What can you do to control rising medical costs in Workers’ Compensation claims? Bring your injured employees back to work.

Recently, the National Council on Compensation Insurance, Inc. (NCCI), reported on some of the trends impacting workers’ compensation across various states.  Some of the items the report covers include employment growth, information on the construction industry, and medical inflation (rising medical costs).

The workers’ compensation industry has a tendency to separate indemnity (wage) and medical costs.  Nothing exists in a vacuum, certainly not in workers’ compensation claims. 

Maybe you think I’ve oversold you with the title of this blog post. Consider the following questions.

What happens when an injured worker is injured and their employer cannot return them to work?

·     They are left to sit at home in their recovery.  Anyone who has spent time at home for a period exceeding one work week as the result of a medical issue or surgery can attest to the impact that being out of work has on you.  You may start to wonder what your co-workers are up to.  Maybe you try to stay connected by checking in or reading some emails from home, but it’s not the same.  You don’t have the context and the opportunity to ask questions – getting second hand information about the goings on at work can actually make you feel even more isolated.

·     The injured worker may begin to question if they’ll ever be able to get back to work.  What will happen if they have permanent restrictions?  Like reading hotel rating reviews, our minds tend to go to the most negative example possible.  The story of the neighbor who had to file bankruptcy because he lost his job after his work injury.  They’ve probably memorized the phone numbers for the attorneys who promise to get them huge sums of money.

·     The injured worker may become deconditioned from lack of activity.  If you’re a mason who’s used to lifting block every day for the past 15 years and now you haven’t lifted anything more than five pounds since your injury, you may have lost some of your strength and stamina.

 

What do these consequences have to do with medical inflation?

·     Isolation may have negative consequences on an injured worker’s motivation to get better.  It may also deplete their ability to cope with the aspects of managing their claim and their recovery.  For those of us who need people around us to support us, to guide us and to motivate us – when you take that away it can leave one feeling alone and without the wherewithal to get up and push through challenging physical therapy sessions or perform the home exercises that help in recuperation.

·     They may have an increased need for prescription pain medications or other medications.  These prescriptions may have negative side effects (and may require additional medications to treat the side effects).

·     Deconditioning may require additional physical therapy or work hardening.  It may also lead a physician to extend the time period between improved work status notes, resulting in increased office visits for progress checks.

Prudent, proactive employers should focus on preventing injuries in the first place.  But, when injuries do occur, a plan that focuses on the whole person (employee) and their return to wellness should be ready to go. 

 

What steps are you taking to prevent future injuries like this from happening? 

What are you doing to communicate regularly with the injured worker while they are totally disabled?

What are you able to offer based on what the anticipated restrictions? 

Are there other concerns that the injured worker has about their employment or benefits?  Address the concerns and to reassure your employees that you will work together reach the best possible outcome for them in their recovery. 

 

It’s never too early to have these discussions.  Start today.

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