Working With Your Medical Provider

As promised, here is the installment on working with your occupational health medical provider. You want one who is sure to support your return to work program consistently.

Your company’s preferred medical provider(s) must understand return to work programs for your program to be effective. Someone with daily responsibilities in workers' compensation, needs to make prior arrangements with one or more to let them know of your Transitional Duty Program. There may be more than one medical provider in your location that is willing to work with you, so reach out to all of them to determine the best fit for you and your employees.

Most hospital systems and traditional ‘walk-ins’ have occupational health programs, however many of them merely accept workers’ compensation insurance, and/or provide health, wellness, and pre-placement screenings. Although they may provide very appropriate medical evaluation and treatment, they may not provide consistent return to work restrictions. 

They also may be inclined to give an employee ‘some time off’ (many times at the request of the injured or ill worker), not realizing that state requirements may limit the amount of money an injured/ill worker can receive. Many employees cannot survive on approximately 60% of their salary allowed by most workers’ compensation programs, and many programs have caps for high earners. Be sure to let the provider know what the rules are for your state. I can almost guarantee you that they will not know.

Your occupational health manager and nurse/coordinator should attend the meeting with each of the medical providers in your immediate location. You can do your own research or ask other employers in your area for recommendations. A drive of more than 20 minutes is probably too long, so you will want to stick to a provider as close to you as possible.

At the meeting, ask the provider’s liaison to explain their program, show you which forms you should expect to see from them, and if they issue return to work restrictions for all injured/ill workers. Minimally providers should give you a tour of their location and be open to tailoring their program as best they can to meet your needs.

When interviewing the health care provider, ask for statistics such as: 

• What percent of injured/ill workers are returned to work with no restrictions
• What percent are returned to work with restrictions
• What percent are placed out of work
• As a rule of thumb, your out of work orders should be no more than 10% of the total number of injuries/illnesses who received evaluation
• Wait times to evaluation
• Many providers will expedite injured/ill workers if you ask, and the provider can do so safely without harm to other waiting patients
• Average length of stay for non-critical care and treatment
• Important to know how long your employees are expected to be away from the work site (We found that following evaluation, some employees 'got lost' or went out to eat on their way back to the work site)
• Expectations for specific injuries
• What is typical for treatment and work restrictions for injuries easily accommodated in a transitional duty program, such as:
• Back strains
• Hand lacerations
• Repetitive motion symptoms (typing or machine induced rotations)

Be sure to advise the health care provider that you do indeed accommodate all types of injuries in your return to work program. Invite the health care provider to tour your facility to obtain a greater understanding of your industry and environment.

You should feel comfortable asking them to expedite evaluation and treatment for your injured/ill workers. The medical provider may or may not be able to accommodate on a daily basis, but may make every effort to comply when possible. Also ask for volume discounts should you expect to send workers regularly for evaluation or if you purchase other services such as drug testing or pre-employment physicals. 

What you want to establish is a working, reciprocal relationship with your medical provider so that if and when problems arise, you feel comfortable calling them to discuss.

If you find that the medical provider does not already provide work restrictions it may be difficult to get them to do so consistently as there are generally many physicians, physician assistants, and nurse practitioners working at any one facility. Gearing all of them up to your needs can be a huge undertaking. Move on to the next provider to see what they can offer.

Once you have selected a provider, be sure to educate all of your employees where they are located, times of operation, etc. Your medical provider should be able to provide you with a document for posting. Post the list for your supervisors and employees and regularly update them as needed. 

A couple of key points that will reduce employee anxiety and increase cooperation are that you have made arrangements up front for no long waits and that the provider is located no more than 20 minutes away from your facility.

Next week I will speak on the Workers' Comp Company Doc, pros and cons. 

Here is another install on Transitional Duty, being that it is the second most important element of an early return to work program and a major contributor to your loss control efforts. (The first you remember, is that injured or ill workers must report the incident prior to the end of their shift.) 

