What can you do to control rising medical costs in Workers’ Compensation claims? Bring your injured employees back to work.

Recently, the National Council on Compensation Insurance, Inc. (NCCI), reported on some of the trends impacting workers’ compensation across various states.  Some of the items the report covers include employment growth, information on the construction industry, and medical inflation (rising medical costs).

The workers’ compensation industry has a tendency to separate indemnity (wage) and medical costs.  Nothing exists in a vacuum, certainly not in workers’ compensation claims. 

Maybe you think I’ve oversold you with the title of this blog post. Consider the following questions.

What happens when an injured worker is injured and their employer cannot return them to work?

·     They are left to sit at home in their recovery.  Anyone who has spent time at home for a period exceeding one work week as the result of a medical issue or surgery can attest to the impact that being out of work has on you.  You may start to wonder what your co-workers are up to.  Maybe you try to stay connected by checking in or reading some emails from home, but it’s not the same.  You don’t have the context and the opportunity to ask questions – getting second hand information about the goings on at work can actually make you feel even more isolated.

·     The injured worker may begin to question if they’ll ever be able to get back to work.  What will happen if they have permanent restrictions?  Like reading hotel rating reviews, our minds tend to go to the most negative example possible.  The story of the neighbor who had to file bankruptcy because he lost his job after his work injury.  They’ve probably memorized the phone numbers for the attorneys who promise to get them huge sums of money.

·     The injured worker may become deconditioned from lack of activity.  If you’re a mason who’s used to lifting block every day for the past 15 years and now you haven’t lifted anything more than five pounds since your injury, you may have lost some of your strength and stamina.

 

What do these consequences have to do with medical inflation?

·     Isolation may have negative consequences on an injured worker’s motivation to get better.  It may also deplete their ability to cope with the aspects of managing their claim and their recovery.  For those of us who need people around us to support us, to guide us and to motivate us – when you take that away it can leave one feeling alone and without the wherewithal to get up and push through challenging physical therapy sessions or perform the home exercises that help in recuperation.

·     They may have an increased need for prescription pain medications or other medications.  These prescriptions may have negative side effects (and may require additional medications to treat the side effects).

·     Deconditioning may require additional physical therapy or work hardening.  It may also lead a physician to extend the time period between improved work status notes, resulting in increased office visits for progress checks.

Prudent, proactive employers should focus on preventing injuries in the first place.  But, when injuries do occur, a plan that focuses on the whole person (employee) and their return to wellness should be ready to go. 

 

What steps are you taking to prevent future injuries like this from happening? 

What are you doing to communicate regularly with the injured worker while they are totally disabled?

What are you able to offer based on what the anticipated restrictions? 

Are there other concerns that the injured worker has about their employment or benefits?  Address the concerns and to reassure your employees that you will work together reach the best possible outcome for them in their recovery. 

 

It’s never too early to have these discussions.  Start today.

Why bother with a job offer letter?

Time consuming, tedious, and seemingly unnecessary -- job offer letters for a worker's compensation claim are probably not an employer's favorite task.  As a RTW person, they're at the top of my reading list.  I realize this is not the case for most.

Why should employers offer a modified or full duty job in writing?

• It clearly communicates the expectations surrounding the return to work.
• What are the restrictions the employer is referring to base their offer on?
• What are the job duties?  Rate of pay?  Hours?  Start date?
• Where and who should the injured worker report to?
• How will other benefits be handled (accrued time, etc.)?
• Who should the injured worker contact if they have questions?
• It documents the offer
• So many times the employers state that they offered work or tried to offer work and the injured worker didn't show up.
• That may work in some states, but in many, employers need some type of documentation to demonstrate the offer.
• The letter is important in showing the amount of earnings the injured employee may be refusing as well as details that help a judge determine if the employee was unjustifiably refusing the work or if it was justified.
• This directly relates to whether the employer is entitled to relief under the WC laws or if the injured worker is entitled to ongoing benefits.
• IF an employer finds themselves in litigation over a job offered, they may need to testify.  This may not happen for months.  Are you going to be able to recall a conversation you had with any great level of confidence during a hearing?  Having everything written out will help ensure that you know what you offered months prior.
• It is a best practice
• Once an employer incorporates this practice into they disability management policies, it becomes routine and simple.
• It may be dictated by various laws other than workers' compensation (which is what this particular post pertains to).

Before issuing a modified or full duty job offer it's a good practice for the employer to contact the injured worker and let them know that modified work (or full duty work) is available.  This will allow them to ask questions in advance of receiving the letter and communicate things with a level of transparency that will hopefully make the process go smoother.

When the duties of a job change or the wages change, it may also be a good idea to send an updated job offer to document the changes.

Although they are sometimes time-consuming, job offer letters can be based upon a template that will pay for its initial investment time and time again.  If you have questions about what needs to go into a job offer letter, please contact your claim representative as each state has its own set of requirements (or lack thereof).

