When an adjuster reserves a file, they focus on probable outcomes. The medical side of the file is usually pretty straightforward. An adjuster can tell based on risk drivers if a person will need surgery, extended rehab, or other procedures based on their medical history.

Return To Work Becomes Complicated When It’s Unclear

What is more difficult is whether or not this worker will return to work should light duty become available. What complicates the process is when the employer is just not sure if light duty work will open, when it will be available, or if they even want the worker to return at all.

Let me explain by using an example. Let’s say a worker needs a back surgery. The employer has light duty positions open, and tells the adjuster that once the worker has restrictions they will place them in work. So, the adjuster will plan to reserve for when the worker is off work post-operatively, and then target a range of when restrictions should be in place and the worker can get back to work.

What will complicate the file is a delay on the employer’s side in getting the worker into light duty. I have reviewed countless files where the employer has stated early on that work is open, but then delayed placing the worker into the light duty work program for weeks or months after restrictions were placed. This not only affects the indemnity costs on the file, but can inhibit the workers overall physical recovery.

Especially with a back surgery, the sooner you get the injured worker off the couch and back to work doing anything the quicker and easier their recovery will be. The last thing you want is the worker sitting around for weeks waiting for the phone to ring. Even worse is when the worker knows light duty in there, and cannot figure out why they can’t return to work.

Claimant Suspicion Can Lead to Higher Claim Dollars

Then the wheels start to turn in the head of the injured party. Maybe they are going to fire me? Why can’t I go back to light duty when I know other workers that returned to work after they had surgeries? Is my employer mad at me because I needed a surgery? Should I get an attorney just in case I get fired because of all of this?

Then when they talk to the adjuster, most adjusters will have no answers for them as to why they can’t return to work as well. After all, the employer told the adjuster that light duty work would be available. Why is this not happening for this claimant? Is the employer not being honest about something in regards to the employment future of said worker? Should I be reserving this file for vocational rehab and start posturing for a potential settlement?

Failure To Communicate

The culprit here, as in many work comp problems, is a failure to communicate. In this example, the employer laid the groundwork for a simple return to work post-op in the light duty work program they have up and running. If there were some political aspects as to why this worker should not or cannot return to work, the adjuster needs to know. Not only for reserve forecasting, but for general return to work forecasting.

Should light duty work not be open for the employee for whatever reason, the adjuster has options to get the worker off the couch and working. The main option is to use an employment vendor that can find transitional light duty work in their own community. This way the worker is still working in some capacity, until they are released to perform full duty work for their own employer. Other options could include work hardening programs, which can be intensive therapy that can help the worker aggressively rehab and get to full duty status faster than traditional therapy methods.

The result of failure to communicate a return to work will result in under-reserving the file. In the end this helps nobody, and the carrier/TPA in general hates to under-reserve anything. It also will make the carrier question the validity of a light duty program in general, and many questions will start to be asked about why this claimant was not able to work light duty when it was promised early-on in the file. Certain carriers will provide discounted premiums based on the existence and use of light duty return to work programs, and if the employer is not delivering on their end of the deal, expect premiums to increase.

It will also create a rift between the worker and their employer. Why was this person singled out to sit at home when others were allowed to return to light duty and make their normal wage? It is almost as if you are penalizing this worker, for whatever reason.

Implement Your Return to Work Program Consistently and Communicate, Communicate, Communicate

At the end of the day, the employer has the option to do what they want with each worker. But the program has to be clear, and applicable to all employees regardless of the injury or surgery that was performed. If you have a light duty program, use it for all of your injured workers fairly. If for whatever reason any particular worker will not be able to return to light duty, make sure the adjuster knows way ahead of time so they can plan other work options accordingly.

Per usual, it all comes down to communication.

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.

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.

If you knew the specific physical demands of every job in your organization and which employee could best handle each, you could significantly reduce injury risks. But the information available to most employers is nowhere near capable of providing this degree of insight. The good news is the technology is available, and an increasing number of companies are tapping into it and seeing positive outcomes.

21^st Century Job Descriptions Using Artificial Intelligence

Automated, detailed functional job descriptions are possible through artificial intelligence and other advanced technologies. Unlike the simplistic, hand-written, one-page job descriptions seen in many organizations, these allow the user to quickly determine which jobs might have the highest risks and the degree to which they can be made safer through various ergonomic and other changes.

Among the more prominent organizations having success with this approach is MyAbilities. The company provided the following example to demonstrate the value of a highly sophisticated functional job description.

The job at hand was that of a landscaper. The question was whether a certain worker – we’ll call him Joe – was capable of performing the tasks and, if necessary, whether changes could improve his ability to do the job.

A database of job descriptions was accessed to determine the basic physical requirements, with several additional tasks to determine their job demands. Transporting mulch, trimming hedges and raking yard debris were added to the description.

Two job profiles were produced;

• One included ergonomic modifications for each added task
• One with no ergonomic enhancements

The task of trimming hedges was viewed in one profile using hand-held trimmers and the other using a hedge trimmer on a telescoping handle. Transporting mulch was profiled with the worker carrying the mulch vs. using a push cart. A yard waste vacuum was one way to rake yard debris, while a hand-held rake was also considered.

