Reduce Work Comp Costs by Carefully Reviewing ‘Ability to Work’ Reports

During a workers’ compensation claim, the employee’s treating doctor will issue numerous ability to work reports. These reports outline the restrictions placed on the employee and determine when the employee can return to work. Often these reports are not fully completed. The result is employees remain off work for extended periods. Not thoroughly reviewing a an ability to work report can also limit the return to work opportunities. Interested stakeholders need to constantly contact the treating doctor, carefully review these reports, and ask questions.

Take Charge of a Report on Workability

Ability to work reports or “disability certificates” are written communication from the employee’s treating doctor regarding restrictions on activity and ability to return to work. These reports are often “rubber stamped” by the treating doctor. Omissions include a complete report on the employee’s status and expected return to work. Here is a list of essential items to ensure are listed on the report and may require additional follow-up.

• Frequent Updates: Never allow an employee’s restrictions to go stale. Ensure the employee’s restrictions are updated on every office visit. Contact the health care provider and specifically ask for updated restrictions if the employee is receiving medical care, but restrictions are not being updated.

• Provide Specifics on Restrictions: Make sure the restrictions reflect the objective and subjective findings within the medical records. An example of this is a record that documents improvement in the condition but no changes in the restrictions on the employee’s activity. Questioning this will avoid concerns the employee will become deconditioned. Send written correspondence asking for a medical opinion as to the lack of change in restrictions.

• Provide Treating Doctor with Information: Treating doctors understandably take the employee’s word regarding activities performed within the work environment. Provide the treating doctor with documentary evidence, such as a video of the employee’s pre-injury position or light duty options. Outlined with specificity movements and actions required, duration and frequency of actions, and specific weights of objects. Providing this information can also bolster arguments in the future regarding the reasonableness of a job offer or why the independent medical examiner’s findings and opinions should be accepted over those of the training doctor.

• Never Forget Return to Work: Keep this issue on the mind of the treating doctor at all times. This can include the return to whole duty, light duty, or modified duty.

Never be afraid to question an ability to work report skeptically. Being persistent and professional is crucial when communicating with the employee’s treating doctor. Be firm but never accusatory.

Explore Defense Options Carefully

Never be afraid to use an independent medical examination or vocational evaluation when you hit a roadblock with the treating doctor. While there are many considerations and limitations when using these adverse reviews, they can be tools that expedite a modification of restrictions when the injured employee is doctor shopping or the treating doctor is enabling the employee’s efforts not to make a complete recovery.

• Independent Medical Examination: Carefully select your medical expert and ensure you have a complete set of medical records and information on the claim. Provide this expert with a factual cover letter that asks the right questions for the claim. Be aware of limitations on obtaining a second examination.

• Independent Vocational Evaluation: The same care should be used as the IME. When selecting the right vocational expert, make sure you have the same information accessible as you would before a medical examination. It is also essential to consider an expert with training and expertise to obtain persuasive opinions should the claim go to a hearing.

Discussing a plan for using these experts with defense counsel is essential. Obtain their opinions on the right expert to use before scheduling.

Conclusions

Never be afraid to question the information provided on an ability to work report by a treating doctor. This starts with a careful review of what is being provided and a proactive response. Ensure all questions are being answered to get the employee back to work. When information is not being received, consider using an independent medical examination or independent vocational evaluation to counteract the employee’s position. Using these tools correctly will promote settlement and reduce 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.

Contact: [email protected].

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