(C) nluz 7/2012

You may laugh at my cartoon (I hope you'll get at least a chuckle), but this actually occurred in one of my clinics. A pole dancer from a nearby club fell off her high heel. Our somewhat conservative doc was his usual professional self, and did come up with a reasonable 'light duty' assignment.

Research has proven that the longer workers stay out of work following an injury, the less likely they are to return to full duty. Pole dancers included. It takes approximately three weeks for a new routineto set in, and the longer injured/ill workers are immobile the longer it takes for them to recover, and the worse it is for the injury. The two best catalysts to a full recovery? Keeping up with normal routines and staying active within restrictions.

The manager/supervisor plays a major role in the development of Transitional Duty tasks, and is responsible to see that the injured/ill worker is adhering to the physical restrictions while at work, according to the physician’s documentation. It may seem difficult, but applying a common sense approach to the assignment of tasks is the best first step. There are three basic physician discharge instructions (work restrictions) following an injury. 

• Return to work with no restrictions
• Return to work with restrictions (job duties and/or number of hours)
• No work (for # days)

The first of course is easy. The employee receives return to work, no restrictions. However be sure to keep a copy of those discharge instructions in the employee’s file. It is best to show closure of an injury which can help determine if any future injuries are new or a recurrence of an old. Your workers' compensation carrier will want to know.

The second, return to work with restrictions, may be anything from reduced hours to reduced tasks; such as weight lifting limits, an elimination of one or more components of a job such as typing, driving, sitting/standing, or no wet work.

It is recommended that ‘functional’ job descriptions be developed for more complex or injury-prone jobs within an organization, and then eventually for all jobs. The following web site goes into detail on what a functional job description should include: 

http://askjan.org/media/JobDescriptions.html

For a sample Functional Job Description click here: http://www.workforcesafety.com/safety/sops/FunctionalJobDescription.pdf

From the medical provider's Work Ability/Work Restriction Instructions, the manager/supervisor then makes out the Transitional Duty assignment. Now, you may be thinking that this is a very complicated task, but it need not be. Look at the employee’s usual job duties and apply common sense to assigning restricted tasks. If you truly have questions, ask your medical provider to refer you to a physical therapist who can help you to modify job assignments. This will of course involve a charge.

It is very important to always adhere to the physical restrictions as established by the medical provider. If the home department cannot comply with the restrictions, do not send the injured/ill worker home! Make arrangements to have the injured/ill worker perform tasks in another department.

Consistency in accommodating ALL employees back to work on Transitional Duty is imperative for the success of the program.

Do not give employees the opportunity to believe that favoritism exists within your organization. The greatest challenge is in assigning tasks particularly when the program is new. Again, the common sense approach works every time. If your employee normally spends the day on a typewriter and provides you with ‘no typing’ as a work restriction, then look at other tasks that employee could perform. Filing, mail delivery, review of policy and procedure for needed revisions, answering the phone, are all tasks that may be perfectly safe for the employee to perform. 

Also look consider job sharing with another department while the employee is recovering. Every department has a wish-list of tasks that never seem to get done. Transitional Duty often provides a way to get those can’t-get-to tasks accomplished! However beware the light duty department trap. This is generally how organizations fall into the permanent light duty black hole.

For those companies that have very task specific workers such as cable companies or construction, determining Transitional Duty tasks pose more of a challenge. But you can bring the injured/ill worker into the office to assist other staff with customer mailing activities, or assign quality and safety monitoring at a work site. You may want to consider volunteer work as well, as an option for a transitional duty assignment when work restrictions are particularly challenging.

Be creative to always keep the injured/ill worker working. And always stay in touch as to how the employee is tolerating the new assignment or tasks, regardless if you consider the employee to be a problem, or if you feel guilty about the situation, or if you think asking questions is being nosy. Making excuses is easy and I've been tempted myself. But open communication shows that you care about that person, as a person. 