Comparing the two job profiles showed several differences, such as:

• Gripping – 6 hours per shift, vs. less than 5 when ergonomic modifications were used
• Lifting – 3 hours rather than under 2 hours

Employee Joe was videotaped doing each of the three tasks with and without the ergonomic modifications. The videos were run through an analytic tool to produce a report that outlined the range of motion used for each job, along with an overall physical demand score for each.

The report clearly showed that when done with the ergonomic modifications, Joe spent much less time with his hands above his shoulders – greatly reducing his risk of injury. Also, his upper arms were in a neutral posture far longer in the ‘good’ ergonomics situation than without the modifications, and he was not reaching as far.

Ergonomic Modifications Significantly Decrease Demands of Job

Using the ergonomic modifications reduced the amount of carrying Joe had to do and replaced it with pushing; lessened the amount of handling of mulch and clippers; reduced the grip force by using the telescoping hedge trimmer; and cut down on the reaching distance by using the debris vacuum instead of a rake. The result was a significant decrease in the demands of the job.

The report that was generated included specific details about the effects on different body parts. Overall there was a greatly reduced impact on Joe’s arms and shoulders when the ergonomic modifications were employed.

This high-level approach to evaluating job tasks and matching them to an employee’s abilities is extremely effective when hiring and returning an injured employee to work. If Joe were returning from a work injury and had sustained an elbow injury, for example, he would be capable of performing the job – if the ergonomic modifications were in place.

Conclusion

Preventing injuries is the one surefire way to reduce workers’ compensation costs. While you may not be able to prevent every workplace injury, using tools based on advanced technologies can dramatically reduce them among new hires and prevent reinjuries from those returning after an injury.

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.

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.

Returning an injured worker to the job before he’s physically ready can be a nightmare. The last thing an employer wants to do is put the employee at risk of reinjury.

On the other hand, waiting to bring an employee back until he is 100 percent recovered prolongs the number of lost work days and impedes the worker’s recovery. Reinjuries, as well as extended disability durations both, add costs to the claim.

What’s needed is an accurate depiction of the physical requirements of a job, along with a deep understanding of exactly what the injured worker is physically able to do or not do. Armed with such information, the employer can make the best decisions for the injured worker and the organization.

ADA Considerations

One issue that may come into play when returning an injured worker is the Americans with Disabilities Act. Employers cannot refuse to let an employee return if he can perform the essential functions of that job — even if that requires reasonable accommodations.

Following return to work best practices will ensure compliance with the ADA. Return to work has even been described as the “ADA on steroids.”

Both return to work and the ADA involve a collaborative process between the employer, employee, and possibly, the medical provider. Whether the disability is work-related or not, the first question to ask is whether the person can do his original job.

In many cases, the worker may be able to perform the essential functions of the job with some modification or reasonable accommodation. That may involve an ergonomic change or schedule alteration, for example. As long as it does not impose undue hardship — either financially or operationally — on the employer, accommodations should be explored, both from a return to work and ADA standpoint.

Return to work best practices entail resuming work as soon as possible, both to help the worker heal and to reduce claim costs. A work accommodation or transitional duty that helps the worker get to the point where he/she can fully do the job is the best course of action.

If the worker cannot perform the essential functions of his job even with accommodations, providing a transitional job elsewhere within the company, or a position off-site would be the next step.

A key to ensuring compliance with the ADA and getting the best outcome from a return to work standpoint is to engage the employee in what is formally called the interactive process. This allows for an open and honest discussion about what the employee can do and how the employer can facilitate the process.

Defensible Return to Work Solutions

There have been new tools developed that can accurately match a person’s physical capacity with specific jobs, allowing for a solid decision as to what the person is capable of doing, whether with reasonable accommodation or not.

An example is a digital job profiles integrated with automated job-matching analysis, developed by MyAbilities, combining ergonomic research with artificial intelligence-powered software that allows for ADA compliance and RTW best practices. It addresses the employee’s physical degree of fitness for the current job and runs those capabilities against all the digital profiles in a company’s job bank. If the injured worker is unable to perform his job, even with accommodation, the tool can identify other positions within the company that he might be capable of performing within his physical restrictions.

Digital job profiles comprehensively describe the physical requirements and features of every possible job. Each job includes graphics and video profiles, which significantly help evaluate and depict its physical requirements. The company’s automated physical assessment used in conjunction with the job-matching tools can quickly and accurately provide a picture of the worker’s physical capacity for various positions.

Under ADA law an employee is required, with or without accommodation, to perform the essential functions of a job achieving the same work product as other employees. However, this same stipulation does not apply under workers’ compensation RTW best practices which take ADA requirements a step further.

The job-matching tool allows employers to leverage the digital job profiles and interactive process to modify the employee’s original position with or without accommodation or provide an alternative transitional duty position.  Exceeding ADA compliance requirements, this RTW best practice would be true even if the worker is unable to perform all of the essential functions of the job or their work product is less than comparable to other employees.

