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/

©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.

Study Reference: The Relationship Between Work-Disability Duration and Claimant’s Expected Time to Return to Work as Recorded by Workers’ Compensation Claims Managers https://www.ncbi.nlm.nih.gov/pubmed/27460477

Hey there, Michael Stack here, CEO of Amaxx and Happy New Year to you as we start this fresh decade in January of 2020. Now, one of the cool things about this time of year as you’ve likely done some planning or some goal setting or setting some expectations for what you want to happen in this year and in this decade to come and maybe reflecting on what went well in the past year or the past decade that we just left behind.

As we started on this new year, I want to give you one quick tip and far as worker’s compensation return to work, a piece that you could integrate into your return to work program and just have that much more accurate expectations. If we think about James Allen’s book As a Man Thinketh, he says that basically what we think about has the greatest odds of actually happening and that is very true in workers’ compensation as well.

When Do You Think You’ll Return To Work?

There was a study in 2016 that looked at the correlation between the expected return to work times and then what actually happens and you’ll see a link to that study below here and I want to have you ask this question, when do you think you’ll return to work?

When do you think you’ll return to work? And the answers will be very accurate as far as the correlation. That’s what this study proved, and I’ve got to run through these numbers here quickly. It was 43% that expected they would be back to work. I’m sorry this is wrong. In less than seven days were accurate. So, 43% had the expectation. They said, yeah, I’ll be back to work in less than seven days. And they were accurate with their assessment. 22% said, yeah, I think I’m going to be back to work in greater than seven days. And they were accurate with their assessment. These are not ‘johnny on the spot’ as far as, okay, 95% of the time. But there’s a significant correlation and that’s the point of getting that understanding of what their expectation is and this one was the most accurate.

Expectations Predict Reality

This one was for people that expected that they would be out of work in greater than a hundred days or 181 days. There were actually returned room to work in seven days or less, so greater than 180 days. My expectation is I’m going to be out of work probably at least six months, you know, I can’t see myself getting back to work before then. Virtually none of them were back to work right away.

The point is, ask that question upfront, ask that question. When do you think you’ll be back to work? And you will get a pretty good indication as far as how to tailor your claims management strategies to that expectation to either help them along and confirm that, hey, you think you’re going to be back, let’s make sure you’re back. If you think you’re going to be out a lot longer, maybe we’re going to need some extra services on this such as nurse case management, etc, to help that claim move further along.

Happy new year to you. I’m excited for this year for you ahead to implement these best practices and see some of those tremendous results, because remember, your work today in workers’ compensation can have a dramatic impact on your company’s bottom line, but it will have a dramatic impact on someone’s life, so be great.

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.

Keeping workers comfortable can reduce costs for employers/payers. The more a worker experiences discomfort, the more likely she is to develop musculoskeletal pain and injuries.

Low back pain, one of the most common reasons for lost workdays, may be due to an improperly adjusted workstation. Improper chair heights, constantly reaching for the mouse, and holding a phone handset between the head and shoulder takes a toll on the body after long periods of time.

Making a few simple adjustments can have a tremendous impact on improving employees’ health and wellbeing and reducing workplace injuries. But many employers and even the workers themselves don’t realize the long-term effects of improper workstation ergonomics. However, easy-to-use tools are available that can have a significant positive impact.

Common Ergonomic Problems

Sitting in the same position for long periods of time, especially with awkward postures of the head, neck, and upper limb can cause pain and injury. One study showed that workers often use poor positioning that can lead to discomfort and musculoskeletal disorders. For example,

• Armrests were used improperly or not at all. Instead, many workers rested their arms on the desk, which can lead to elevation of the shoulders and increased tensions in the neck, shoulders, and trapezius muscles. They also sit forward in their chairs, instead of getting lumbar support, which can cause pain, especially if workers are in this position for more than four hours at a time.

• Monitors are often placed too low, forcing a flexion of the cervical spine.

• A mouse that is not aligned with the shoulder, as is often the case, forces the shoulder in abduction, which has been associated with musculoskeletal symptoms of the neck and upper limbs. Long use of the mouse can cause musculoskeletal disorders in the neck and wrist.

• Workers who use desktop phones typically did not have headsets available, forcing them to hold the phone between their heads and shoulders, causing strain on the spine and shoulder. Workers who text may develop hand and wrist discomfort if the forearm is not properly supported.

Self-Assessment Ergonomic Fix

Office workstations come in a variety of styles and typically allow for multiple adjustments. Proper ergonomics ensure the worker is comfortable and not putting himself at risk of pain or injury.

One tool increasingly being used allows the worker to see how well he is or is not ensconced in his workstation; in terms of his posture, the height of the equipment, the reachability and other factors.

Called Rapid Office Strain Assessment (ROSA), provided by MyAbilities, it enables the worker to conduct a reliable self-assessment and provides self-guided training to make sustainable office ergonomics changes, based on the latest in ergonomics research.

ROSA consists of a video and diagram-based checklist that can quickly quantify the exposure of workers to risk factors in office workplaces, and provide users with immediate risk levels and intervention strategies. Each ‘page’ of the checklist corresponds to a particular risk factor. The worker clicks on the most appropriate box for each. Based on the responses, a score is calculated that identifies whether the worker is at high or low risk for injury.