The third discharge instruction, no work, should be rare and only for the most severe of injuries such as head and/or eye injuries, severe bleeding requiring extensive stitches, etc. No more than 10% of your total injuries/illnesses should receive an out-of-work order. If you believe that the medical provider was too strict in its discharge instructions, contact them for an explanation and to assure them that you provide Transitional Duty. Ask for a revised work restriction form. Also, be aware that some employees will say their employer does not have a Transitional Duty program. So counter:

• To avoid ‘no work’ restrictions, a manager or supervisor should accompany the injured/ill worker to the medical provider, particularly when the Transitional Duty program is new. Be sure he/she brings the (functional) job description and any Material Safety Data Sheets (MSDS) that apply. 

This may cause staffing difficulties initially but by escorting an injured/ill worker to the medical provider you send two messages. The first is that the employer cares about the individual’s welfare. And the second is that it shows that the employer takes its Loss Control program seriously and will accommodate all injured/ill workers. This leaves little room for abuse of the system for those few employees who just want some time off or who feel ‘entitled’. 

Next week I'll provide some information on how to manage your occupation health care provider. Their cooperation is essential to your workers' compensation efforts.

The Permanent Light Duty List (A Bad Idea) Part 2

As promised, a further discussion on the Permanent Light Duty List and employees who may be on light duty or restricted work indefinitely. Both circumstances are unnecessary and a cost burden to your organization. 

Last week I spoke on limiting the length of time someone can be on light duty. An important part of this process is The Transitional Duty Meeting. I use the word transitional as it denotes a process not a condition. 'Light Duty' and 'Restricted Work' may sound permanent to an employee or to his/her manager but the terms are used interchangeably.

The Transitional Duty Meeting should be held:

• Anytime there is confusion about the employee's situation
• Prior to the end of the first three months if the injured/ill worker is requesting an extension
• At the end of the extension to sum up the case before the injured/ill worker is put out on indemnity

You will find that these meetings are not actually needed all that often, but they are an excellent communication tool after a complicated or confusing injury or illness. However, let everyone know up front that your workers' compensation policy now includes Transitional Duty Meetings. Like you and I, employees want to know what to expect.

A Transitional Duty Meeting is composed of the following people: 

• The injured or ill worker
• His/her direct report (supervisor or manager)
• A representative from Human Resources (the one who processes the claim)
• Your workers' compensation medical designee (on-site nurse, safety officer, occ health physician, etc.)
• Someone from executive leadership such as the Vice President of Human Resources or COO

The meeting should be opened by executive leadership who requests that everyone introduce themselves, then defines the purpose of the meeting; which is to be sure everyone is on the same page as to the employee's condition and expectations for recovery and return to full duty.

The injured/ill worker is then asked to present the facts about his/her situation - how the accident occurred, how he/she is feeling, how the restricted work assignment is working out, if there are any questions or issues, dates for further treatment or testing, etc. This is the time to hear directly from your employee, for you to show that you care and that you take your policy seriously.

The supervisor or manager is then asked to do the same. Have problems been noticed? Has the worker done more than what is allowed during the recovery phase? Are there questions or problems with medical appointments, etc.? 

The remaining members participate as necessary, including the sharing of relevant information from the insurer or Third Party Administrator (TPA). But executive leadership should not try to run this meeting. He/she is there to show (silent) support for the workers' compensation program and interject only when there seems to be an obstacle in the process. At this meeting dates are established, new information is provided, and follow-up is established, without the VP's influence in most cases. 

Granting an extension should only be approved when medical evaluations indicate that a full recovery is possible. If you suspect an employee to be fraudulent in his/her claim or recovery, the Transitional Duty Meeting is the best way to identify it, and can actually prevent fraudulent activity in the first place. More on fraudulent claims in a future entry. Feel free to schedule them as you or your team feels the need to do so. These meetings will prevent the need for indefinite or permanent light duty.

However, if you do have a Permanent Light Duty List, how do you get your employees safely off it? 

