Vocational rehabilitation and working with a Qualified Rehabilitation Consultation (QRC) can reduce workers’ compensation costs and get an injured employee back to work in a timely manner.  Problems can arise when the QRC starts acting like an advocate for the injured employee.  Members of the claim management team and other interested stakeholders need to be on the look-out for QRCs gone wild – and ensure they are working for the rehabilitation plan, and not the employee.

What are QRCs?

QRCs are trained vocational rehabilitation consultants than assist employees in post-injury return-to-work and medical management activities.  Requirements for QRC registration are typically governed by administrative rules established by an industrial commission.  They are appointed following a work injury where the employee’s injury is severe enough to require extended time off work.  They should have a solid medical background, and understanding of the labor market and empowering employees to return to suitable gainful employment.

Acting in the Best Interests of the Rehabilitation Plan

QRCs will meet with an injured employee at appointed times set forth in statute or rule and determine the vocational goals.  This includes an assessment of various factors, which can include:

• The nature and extent of the employee’s injury;

• Restrictions and other limitations placed on the employee post-injury;

• Transferable job skills and ability of the employee to return to work;

• Ability of the date of injury employer in returning the employee to work, including in a light-duty capacity.

QRCs are required to be neutral parties and not an advocate for the employee.  The best interests of all parties need to be carefully balanced and taken into consideration.

Qualified Rehab Consultant Misconduct

QRC misconduct is defined by statute or rule in each jurisdiction.  There are general principles that govern the conduct of a QRC.  Proactive members of the claim management team need to be on the look-out for these factors and take appropriate action against a QRC that steps outside their role.

• Failure to perform rehabilitation services with reasonable skill because of negligence, habits, or other cause. This can include a number of different factors and behaviors.  It can be something as basic as missing meetings or appointments, and consistently not returning telephone calls in a timely manner.  It can also include failing to properly supervise QRC interns and support staff;

• Engaging in conduct that is likely to deceive, defraud, or harm the public;

• Fraudulent billing practices, or failing to properly bill for vocational rehabilitation services; and

• Engaging in adversarial communication or activity. This can include behaviors such as offering opinions on the facts of the case, litigation strategy, requesting information not related to the rehabilitation plan, failing to report all relevant information, and not complying with authorized requests for information.

QRCs need to take their responsibilities seriously.  Let the attorneys advocate for their client(s).

Removing a QRC From the Rehabilitation Plan

Each jurisdiction has the mechanisms and standards for removing a QRC from the rehabilitation plan and installing a difference vocational assistant.  Most states look at the “best interests of the parties” when making such changes.  Factors for consideration include the following:

• Loss of trust of the QRC. Claim handlers making this argument should provide concrete evidence on how the QRC has “picked sides” in a dispute – become an advocate for the inquired employee;

• Duplicative time and costs that may be incurred as the result of the removal/change in QRC. This is an argument that can be made when the claim management team opposes the change in QRC;

• Reputation and years of experience and complexity of assignments by the individual; and

• Geographic location of the QRC. In some instances, one QRC may be better than another if the employee relocates.

Conclusions

QRCs play an essential role in vocational rehabilitation and getting an injured employee back to work.  Claim handlers need to be diligent in making sure the QRC is doing their job and being an advocate for the rehabilitation plan, and not a party.  Failure to do so will result in an employee being off work for a longer time, and more money spent on vocational rehabilitation costs.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

©2019 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Vocational rehabilitation is an essential workers’ compensation benefit for employees suffering from the effects of a work injury.  It not only helps the employee understand their medical care and treatment, but provides them with assistance in getting back to work.  This reduces the money spent on a workers’ compensation claim and improves program efficiency.  Members of the claim management team need to examine their files to ensure this benefit is being provided in a responsible manner.  When there is no longer a benefit to the employee, steps must be taken to discontinue services.

When is Vocational Rehabilitation Appropriate?

Vocational rehabilitation services are provided to employees who are qualified under a workers’ compensation law.  This is a benefit that did not come into acceptance in most jurisdictions until the 1970s.  It is generally not available to an employee unless they have been off work for an extended period of time.

In order to qualify, a consultation is usually performed by a Qualified Rehabilitation Consultant (QRC), and a recommendation is made regarding the employee’s status.  Factors generally considered include:

• Whether the employee is permanently precluded or is likely to be permanently precluded from engaging in their usual and customary occupation or from engaging in their pre-injury job;

• Whether the employee is reasonably expected to return to suitable gainful employment with the date of injury employer; and

• Whether the employee can reasonably be expected to return to suitable gainful employment through vocational rehabilitation services by taking into consideration the treating physician’s opinion regarding the employee’s ability to work.

Vocational Rehabilitation is Being Provided – Now What?

During vocational rehabilitation, the QRC will issue regular progress reports.  It is essential that the claim handler monitors vocational rehabilitation once it has been approved.  These reports outline the services being provided and the progress the employee is making in recovering from the work injury.  Important issues to consider when reviewing periodic reports are as follows:

• New or continuing physical limitation that significantly interferes with the completion of the rehabilitation plan;

• Whether the employee is participating fully with the plan; and

• Whether the goals of the plan should change, or be modified.

Steps should be taken to termination vocational rehabilitation services if it appears the employee will not benefit from ongoing assistance from the QRC.

Do Not Pass Go: Shutting Down Vocational Rehabilitation Services

Each jurisdiction has the prescribed method one must follow in order to terminate the rehabilitation plan, and discontinue ongoing services from the QRC.  While the process may differ, there are general requirements that are considered when putting an end to vocational rehabilitation serves.

• A new or ongoing physical disability that significantly interferes with the completion of the rehabilitation plan. This is sometimes the case when the employee has a significant setback in their medical care or new injury or disability that is not related to their work injury;

• The employee is not cooperating with the vocational rehabilitation being provided by the employee. Common examples include missing medical and physical therapy appointments, or failing to keep in contact with the employer and/or QRC; and

• The employee is not participating effectively in the implementation of the rehabilitation plan.

The focus of the arguments made to terminate ongoing vocational rehabilitation services is whether the employee would benefit from additional vocational rehabilitation assistance.  The party seeking to cease these services has the ultimate burden of proof.  Grounds for stopping these services that are absolute usually include:

• An employee who has returned to work with a negligible wage loss, or without a wage loss. Expectations of near-term future earnings can also be taken into consideration;

• Settlement of a workers’ compensation case, which closes out future vocational rehabilitation services;

• The employee is no longer making themselves available for services;

• Death of the employee.

The closure of a rehabilitation plan generally requires a form to be filed with the industrial commission.

Conclusions

Members of the claim management team must closely monitor every workers’ compensation benefit being received by an employee.  This includes keeping abreast of the employee’s status and cooperation with vocational rehabilitation benefits.  While this is a useful benefit, steps should be taken to terminate it if evidence supports the conclusion the employee would not likely benefits from ongoing vocational rehabilitation services.

Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

©2019 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.