking to return to work) is extremely important.  Do it not to avoid attorney involvement, but because it's the right thing to do.  Even if you don't have work available, having a discussion with the injured worker about their restrictions and what they think they can do could result in you identifying some options. 

Employers have reputations to maintain that directly impacts the quality and quantity of people who want to work for them.  I'm sure you could name a few places in town that don't treat their employees the greatest and you may have even silently sworn to never work there. 

When someone wants to return to work, the very least you can do is return the call.  You never know how much it may pay off in the end.

I'd be remiss if somehow I didn't tie this post to the New Year.  Make 2015 a year to implement the Golden Rule -- at the very least, when you have an injured worker who wants to return -- after all, lore has it that this only happens once in a blue moon.  (If you read this, you'll learn that blue moons, too, aren't all that rare).