Using Medical Disability Guidelines to Estimate Return to Work

Members of the claim management team face many challenges in handling their files in workers’ compensation claims.  When an employee misses work, the team needs to make efforts to return that person to work, and also have a good idea when this will occur.

Medical disability guidelines can assist an employer and the claim management team in planning for the future return of an injured employee. Medical disability guidelines are an essential planning tool because they provide an employer with a time frame as to how long an employee, on average, will be away from work. Large self-insured employers, TPAs, insurance companies as well as captives and associations that handle claims all use online medical duration guidelines.

Understanding Medical Disability Guidelines

Medical disability guidelines are simply that – a guideline.  They do not offer the medical provider or employer a precise number, but rather a range of time the guideline’s user can anticipate the employee will be off work depending on the difficulty of work. Other important issues to consider include:

• The range of time is based on a compilation of extensive data about numerous injuries;

• The collection of data is sorted by the nature and the extent of injury;

• The greater extent of data, the more accurate a disability duration prediction is; and

• The field of occupational medicine continues to grow and expand, providing a constantly evolving and growing accumulation of data.

It should be noted that medical disability guidelines are designed to provide physicians, employers, and employees with ranges and guidance, not precise answers. Guidelines often have a minimum recovery time, a maximum recovery time, and an optimum/average recovery time. The specific employee’s willingness and inclination to return to work can be measured in three ways:

• Restrictions;

• Limitations; and

• Willingness to tolerate the symptoms brought on by the injury.

Working with Medical Providers on Return-to-Work

The medical provider will set restrictions on what the employee should perform. While the employee may be capable of doing the activity, to do so could pose a risk to the employee and possibly others. An example of this is an employee with an injured arm might be capable of driving a dump truck, but there is a risk the injury could impair the employee’s ability to do so, posing a risk to both himself and others.

The medical provider will also take into consideration of limitations of the employee.  These limitations include:

• Limitations based on a functional capacity evaluation; and

• When the employee should be able to reach their optimal performance level.

For example, an employee with an injured back will not have the physical capability to lift heavy objects. Limitations are normally in place for what would be considered the average time a person will be off work.

Dealing with An Employee’s Work Restrictions

Restrictions placed on an injured employee should closely conform to the minimum column of the medical disability guidelines while the limitations will often correlate with the optimum recovery time in the guidelines. The maximum amount of time an employee should be off work is reflected by the concept of tolerance.  The greatest variance in the medical disability guidelines arises from the willingness of the employee to tolerate the symptoms of the injury. The medical provider may look at the medical disability guidelines and establish what is the normal recovery time for an injured person who has a particular nature and extent of injury. Individual factors such as fatigue and pain can impact an employees’ disability duration.

Personal factors can also play a role in the recovery and disability duration including:

• Comorbidities (diabetes, obesity, etc.), which can distort the disability duration; and

• The employee’s motivation to return to work will influence their tolerance level. These motivational factors can include income (satisfied with the tax-free income of workers’ compensation), job dissatisfaction, self-esteem, health insurance provided by the employer, etc.

These are not medical reasons for disability but impact the employee’s willingness to tolerate injury symptoms, and therefore whether or not the employee disability duration falls within the medical disability guidelines. The maximum time frame is often placed at the 90^th percentile, where 90% of the people with the type of injury involved have returned to work.

Conclusions

The medical disability guidelines are evidence-based disability durations. They are multidisciplinary in scope with their findings continuously updated to reflect an improvement in medical care and medical practice. They are best used to answer the question, “how long will the injured employee be off work.”

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 the founder & lead trainer of Amaxx Workers’ Comp Training Center .

Contact: mstack@reduceyourworkerscomp.com.

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

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