There is a way. The organization I mentioned last week had 13 people on its Permanent Light Duty List for up to 2 years. Within about two months, twelve returned to full duty and the thirteenth was settled with and left the organization. Here is the process:

1. Your workers' compensation medical designee (on-site nurse, safety officer, occ health physician, etc.) pulls all paperwork related to each claim and establishes a file for each individual, to include medical reports, dates of incapacity, and job description. A Functional Job Description is best if you have one.

2. Your designee makes arrangements to have each employee on the list evaluated by an occupational health physician, who will need any and all medical reports as well as the (functional) job description. 

Note: You may not have your own occupational health physician. If not contact your local hospital or workers' compensation medical provider, insurer, or TPA to find one. If there are none in your locale, many orthopedic surgeons, chiropractors, or osteopathic physicians sub-specialize in occupational health. Let them know up front why you are contacting them and the goal of the evaluation (which is a determination of an employee's capacity to return to full duty).

3. Your designee then sends a written letter to each employee on the list stating that it is time for he/she to discuss the permanent (or indefinite) light duty assignment with management and that a medical evaluation is required. Provide a date to meet.

4. Your designee discusses the situation with the employee then facilitates the medical appointment. Request that a written report is forwarded to him/her directly from the physician. In most cases, you will find that your employees will be returned to full duty.

5. Your designee then contacts Human Resources as to the outcome, as well as the insurer or TPA so they can close the case. Human Resources may need to help the employees find suitable positions within the organization if their old jobs have since been filled. You may also find that some employees choose to find employment elsewhere once they are asked to return to their old or similar position.

6. If permanent injury is identified, then it is best for the organization to seriously consider settling the claim. Discuss the findings with your TPA or insurer. Consistency is key to a successful program, and it is financially wise to cut future workers' compensation expenses now by reducing your number of current open claims. If you do not want to settle, if you feel committed to the injured worker, then ask Human Resources to place the employee in an already established job that has an existing job description for which they are fit to perform.

Next entry will be a continuation of post-injury management and the importance of an early return to work program, light duty, or as I will refer to it going forward, the Transitional Duty Program. If you have any questions meanwhile, please feel free to post and I will answer them as quickly as I can. 

The Permanent Light Duty List (A Bad Idea) Part 1

Today I thought I'd cover an easy-to-fix workers' compensation program design flaw that will get you moving towards best practice in claims control, reduce indemnity expenses, and improve employee relations. This newest easy fix? Never have permanent light duty assignments. 

Many employers think that Permanent Light Duty is the only way to manage injured workers who don't seem to be getting better. You may be legitimately concerned about your employees, feel guilty about the incident, or just plain out of ideas. And if you are like many organizations, your light duty list has been created and then forgotten. An equally offensive offshoot is the extended stay assignment. In this case the injured/ill worker is on restricted duty indefinitely. There's no end in sight which leads to a high cost of claims and a great deal of frustration. 

Being that workers' comp is a line of business within the organization like any other line of business, let's first take the emotion out of it. An employer should not be writing job descriptions for individual employees, unless of course it is to fill a hole in production or service that requires a particular expertise. Having had an injury/illness does not meet that standard. In addition, other employees, and organized labor if you are a unionized shop, do not look favorably upon specialized treatment which causes a confrontational culture within your ranks.

Also, when you have individuals on no-end-in-sight work restrictions or modified job duties for an extended period of time, those employees may be able to legally fight to make those positions permanent. Your labor law attorney will know more regarding the state laws under which you function. And I don't think I need to go into detail about workers who have issues with their supervisors, or those who don't like their jobs who end up on light duty. In these circumstances you may find both the employee and his/her manager willing to continue the light duty assignment indefinitely.

One of my clients, a large Massachusetts employer, had 13 people on its Light Duty List. The longest employee was on light duty for over two years! All but one were returned to full duty after it was medically determined that they were indeed fit to return to their old jobs. The employer decided to settle with the permanently injured worker which was accepted without contestation.