Defining Disability - Part III: The Regulatory Perspective

The disability time clock

We've said it before and we'll say it again, upon issuance of that work-related disability note, the clock starts ticking.  Before that work status report makes it to the employer or claim representative's desk,   Many states have some type of waiting period in which wage benefits are not due under a workers' compensation claim. Typically these waiting periods are something like 3, 5 or 7 days.  After this waiting period has expired, in some states, the injured worker is then entitled to wages from the first date of disability (retroactive to the first date of disability).  Other states, the retro period is longer.  An example of this is Pennsylvania.  The waiting period is 7 days.  So if you're disabled for 7 days or less, you are not entitled to wage loss benefits.  However, if you're disabled for 8 days or more, you're entitled to benefits from that day forward, up until the 14th day.  If you're disabled more than 14 days, then you're entitled to benefits retroactively to the first day of disability.  Not sure why people get confused by this...

Not only does the first date of disability impact the wage calculations, it also starts the compensability decision clock.  States have compensability due dates or deadlines that dictate how long a claim representative or workers' compensation carrier has to accept or deny a claim.  This is based on the workers' compensation laws in each state.

Impairment or Permanency Ratings

Whether or not an employee is back to work can have an impact on their permanency or impairment rating.  In some states, an injured worker is entitled to wage benefits based upon their earning capacity after an injury.  In others, they may qualify for an impairment or permanency rating.  This is a very basic generalization for explanatory purposes only, however, when an injured worker has an injury to a particular body part (or in some states, any injury) they may be found to have a permanent impairment.  In an attempt to compensate the injured worker for their permanent impairment, they receive a rating from a physician who evaluates the degree or percentage of impairment.  Many states have a schedule of injuries that indicates how many weeks of disability benefits an injury equates to.  This rating, given as a percentage by a physician, is then multiplied by the number of weeks to get the total amount of permanency.

There are also factors that can increase or decrease a rating, depending on what state the injured worker is receiving benefits.  Some states take into account the injured worker's RTW status.  If they are not back to work or of they are back to work can impact the amount of their rating.

Employers are encouraged to offer modified duty, not only to reduce an impairment rating, but because it also helps that injured worker's recovery.  This posts primarily focuses on the "laws" and "regulations" as they relate to disability, but that is what takes place from this perspective.

Much of what the laws look at is related to when benefits are due, how much the injured worker is entitled to, and what makes them eligible or ineligible.  The laws focus on earning capacity and residual impairment related to the work injury.

They don't take every circumstance into consideration, they may not even consider if the employer has work available or not - it may be that once and injured worker reaches maximum medical improvement, they are no longer entitled to a certain level of wage benefits.  The laws dictate the benefits due to injured workers and the actions of the workers' compensation carrier.

We hope you found this series of posts to be informative.  Each of us have our own perspective on disability and its definition depending on what we do -- as employers, injured workers, medical providers, and insurance carriers.  If we expect to understand what the other person is saying, we must understand where they're coming from and what the word "disability" means to them.

Defining Disability - Part II: The Workplace/Employer's Perspective

In our last post we introduced three different perspectives as they relate to how we define "disability."  The goal of these posts is to enlighten the respective participants in the WC/disability management community as to the various lenses through which others are viewing disability - doctors, injured workers, employers, and workers' compensation professionals.  With greater understanding, the hope is that we can cut out some of the miscommunication and confusion, creating a greater awareness of where people are coming from -- yes, we're talking about the radical idea of empathy in workers' compensation.

This post will outline some of the constructs we use to define disability when we're talking about it from the employer or workplace setting.

Workplace/Employer Perspectives - Workers' Compensation

We'll preface this post by stating that we're not going to address FMLA or short/long term disability - rather we will focus on disability as it relates to modified duty in the workplace.

It is common practice for an injured worker to bring their employer a "Return to Work" or "Work Status" note from their treating physician as a result of a work related injury.

The employer is now in a position to make a determination as to whether they can or cannot accommodate the restrictions.  Maybe the injured worker's pre-injury position falls well within their restrictions.  More often than not, the restrictions impact some aspect of that injured worker's job.  Consider a person who sits at a desk but has walking limitations.  They can perform their job, but may need a closer parking space or a wheelchair to navigate the building until they can reach their desk. 

With the exception of very large companies, most employers don't have one person who solely handles workers' compensation claims and manages the return to work of injured employees.  If they do, then the frequency of their lost time claims probably justifies their pay.  For the average employer, workers' compensation is not something they have to handle every day (and they're thankful for that). 

Considerations for Employers and Employees

We will assume that an employer has identified work within the injured employee's restrictions.  Much of the focus rests on the actual work the injured worker is performing and what work their doctor says they can and cannot safely perform. 

Employers aren't always considering the other factors that may impede or promote return to work outside of the "disability" note.  Does the supervisor understand what the injured worker is being asked to do on modified duty?  Do they understand that they cannot/should not ask the injured worker to do work outside of their modified duty work assignment if it falls outside of the work restrictions?  Who should the injured worker address concerns with? 

Does the injured worker have a good relationship with their employer and coworkers?  Have their been past performance issues that the employer may be weighing in to their ability or inability to offer work (right or wrong it happens)?

