Interested stakeholders who return employees to work following an injury can dramatically reduce workers’ compensation program costs. Studies also indicate that there is an increase in workplace morale. To have a best-in-class program, members of the claims management team and employer representatives must have a return to work “toolbox.” Now is the time to see if you are using these items correctly.
Work Hardening Programs
It is crucial to have a work hardening program when seeking to get an employee back to work. This is because employees who have been off work for two weeks or more become deconditioned. A sudden return to work that is not done correctly will more often than not fail.Effective work hardening is accomplished by an interdisciplinary team that includes several different specialists. This includes medical staff, qualified rehabilitation consultants, and occupational medicine specialists that work together to ensure the employee and employer’s needs are met. A common work hardening program will include:
- Providing specific physical requirements of the employee’s position in a simulated environment;
- Assisting the employee in performing the physical requirements until they can perform all duties for required time limits; and
- Allowing the employee to return to work when they are ready.
When completed correctly, the employee can return to work and will succeed.
Independent Medical Examination and Functional Capacity Evaluations
These are two often overlooks items in the toolbox when it comes to returning to work. The IME and FCE should be used together to ensure the employer and insurance carrier have sufficient evidence to counteract claims the employee cannot return to work.
It is essential to time the IME correctly. It can only be used once without engaging in additional litigation to compel a subsequent examination. Decisions that need to be made include:
- Obtaining a complete set of medical records on the employee;
- Having sufficient information regarding the employee’s work injury and status. Taking the employee’s deposition before the examination is a must; and
- Selecting the right medical expert. Considerations should include whether the doctor has expertise in the medical issues at questions and credibility.
The FCE is used to evaluate the employee’s physical capabilities and ensure restrictions on activity accurately reflect their ability. It can include observations of the effort an employee gives when performing activities. Criteria will include:
- Dynamic strength, which involves movements one would perform in a copy. This can include lifting, carrying, overhead movements, etc.;
- Mobility and flexibility; and
- Overall ability to tolerate functional activities.
The expert who performs this testing needs to understand the requirements of the employee position (or position they may work in post-injury) and sets up a series of activities or tasks that involve these same movements. Testing typically can last two to three days.
The IME and FCE should be used in conjunction to determine the etiology of an injury, the nature and extent of the work injury, issues concerning permanency, restrictions on activity, and the appropriateness of restrictions provided by a treating medical provider. The results can also be compared to baseline testing if conducted to determine other issues of compensability.
Telephonic Disability Intervention
This is a valuable and often overlooked resource that interested stakeholders can add to their return to work suite of services that assist employees with the psychological barriers of returning to work. Following a work injury and subsequent disability, there is a stigma that is attached to the individual. Using these services can assist the employee in making a complete recovery.
By implementing these services, the employee has access to trained professionals that help the employee get over these barriers. Services that are offered include:
- Provide structure to the employee’s post-injury life;
- Assist in helping the injured worker schedule activities;
- Motivate the employee to make positive choices in their everyday activities; and
- Improve the quality of life for someone suffering from the effects of the work injury.
While this service costs money, it can positively impact the bottom line by getting the employee back to work.
Return to work should be a consideration of the defense interests following a work injury. This can be accomplished by prioritizing it and using tools such as work hardening, IMEs and FCEs, and telephonic disability intervention. When done correctly, the employee can be assisted in getting back to work in an effective and timely manner, resulting in lower workers’ compensation program 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 the founder & lead trainer of Amaxx Workers’ Comp Training Center, which offers the Certified Master of Workers’ Compensation national designation.
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