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.