Vocational Rehabilitation Qualified Rehabilitation Consultant Misconduct

vocational rehabVocational 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;

 

 

  • 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.

 

 

 

Michael Stack - AmaxxAuthor 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.

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