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.