Conclusion

Getting injured employees back to work is a win-win for everyone — as long as the job involved is appropriate for the worker’s level of fitness. By collaborating with the injured worker and using sophisticated tools, such as the job-matching analysis developed by MyAbilities’ will ensure the best outcomes.

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.

Workers’ Comp Roundup Blog: https://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.

A functional capacity evaluation (FCE) is a comprehensive series of test administered by an occupational therapist or a physical therapist who has had specialized training in performing a FCE.  The tests are specifically designed to measure:

• stamina
• dynamic strength
• mobility
• flexibility
• body mechanics
• cardiovascular condition
• balance
• coordination
• dexterity
• ability to tolerate functional activities

Used to Determine Employee’s Readiness to Return to Work

In workers’ compensation claims, a functional capacity evaluation is often utilized to determine the injured employee’s physical readiness to return to work and to measure any physical limitations the employee will have as a result of the work comp injury.  A FCE can also be utilized to determine the injured employee’s physical capabilities for vocational retraining when the injured employee will be permanently unable to return to his/her prior vocation.

A functional capacity evaluation can be one of two types, either a job-specific FCE or a general purpose FCE. In a job-specific FCE, the therapist is provided a detailed job description prior to the testing in order to tailor the FCE to the specific job of the employee.  To have a very accurate FCE, the therapist should visit the job site to have a detailed understanding of the functions of the job.  In a general-purpose functional capacity evaluation, the testing measures the employee’s strength and tolerance in completing standardized or common work task.

Test Can Last Several Hours to Two Days

After a determination of the type of FCE, the appointment date is scheduled for the injured employee.  An FCE can last from several hours to two days, depending on the nature and extent of testing.

At the start of the functional capacity evaluation, the therapist will perform a comprehensive interview of the injured employee.  The interview is designed to identify any factors that could impact the employee’s ability to participate in the FCE.  The therapist will want to know if the employee has any issues with asthma, COPD or other lung/breathing problems, high blood pressure, physical limitations besides the work comp injury, and obtain the employee’s own assessment of their physical condition including the employee’s perception of his/her pain level.

Measure Various Physical Tests

In conjunction with the interview, the therapist will complete a clinical assessment of the employee to establish a baseline for the FCE.  The therapist will measure the employee’s range of motion, balance, grip strength and coordination to establish the testing plan.

In a job-specific FCE the therapist will measure the employee’s ability to lift, carry and perform other tasks in comparison to the performance levels identified in the employee’s job description guidelines. In the general purpose FCE, the therapist will measure the employee’s maximum ability to lift, carry and perform routine work-related task.

5 Categories of Physical Demands

The U.S. Department of Labor characterizes jobs in 5 categories depending on the physical demands of the job.  For instance, an over-the-road, or long-haul truck driver is classified as a “heavy” physical demanding job.  The 5 categories are defined as:

• Sedentary:  exerting up to 10 pounds of force occasionally

• Light:  exerting up to 20 pounds of force occasionally or up to 10 pounds of force frequently

• Medium:  exerting 20 to 50 pounds of force occasionally or 10 to 25 pounds of force frequently

• Heavy:  exerting 50 to 100 pounds of force occasionally or 25 to 50 pounds of force frequently

• Very Heavy:  exerting in excess of 100 pounds of force occasionally or in excess of 50 pounds of force frequently or in excess of 20 pounds of force constantly

If the therapist is performing a general purpose functional capacity evaluation on a truck driver, the therapist would determine the truck driver’s job is a “heavy” physically demanding job. The general purpose FCE testing would measure the employee’s ability to meet the requirements of the “heavy” job classification.  However, some truck drivers are “drive and drop” drivers where they never touch the cargo.  The hardest part of their job is cranking the landing gear of the trailer up and down and disconnecting the fifth-wheel.  Their job requirements would fall in the “medium” job classification for physically demanding.  Therefore, when there can be different levels of physical effort needed for a job title, it is to both the employer’s and the employee’s benefit to provide a detailed job description to the therapist and to request a job-specific FCE.

Biggest Issue is Validity of Effort by Injured Employee

The biggest issue with FCE is the validity of the effort put forth by the injured employee.  If the injured employee has been advised by his/her attorney that the better they do on the FCE, the lower their permanent partial disability settlement will be, the employee is given a financial incentive to put forth less than their best effort.  If there is any concern the employee may not make a sincere effort in the FCE, the therapist should be advised prior to the FCE.  The therapist can give the employee several different tasks or activities that measure the same physical ability.  If the test results reflect a variation in the employee’s ability within a specific category when measured by two or more different methods, the therapist will be able to identify the employee who is trying to game the testing and include in their post testing report the fact that the effort put forth by the employee was inconsistent.

Results Compared Against Specific Job Description

When the FCE testing is completed, the therapist will compile the employee’s test results.  The test results will be compared against the specific job description requirements or the general physical level classification of a job to see if the employee can return to performing the job. The results of the FCE are then reported to the treating doctor and workers’ compensation adjuster and/or nurse case manager.

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.

Workers’ Comp Roundup Blog: https://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.