Vocational Rehabilitation: Who has the best outcomes and why it matters

When an injured worker receives permanent restrictions that prevents them from returning to his/her pre-injury position a few things may happen.  The employer may modify the injured worker's pre-injury job to accommodate the restrictions.  The employer may offer the injured worker a different position within the organization.  Unfortunately, sometimes an employer is either unable or refuses to do so and the injured worker is without a job to return to.  While many of us would say, well I'd just go out and find another job.  As research has shown, if you're a married male, younger than 50 years in age, who has a solid education, not attorney represented for your claim, and who participates in a vocational rehabilitation program -- yes, you most likely will (Blackwell, Leierer, Haupt & Kampitsi, 2003).  That's because individuals who fit this demographic profile have been found to have the best return to work outcomes after a claim.  That is not to say that other injured workers won't benefit from vocational rehabilitation services such as retraining or on-the-job-training.  Generally speaking, the more transferrable skills and individual possesses, the more likely they are to find work in another setting.  A lower education level and being over the age of 50 may limit an individual in their job search.

It also makes sense that the less "employable" an injured worker is, the more it increases the exposure of the claim -- thereby increasing the value of the claim. The goal of any vocational rehabilitation plan is to assess an injured worker's employment history, transferrable skills, education, and provide services (re-training, job search tools) to identify employment opportunities.  The more dismal the re-employment picture is, the greater the challenge it is to return the injured worker to gainful employment.

Employers can take steps to avoid this process by identifying employment opportunities within their company, looking at potential modifications (see our post on AskJAN.org) or any cross-training opportunities within their organization.  When you can control or influence the outcome, your results will usually be better than when you let an injured worker's future be subject to the employment market.

Employers who have injured workers that are given permanent restrictions should think long and hard about providing modified duty, on a permanent basis to their injured workers.  It is not a decision to be taken lightly.  An unrestricted person may have a difficult time finding work, let alone adding in physical restrictions and a period of unemployment due to a work injury. 

References:  Blackwell, T. L., Leierer, S. J., Haupt, S. & Kampitsis, A. (2003).  Predictors of vocational rehabilitation return-to-work outcomes in workers' compensation. Rehabilitation Counseling Bulletin, 46(2), 108.

Concurrent employment conundrum: Return to Work for those who work more than one job

Some states provide benefits for concurrent employment if the injured worker is unable to work one or both (or more, I suppose) of their pre-injury jobs.  The workers' compensation policy covering the injury pays for the lost wages the injured worker sustains due to the work injury, which includes wages lost at another job.

Here's the scenario:

Steve works for No Leaks Plumbing as a plumber.  He also works part time as a bartender at Ps and Qs,Pub on the weekends.  While Steve is working to loosen a pipe under a sink at a customer's home (working for No Leaks Plumbing), he injures his right shoulder.  After going for treatment, he is given one-handed restrictions.  The good news is, No Leaks Plumbing is insured with Eastern Alliance and has a solid return to wellness program.  No Leaks Plumbing can bring Steve back the following day to work within his restrictions.  Unfortunately, Ps and Qs Pub cannot. 

What's the big deal, right?

Well, if the state that Steve files a claim in considers concurrent employment wages as part of the claim, then it can have implications for No Leaks Plumbing.

When calculating the compensation Steve is due as part of his injury, the claim representative would obtain wage information from No Leaks Plumbing and Ps and Qs Pub.  These wages would be combined to determine Steve's pre-injury average weekly wage (AWW).  Based upon the AWW, Steve's compensation rate, or temporary total disability rate, would be roughly 66 2/3% of the average weekly wage.

Let's say Steve makes $1000 per week at No Leaks.  He makes $200 working at Ps and Qs Pub.  One may think that since Steve is working for No Leaks without a loss of earnings, his wages from Ps and Qs Pub wouldn't matter. That is incorrect.

Steve's AWW would be $1200.  If Steve is able to earn his pre-injury hours, earning his pre-injury wages on modified duty, the compensation carrier would still owe Steve 2/3s of the difference between his post-injury earnings and his pre-injury average weekly wage.  In this example, it would be $1200 (AWW) - $1000 (wages working modified duty) = $200.  66 2/3% of $200 = $133.33.  Steve would receive a paycheck from No Leaks, and a temporary partial disability (TPD) check for a percentage of his lost wages from Ps and Qs Pub, in the amount of $133.33.

This puts No Leaks in a difficult position.  They support modified duty but Ps and Qs Pub does not.  The claim representative can attempt to work with Ps and Qs to bring the injured worker back to modified duty, but the pub really has no reason to, other than to have an employee performing some type of work. 

Keep in mind, as long as an injured worker's earning capacity is reduced, due to the work injury, then there is likely going to be benefits due to that worker.

What can be done in this situation?

• The claim representative can encourage the injured worker to discuss modified duty with their concurrent employer
• Obtain a job description from the other employer to help the treating physician determine what the injured worker can safely do at the pub.
• The primary employer (No Leaks) could consider placing the injured worker at a local not-for-profit organization through transitional duty to reduce exposure under the claim, rather than simply paying the injured worker their pre-injury wages.
• If all attempts fail to bring the injured worker back to work at the other employer, the primary employer (No Leaks) may be forced to cover the secondary employer's wages until the injured worker is recovered to perform the work at the pub.

Concurrent employment creates a unique challenge for employers and insurance carriers.  An effective RTW program can help control workers' compensation costs, and can help employers control the aspects of their claims that are within their control.  Sharing expertise and experience with the secondary employer may help them understand why it is a good idea to bring an injured worker back to modified duty.

You've heard of early RTW, but what about late RTW?

