Using a Disability Case Manager in Vocational Rehabilitation

Vocational rehabilitation services play an important role in returning injured employees back to work. If this is done effectively, the costs of each claim will rapidly diminish. Given the nature of these programs, it is important to claim handlers to manage the cost of vocational rehabilitation and make sure the right pieces are put in place. If this is not done, any program or plan will increase their workers’ compensation program costs.

What is Vocational Rehabilitation?

Vocational rehabilitation is intended to return qualified injured employees back to work in suitable employment in a manner that is in the best interests of all parties. Individual jurisdictions classify when an injured employee is able to consider these services but is generally available to those expected to be out of work or disabled to some extent for a period of 90 days. Factors to consider include:

• ­Whether the injured employee can return to the former job, or perform similar job duties at another place of employment;

• Whether the employee will eventually be expected to return to “suitable employment” in the foreseeable future; and

• Whether such services are necessary through the assistance of a Qualified Rehabilitation Consultant (QRC) to achieve these goals.

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Important People in Vocational Rehabilitation

Vocational rehabilitation services can be provided by a Qualified Rehabilitation Consultant, or a Disability Case Manager (DCM). It is important to understand what these individuals do and how they are different.

• Qualified Rehabilitation Consultant: This is someone who can perform a myriad of vocational rehabilitation services. They typically involve in medical case management, return-to-work coordination, analyzing transferable job skills, and provide vocational testing. They also play an involved role in the development of a retraining plan and will provide expert vocational testimony. While a Qualified Rehabilitation Consultant can be employed by an insurance carrier, they are in most instances an employee of an independent firm.

• Disability Case Manager: This is an individual that usually works for the insurance carrier and provides similar functions when it comes to medical case management and return-to-work coordination. They will also analyze different jobs available to an injured employee, provide an ergonomic consultation, and perform life care planning activities. DCMs are generally not regulated by the industrial commission and are directly selected by the employer/insurer – without consultation by the employee or their attorney.

Effective Use of a Disability Case Manager to Reduce Vocational Rehab Expenses

Defense interests sometimes fear the use of a Qualified Rehabilitation Consultant notwithstanding the general requirements that they remain neutral and not advocate for a particular party. These fears are often misplaced, and members of the claim management team should always seek the assistance of Qualified Rehabilitation Consultants, and cooperate. Notwithstanding the benefit of a Qualified Rehabilitation Consultant, they may add to additional costs that can be eliminated through the effective use of a Disability Case Manager.

DCMs are generally found within insurance carriers and can serve as a valuable resource on troublesome workers’ compensation claims. This includes using a DCM to better direct a claim in the following situations:

• Guidance on whether a vocational rehabilitation consultation with a Qualified Rehabilitation Consultant may be necessary, or the appropriate timing of such event;

• Decisions on when or whether surgical intervention may be appropriate. They can also be used when there is a request made for a second opinion, or imaging such as a repeat MRI;

• Serve as an intermediary between the claim handler and an unrepresented injured employee. Instead of having the injured employee contact the overworked claim handler on questions of ongoing medical care, scheduling of appointments/surgery, a Disability Case Manager can assist and provide timely responses; and

• Assistance in calculating the employee’s average weekly wage. They can also assist the employee in obtaining information required to perform these important calculations.

In sum, a Disability Case Manager can be used to improve the lines of communication between the employee and claim handler and prevent unnecessary litigation.

Selecting the Right Disability Case Manager

There are a number of factors that should be considered when assigning a DCM to a workers’ compensation claim. This includes a careful review of the injured employee’s background and then matching them with the right person. Factors to consider should include:

• Expertise and educational background;

• Complexity of the case, and overall claim experience in claims;

• Generational considerations, and demeanor of the injured employee; and

• Geographic locations.

It may also be important to have a team of multilingual Disability Case Managers to assist on cases where the injured employee does not speak English as a primary language.

Conclusions

Vocational rehabilitation is a necessary benefit in the workers’ compensation system that is often overlooked. It is important that members of the claim management team take a number of factors into consideration and use a DCM to control workers’ compensation costs. This may help better direct vocational rehabilitation efforts, and get the injured employee back to work in a timely manner.

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.

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