Early workers’ compensation laws did not include vocational rehabilitation benefits. The purpose of adding these benefits was to rehabilitate someone suffering from a work injury and return them to the labor market with an economic status as close as possible to that the employee would have enjoyed without the disability or injury.
Rehabilitation Eligibility and Initial Consultations
The guidelines for vocational rehabilitation vary in each jurisdiction. The majority rule does allow for injured employees to receive vocational rehabilitation benefits if they are not able to return to their pre-injury employment without residual disability or work restrictions. Additional threshold issues include possible affirmative defenses the employer and insurer may assert.
Once an employee is determined to be eligible for vocational rehabilitation services, one would undergo a consultation. The purpose of this discussion performed by a vocational expert includes:
Understanding the employee’s injury and need for future medical care and treatment;
Discussion regarding work restrictions related to the employee’s condition(s); and
Develop a rehabilitation plan to return the employee to work.
Proactive members of the claims management team need to review all claims from the onset to determine issues of eligibility for rehabilitation services. This review should never be limited to the physical limitations of an employee. It is important to pay attention to issues concerning compensability, which include:
Notice and statute of limitations;
Intoxication;
Prohibited Acts;
Self-inflicted injuries; and
Whether the injury arose out of and within the course of employment.
Development of Rehabilitation Plans
Following the rehabilitation consultation, a vocational expert will prepare a rehabilitation plan for the injured worker. Issues addressed in this Plan include:
Whether the employee will be permanently precluded or likely to be permanently precluded from engaging in their usual and customary occupation;
Whether the employee is reasonably expected to return to suitable gainful employment with the date-of-injury employer, or another employer; and
What additional rehabilitation services the employee may require. These services can include such things as physical reconditioning, job search assistance and the possibility of retraining.
It is important for claims handlers to remain engaged following the issuances of a rehabilitation plan. This plan includes the monitoring of ongoing rehabilitation services and keeping in contact with the qualified rehabilitation consultant (QRC) working with the employee. Failure to do so can result in prolonged disability and excessive or unnecessary charges related to vocational rehabilitation services.
Moving Injured Workers Back to Work
The goal of every rehabilitation plan should be returning the employee to suitable gainful employment. Tools to accomplish this goal include:
Disability Status Reports: These are required reports QRCs are required to file with the industrial commission and all parties on a regular basis. It is important to monitor and scrutinize these reports. Claim handlers should demand progress in moving issues concerning job search and related re-employment activities forward. If consistent progress is not seen, one should consider having the employee undergo an independent vocational evaluation (IVE).
On the Job Training Plans: Many jurisdictions allow vocational experts to use these plans to develop transferable job skills. A defined plan should include information on a desired position for the employee, skills the employee will acquire through this training, tools, and supplies needed to accomplish the plan’s objectives and an expected average weekly wage upon completion.
Written Job Offers: This is an opportunity to encourage re-employment by the date of injury employer when one feels the employee is ready to return to work. Examples of a well-written job offer details the position being offered, length and frequency of activities to complete a task and wages the employee will receive.
Conclusions
Proactive members of the claims management team need to understand vocational rehabilitation benefits and how it impacts a claim. This understanding includes being fully engaged and seeking opportunities to return the employee to work effectively.
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 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.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.