1. Chair.

• • The ideal is such that the worker’s knees are at 90° and reach the floor. The worker checks the most appropriate box, such as:
    • Knees at 90°
    • Chair too low — knee angle < 90°
    • Chair too high — knee angle > 90°
    • Chair too high — feet don’t touch the ground
  • Insufficient space under the desk for worker to cross his legs
  • Chair height is not adjustable
  • There should be 2-3” (one fist) between the edge of the chair and the knee. The boxes question if the seat pan is too short, too long, or not adjustable.
  • The elbows should be at 90°, and the shoulders relaxed. The boxes question the armrests’ height, width apart, and adjustability.
  • There should be adequate lumbar support so the recline is between 95 – 110 degrees. Questions in the boxes pertaining to the angle of the backrest, and whether there is adequate – or any – lumbar support.

2. Monitor

• • The monitor should be positioned so the top is slightly below eye level, and the head is in a neutral position. Questions related to the height level as well as glare and the presence or lack of documents holders.

3. Mouse

• • The mouse should be in line with the shoulder, and the wrist kept straight. The assessment questions whether the mouse is positioned too far away from the body, the pinch grip, and whether it is located on the same or a different surface from the keyboard.

4. Keyboard

• • The wrists should be straight while typing. The questions pertain to the height and positioning of the keyboard.

5. Phone

• • This should be accommodated via a headset or held in one hand. Questions ask about hands-free options and how far away it is located.

A score for each element is tabulated depending on the worker’s answers, and a final, overall score calculated. On the scoring of 1-10, anything over a 5 is considered a high-risk factor for MSDs and suggested for tweaking.

The final report includes assessments and recommendations for adjustments to reduce the risk. These reports, and the recommendations contained within them, have proven to reduce discomfort in office workers. All of this is possible without the use of new office equipment – just adjusting the existing furniture.

Conclusion

ROSA is one of the simpler and less expensive tools to enhance ergonomic appropriateness for office workers. One of its advantages is that the worker himself can experience how a simple adjustment increases his comfort, thus increasing the likelihood he will adhere to the change.

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.

The claim handler’s main role is to get an injured employee back to work.  The timeline on how this can happen depends on a multitude of factors, including the severity of injury, age of the patient, prior injuries to the same area, the diagnosis, and their occupation.  Employers and other interested stakeholders are sometimes afraid of returning an injured employee into their workplace.  This drives workers’ compensation costs and increases workplace anxiety among other employees.  Now is the time to focus on return-to-work efforts to reduce the cost of workers’ compensation, and increase morale.

It All Starts with the Employer

Employers need to take responsibility for return-to-work and make it a central part of their workers’ compensation program.  This is because the employer controls a lot of the future for the injured worker.  It is time for employers to stop making common excuses and get their injured workforce back into the work environment – even within their own organization.

Make Light Duty Work Available

This is always the easiest excuse to make.  Countless studies have shown that injured employees are willing to work and would prefer it to staying at home, watching TV, and doing other stereotypical things that come to mind when someone is off work.  The short-term impact is that individual lose confidence and self-worth, and becomes deconditioned.  Proactive employers can be creative when it comes to light-duty work.  This can include creating a job, which can include maintenance projects or other activities that advance the interests of the employer and keep the individual engaged.

Do Not Fear Work-Related Aggravations

Employers are often afraid of offering light-duty work to an injured employee given the possibility of an aggravation of the underlying work injury.  The argument is, “I am afraid my injured employee will aggravate the injury when returning to work.”  This is a valid concern.  However, these same aggravations could also occur when the employee is convulsing at home. Yes, the risk is there, but not if you as the employer plan accordingly, and be smart about putting the worker back on light duty.

Do Not Fear A New Work Injury

“What if the employee slips or falls?”  This is another common concern of employers.  Again, injuries can happen anywhere.  It all comes down to common sense.  Have the employee do something safe.  The point is not to have them riding the edge of risk every day until full duty resumes.

Don’t Be Afraid the Injured Employee Will Hurt Someone Else

President Franklin Roosevelt once proclaimed, “The only thing we have to fear, is fear itself.”  The modern workplace is filled with risk.  However, using common sense when it comes to post-injury employment pays dividends.  Return-to-work minimizes the exposure of wage loss being paid on a claim and also reduces medical care and treatment an injured employee may receive.

Injured Employees Are Productive

The productivity of an injured employee is subject to many urban myths and legends.  If the employee has a hand injury, it does not make sense to have them packing boxes, taping them, and carrying them out to the loading dock.  Everyone can be productive if the circumstances are favorable to their strong points.  Be creative!

No Job Description – No Problem

No job description provides an easy out for a claim handler not to seek return-to-work.  On the other hand, it is an opportunity for an employer to review all the positions in the company, and create them before injuries occur.  It all comes down to the employer’s commitment to saving money.

Don’t Ignore the Value Add

Employers generally have the option of paying an injured employee their full wage for doing something other than their pre-injury position.  While the employer does not receive the “full value” of the employee’s work, they do receive the benefit of lower workers’ compensation costs.

Conclusions

There are many excuses when it comes to returning an injured employee to work.  At the end of the day, it is your job as the employer to set the tone for being proactive.  Team up with your HR department and make those job descriptions.  Be creative about light-duty work and what a person can do.  It is still better than letting the injured worker control the claim since the only job would be to check the mail for a compensation check.

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.

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.