What does this mean to an employer? Improved productivity, improved employee/management good will, and reduced claims expenses. (If it's not you, then your insurer or TPA is paper managing those cases which they charge back to you.) A point to remember going forward is that most injuries heal within 3 weeks. Your light duty program must have end dates to be efficient and encourage wellness. There are some injuries that may take several months especially if surgery is involved, however the following addresses both circumstances. Let's look at the details.

Best practice programs have two important dates written into policy. The first is that light duty is a maximum of three months. Within three months the employee returns to full duty. By setting this standard your injured/ill worker knows what to expect. Remember, family and friends love to make recommendations about what to do after a work related event so you have to set the standard, and stick to it. If your employees are better in 2, 4, or 6 weeks, that is when they return to full duty.

When this is not possible and an employee is medically unable to return to full duty within three months (surgery is involved, medical evaluations are yet inconclusive), the second written policy date of importance is that light duty may be extended for an additional three months, however in order to receive the three month extension, medical evaluations must indicate that a full recovery is possible.

Next entry I will cover another unique program design element that should never be missed when an extension is required (The Transitional Duty Meeting). I will also share how we got our 13 employees safely off the Light Duty List. Meanwhile you might want to pull the files of those people on permanent (and date unknown) light duty to see what you have that needs managing. 

Hopefully you have already incorporated my first rule of workers' compensation: employees must report an injury or illness prior to the end of their shift, so that you can begin this next policy change - putting end dates to your light duty, restricted work assignments. Workers' Compensation does not have to be difficult, just managed well! Good luck, and I look forward to any comments, suggestions, or experiences you wish to share!

The 'First Rule' in Workers' Compensation

Greetings! So, is there a best practice approach to claims control that truly works, and benefits everyone involved - the employer interested in reducing expenses, the manager responsible for production, and the injured or ill worker as her or she traverses the path to a full recovery? Yes, there is! I hope this forum will be of benefit to those of you with the arduous task of managing workers' compensation claims. I learned the hard way after being promoted to Director of Corporate Health Services for a large health care system. I've decided to share my 'common sense' program design with you. You see, managing workers' compensation claims doesn't have to be difficult.

Each week I'll add an element that is easy to incorporate into your existing program that has been proven to work! If you are anything like me, the confusing volumes of information available on loss prevention cannot be compared to practical experience, by someone who is practical and not paralyzed by detail. I hope you will trust me. I have both an RN and an MBA and experience with revenue generating and non-revenue/cost center responsibilities in workers' compensation program management.

So, what is the first rule, never to be broken? Your injured or ill worker must report the injury or illness prior to the end of his of her shift. Simple right? Make sure this is included in your policy and procedure manual immediately if not sooner. It is the most significant element of a loss control program. But consistency is key. You must never relax this for anyone in the organization, including upper management. Let them know that they will be pleasantly surprised to see that suspected fraudulent claims if you have them, will suddenly drop off. It's very easy to enter a false claim from days or weeks ago, but difficult to do the same day of the fabrication.

However, most claims are legitimate. But many injured or ill workers worsen their condition after leaving work if they don't know what their restrictions are, like picking up children or mowing the lawn. Without medical evaluation they can worsen an injury, which your employer will pay for in lost time and medical expenses. Additionally, you as the manager need an immediate awareness of the issue to implement corrective action and prevent additional injuries, the ability to discuss the situation with witnesses if any, and the opportunity to provide the injured or ill worker with that immediate medical attention. 

This one policy requirement reduces the cost of workers' compensation by positively influencing the outcome of the claim. Good medical care is immediate and includes discharge instructions to be followed both at work and at home. Be sure your workers are aware of this - work restrictions apply to both. All best practice loss control programs contain this critical policy requirement. You can also include that if employees do not comply with policy then your insurer or Third Party Administrator may deny the claim. They may or may not, but putting this information out there is another way to encourage compliance.

I have a new blog: Please check it out here: The Biological Human - Wellness Tips for Body, Mind & Soul