So much of what we hear about return to work focuses on early return to work. The majority of injured workers receive medical care, return to modified duty and then eventually their pre-injury jobs. But there's also a group of injured workers who receive medical care, and are given restrictions that are ultimately deemed permanent.  The injuries are typically more severe, or require more than conservative treatment.  Eventually, disability persists so long that we lose focus on return to work as a treatment goal. As Sullivan and Hyman (p. 1, 2014) put it,

     "Evidence-based clinical guidelines emphasize early return-to-work as a critical          
     treatment objective in the management of recent onset pain conditions.  However, 
     something changes when a pain condition becomes chronic.  For chronic pain        
     conditions, return-to-work is rarely put forward as a primary treatment objective.  
     Consequently, successful return to work is rarely an outcome in the treatment of chronic 
     pain conditions."

In their editorial, the authors emphasize the importance of remaining active in ALL phases of recovery, even after an individual's pain becomes "chronic."  If all the treatment that is provided (primarily prescription pain medications) does nothing to improve the individual's level of function, then they aren't really working, are they?  One can argue that pain medication alleviates the individual's pain, but if that doesn't result in an increase in function, is it worth it?  Why aren't we focusing on function?

There's also an assumption that individuals with chronic pain cannot work.  The authors cite a study in which 40% of chronic pain patients who underwent a return-to-work intervention program were successful in their return to work.  If you don't think it is an option, you will never look for information to prove yourself wrong.  Employers who adamantly proclaim that they don't have modified duty will not then go look for modified duty options.  Injured workers who believe that they will never return to work will most likely not look for opportunities to go back to work. 

"Beliefs are the roadmaps of behavior" (p. 2, 2014).  We must keep return to work on the table.  When I say "we," I mean insurance professionals, case managers, medical providers, employers, and injured workers.  The return to work may not be a pre-injury position, but there is work out there for those who want it.  Take workers' compensation, or any other type of benefits, out of the equation, and focus on the individual.  This is their life, for the rest of their life, not just until their benefits expire or their claims settle.  What are "we" doing to provide the best outcome and what are we doing to return them to wellness via return to work?  Can we really expect an injured worker to stay motivated if their physician has thrown in the RTW towel?

To read the editorial, click here.

References:
Sullivan, M. J. L., Hyman, M. H. (2014).  Return to work as a treatment objective for patients with chronic pain?  Journal of Pain Relief, 3(1).  doi:  10.4172/2167-0846.1000130 







Why employers should support employees before and after a work injury

When employees are treated fairly, they are more likely to have a stronger commitment to their workplace.  When employees feel they are not being treated fairly, they will be less motivated to return to work or put in extra effort to overcome even minor obstacles. 

In a 2006 study of social support as a factor in the return-to-work process, researchers found that social support was reported as a key contributor to a successful work re-integration (Lysaght & Larmour-Trode).  The authors of this study found that the so-called "soft" aspects of the RTW process were relevant to RTW and important to injured workers and supervisors alike. 

Relationships, in and out of the workplace, help us deal with stress.  When you have a work issue, you may confide in someone outside of work, or maybe a co-worker who understands the situation.  When you have an issue at home, a co-worker can be an objective third party to help make sense of things.  These forms of social support also apply to work-related injuries and the RTW process. 

Previous research has identified four sources of support in the workplace (p. 256):

• Informational:  information, suggestions, recommendations

In the RTW context, injured workers need information about how to complete paperwork, what the RTW process involves, as well as advice on what they can and cannot safely do within their work limitations.  While it would appear some that the onus to obtain this information is on the injured worker, supervisors or other parties, can assist injured workers by providing them with information or assisting them with obtaining that information.  Sometimes it just takes a simple conversation to alleviate mounting concerns.

• Instrumental:  compensation/wages, hours, work

Employers can provide instrumental support by providing ergonomic assessments, modifications of job duties, or work schedule accommodations.  Any step that an employer can take to increase an injured worker's sense of autonomy and contribution will aid in their re-integration into the workplace.  Meaningful work duties with a clear business purpose are ideal options for RTW.

• Emotional:  listening, genuine concern and caring about employees

Employees want to know that their employer genuinely cares.  The aforementioned study found that co-worker support was also repeatedly mentioned by the interviewees.  Some reported their coworkers worked to assist them, asked how they were doing, and included them in social activities outside of work before they returned to modified duty.  Others recalled negative experiences of co-workers making hostile comments, or ignoring the injured worker.  Management has a key role to play in addressing negative treatment of co-workers who return to modified duty after a work injury.

• Appraisal:  feedback regarding performance, social comparisons

While this can be a delicate topic, it's important for supervisors to understand an injured worker's need for feedback once they return to work.  This allows for open communication about the injured worker's recovery, the appropriateness of the duties assigned to them, and their overall experience back at work.  Treating employees fairly, whether on restrictions or not is key and should not be overlooked.

An employer's relationship with their employees should provide support in these four areas before an injury occurs.  Work to strengthen these relationships today and it will undoubtedly help when you are working with an injured worker on modified duty.

Source:  Lysaught, R. M., & Larmour-Trode, S. (2006).  An exploration of social support as a factor in the return-to-work process.  Work, 30, 255-266. 

Upcoming Blair County (PA) Chamber of Commerce Event: Developing RTW Programs 3/21/14

This Friday, March 21st Eastern Alliance Insurance Group's RTW Specialist, Sarah Tayts, will be a co-panelist at the Blair County Chamber of Commerce's March Safety Meeting.

The panel will be discussing the development of RTW programs and how employers can successfully gain support for RTW in their organization.  

If you're interested in attending, click here to register for the event.  You can also visit the Chamber's website at www.blairchamber.com

When:              3/21/14 7:30-10 am

Where:            Hampton Inn

180 Charlotte Drive
Altoona, PA 16601

Cost:               $15 – Chamber Members
                        $30 – Non members