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.

What happens after RTW?

If you’ve been following this blog, you’ll realize many of our posts focus on the process of identifying modified duty, the benefits of RTW, and developing RTW programs.  Getting someone back to work is important, but it doesn’t stop at the RTW date.  It’s a phase of the return to wellness process that must be managed.

What happens after an injured worker returns to work?
I’m sure one could find bits and pieces of answers to this question in books, and there are plenty of scholarly journal articles on this topic, trust me.  Personal experience will teach employers the most in this regard.  Not the answer you were looking for?  What follows is an attempt to summarize the most frequently learned lessons.

Communicate the return to work date to your claim representative immediately!
There simply aren’t enough font embellishments with which one can emphasize this point!  Prompt communication of the injured worker’s return to work will prevent plenty a problem:  over payments, taking credits against future benefits, getting the appropriate forms filed with the state’s workers’ compensation authority…  It’s also a great feeling for the claim representative to know that we’re returning someone to modified duty.  So it not for any other reason, notify your claim representative to provide them with the good news.

Medical treatment
Just because an injured worker returns to modified duty, doesn’t mean that they are no longer entitled to medical benefits.  This is a concern of injured workers when they contemplate RTW.  Returning to modified duty is part of an injured worker’s recovery.  As one person put it, you don’t get better and go back to work, you go back to work to get better.  It is common for an injured worker to continue physical therapy or use of prescription medications after RTW.

Employers should encourage injured workers to schedule their physical therapy and doctor’s appointments outside of the work day.  Check with your claim representative, as it depends on the state and the type of appointment (IME, etc.).  It may also be a good idea to locate a physical therapy location that is on the injured worker’s way home.

Wages
What happens if the injured worker receives less in wages than they previously earned?  As with all answers to WC claim questions…it depends.  In most states, there are temporary partial disability benefits.  These are paid as a percentage of the difference, or gap, in post-injury wages compared to pre-injury wages (calculated as the average weekly wage – AWW).  These percentages range from 50% to 90%. 

Employers process their payroll as usual and if the injured worker’s weekly earnings are less than the pre-injury average weekly wage, they should submit the payroll records to their claim representative who will review and process any TPD benefits due to the injured worker.  So, the injured worker will receive a paycheck for hours worked, and a TPD check for a percentage of the gap. 

What if the injured worker is disruptive or violates company policies?

What employers need to know about DE House Bill 175

On June 27, 2013, DE Governor Jack Markell signed House Bill 175 into law, amending Titles 18 and 19 of the DE code.

Employers and insurance carriers have an increased responsibility to ensure they are communicating available modified duties to the injured worker's physician.  While the Employer's Report of Available Modified duty is not a new form, the recent changes now provide an incentive for employers to make sure these forms are being sent for each claim where temporary total disability (TTD) benefits are being paid under an Agreement As To Compensation-- an employer's eligibility for a Safety Credit requires that the they are compliant with these "back to work" procedures.  According to the bill, as of September 1, 2013, safety inspections will now include a review of the employer's compliance with these procedures, dating back to July 1, 2013.  Please review 2379(4) regarding the workplace safety credit changes.

According to 2322E.(d) of the Delaware Code, employers should provide their injured workers' physician with a completed Employer's Modified Duty Availability Report within 14 days in addition to their insurance carrier.  So, send a completed copy of this form to the doctor and to your claim representative, and do so timely. 

Having a modified duty job bank may assist employers in identifying modified duty options for their injured workers.  Utilizing our modified duty task lists forms (found at eains.com/ecovery under the ecovery Library) may be a good first step in coming up with modified duty ideas. 

Place a completed copy of the Employer's Modified Duty Availability Report form in the injured worker's WC claim file for your safety credit inspection.  Consider dating when it was sent and to whom, or include a copy of a cover letter if you use one.  According to the code, the workplace safety credit inspections will review up to three years' worth of history. 

Nothing in this post is to be construed as legal advice or risk management advice.  If you have specific questions regarding these changes, please contact your counsel or the Office of Workers' Compensation, or the Insurance Department's Consumer Services agency at 302-674-7300.

Rx meds putting a kink in RTW plans? Read this...

Hank is a material handler who sustains a compensable work-related injury.  As part of his treatment, his physician prescribes prescription pain medication, particularly a narcotic pain medication, such as Oxycontin.  Hank's treating physician also releases him to return to modified duty, with restrictions of no lifting greater than 10 lbs., can drive a vehicle, but no heavy equipment or tow motor. Fortunately for Hank, his employer has a modified duty program and is interested in bring him back to work --- but there's one problem.  His employer has concerns about Hank's ability to perform the modified duty job they have for him.  They were hoping to have Hank perform light courier work between plants, but they don't want him "all drugged up while operating a company vehicle."

These are legitimate concerns. Many employers find themselves in this same predicament:  there is a release to return to work, but the injured worker is on heavy pain medications which may create additional liabilities for the employer.  What's an employer to do?

Communication is key

If there is a nurse or medical case manager assisting with this claim, send him or her a list of the modified duties, or a modified duty job analysis form, to discuss with the physician.  Often times having something to demonstrate the availability of modified duty will help facilitate a RTW, but can also encourage the physician to prescribe medication that will not impeded an injured worker's ability to operate a vehicle, etc.  Perhaps they can provide some alternative medication for the injured worker to take during working hours.  If it is an injured worker who has been on heavy pain medications beyond the recommended time frames, it may also give the physician another basis to adjust the patient's pain regimen.

Understand the risks

Not all medications will prevent an injured worker from driving, just not all dosages will have the same impact on each individual.  Unfortunately there is no magic screening to determine how each individual will react to a particular dosage.