While many of these factors do not impact the injured worker's entitlement to benefits, it can impact the outcome of the claim and should not be overlooked.

From an employer's perspective, they are focused on the work that needs to be done to continue their operations, costs associated with having a workers' compensation claim, the costs associated with replacement labor/overtime to compensate for the injured worker's disability, and hopefully they're considering the positive impact that modified duty can have on all of these factors.

Tune in next time when we'll be discussing RTW from a regulatory perspective.  Rest assured, the title is far less interesting than the useful content provided in that post.

Defining Disability - Part I: The Medical Perspective

Whenever we have a discussion with someone, we’re processing the information they are relaying based upon our own experiences and interpretation of what the other person is saying.

It never matters what you think you said -- it’s what the other person heard.

If you asked 20 people to define the word “disability” you’d receive 20 different, albeit somewhat similar, responses.  They’d all most likely focus on comparable aspects of the word, maybe even involve like examples.  There would also be some stark differences.  This is because we’re all defining it based upon our personal experiences and where we sit in the world.

This series of posts will focus on our unique perspectives into the definition of disability – medical, workplace, and regulatory definitions.  I encourage you to ask a sampling of people to define disability to you.  Think about the frameworks they’re using – physical limitations, work situations, developmental limitations, etc.  Consider why someone is using that frame of reference – it’s based upon their experiences.

Medical

When a person sustains an injury or illness, their doctor, or other medical professional, often discusses what types of activities they should avoid and what activities are “safe,” often putting some type of limitation on a particular activity.  An example of this would be no overhead lifting or no lifting over 15 lbs.  These recommendations are based upon past experience, objective reference guides, and individual attributes of the injured or ill patient.  The healthcare provider is often considered the “expert” who is making these determinations.  As you can see, they play an incredibly important role in stating what the injured or ill person can and cannot do based upon their medical (physiological) condition.

The medical definition of disability does not contemplate what the injured worker’s job requirements are – if you cannot lift 15 lbs. at work, it is not safe to lift 15 lbs. at home.  In this respect, we’re focusing on what the injury is, what it has done to your body and what you’re subsequently not capable of safely performing as a result of the injury.

What types of challenges are presented?

In the various arenas that these restrictions are used, the information may not be considered adequate or sufficient from the end-users’ perspective.

Injured worker: 

• What does 15 lbs. really feel like?  I don’t carry a scale around with me, how will I know? The result is general avoidance behavior.  The injured person will avoid lifting things with unknown or uncertain weights.  I know I can lift that  5 lbs. bag of sugar because it says it weighs 5 lbs., but I know I can’t lift my dog because the last time we were at the vet, she weighed 27 lbs.
• There may not be a clear understanding of why the restrictions are in place, i.e., what additional damage could be done by exceeding the restrictions.  Conversely, fear or re-injury and avoidance behavior can result in unintended negative consequences such as “frozen shoulder.”  This can occur in shoulder injuries due to lack of motion.

Employer:

• Similarly to the injured worker, they’re not sure what each aspect of their employee’s position entails.  There’s probably a fear of re-injury as well.  This can lead an employer to say that they don’t have work and that it’s best to let the injured worker recover before returning.
• The employer may not understand fully what work the injured worker can and cannot safely perform. The employer may be trying to complete FMLA, short term disability, and/or workers’ compensation paperwork with the information provided.  Often times a disability note provides the date it was written and the current restrictions.  This is only part of the information needed to complete these forms.

We’re provided with some of the information we need, but not everything we need for every system that the injured worker maybe find themselves in.  This results in follow up paperwork that is generally specific to the employer or insurance carrier.  Each of these parties has their own “definition” of what disability means.

What can injured workers and employers do to navigate these definitions?

• Injured worker
• Understand what information your employer and/or their workers’ compensation insurance carrier needs.
• Ask questions
• How is disability defined?
• In some state workers’ compensation systems it solely depends on earning capacity as a result of your work injury/illness.  In others it may have differing definitions. If you don’t understand, keep asking questions until you do.
• Questions for your doctor:
• Can I safely perform duty x?  How does my activity level impact my recovery?  What are some of the signs that I’ve done too much or too little?  If I feel good can I do more?
• Employer
• Understand what information your company needs to make a determination about modified duty:
• What is the injured workers’ job?  What are the physical requirements?  Are there other jobs that fit these restrictions?
• Ask the physician to approve or comment on the pre-injury or modified duty job description.
• If you aren’t sure what they can safely do, ask!
• Communicate with the injured employee to make sure everyone has the same understanding of the work and the restrictions.  

It may be helpful to explain what framework you’re using when describing or defining disability.  An example of this would be a doctor saying, “From a medical standpoint, your rotator cuff is torn.  At this point in your rehabilitation, you’re able to use your injured arm to lift no more than 2 lbs., no higher than counter/waist-level height.” 

That’s informative for an injured worker to know, but what does that mean in terms of them returning to work? 

Be sure to check out the rest of this series on the different ways disability is defined and why it matters.