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Good Evening
11:02:09 PM CDT
Sunday, September 14, 2014

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Return To Work

Topics Vocational Rehabilitation Forms & Publications Physical Demands-Strength Rating
Return to Work Services Preferred Worker Program WSI SAW/RTW Initiatives Actions and Motions
Transitional Work Job Development Vocational Rehabilitation Brochure The Role of Medical Case Manager
On-Site Return to Work School Coordinator Preferred Worker Program Brochure  
Medical Case Managers When Work Related Disability is Medical Required MCM Referral Criteria  

**Awareness of how rarely Work-Related Disability is Medically Required
Only a small fraction of medically excused days off work are medically required – meaning work of any kind is medically contraindicated. The remaining days off work result from a variety of non-medical factors such as:

  • Administrative delays of treatment and specialty referral
  • Lack of transitional work
  • Ineffective communications and lax management
  • Logistical problems

These days off are based on non-medical decisions and are either discretionary or clearly unnecessary. Absence from work is “excused” and benefits are generally awarded based on a physician’s decision confirming that a medical condition exists. This implies that a diagnosis creates disability.

However, from a strictly medical point of view, people can generally work at something productive as soon as there is no specific medical condition to keep them from working (see Table 4 below). The key question is what kind of work? Many obstacles that appear to be medical are really situation-specific. For example, an employee with a cast on the right foot cannot drive a forklift, but can perform other tasks until the cast is removed. A person recovering from surgery may not be able to work a full day in the office, but could work half days. In fact, people often sit home collecting benefits because their employers don’t take advantage of their available work capacity. Today, these decisions generally are misclassified as “medical,” and as such are not examined.

Recommendation:

  • Stop assuming that absence from work is medically required and that only correct medical diagnosis and treatment can reduce disability.
  • Pay attention to the non-medical causes that underlie discretionary and unnecessary disability.
  • Reduce discretionary disability by increasing the likelihood that employers will provide on-the-job recovery.
  • Instruct all participants about the nature and extent of preventable disability.
  • Educate employers about their powerful role in determining Stay-A-Work/Return-to-Work (SAW/RTW) results.

Current Initiatives/Best Practices: Clinicians, employers, and insurers can now use the following criteria (see Table 4) to determine whether a disability is medically required, discretionary, or unnecessary. If all parties use these definitions, clearer communication and better decision making will result. In particular, physicians will no longer have to make employment decisions, and employers will stop misclassifying business decisions as medical decisions.

Table 4 – When is a Disability Medically Required, Medically Discretionary, or Medically Unnecessary? *
Medically Required Medically Discretionary Medically Unnecessary

Absence is medically required when:

  • Attendance is required at a place of care (hospital, physician’s office, physical therapy).
  • Recovery (or quarantine) requires confinement to bed or home.
  • Being in the workplace or traveling to work is medically contra-indicated (poses a specific hazard to the public, coworkers, or to the worker personally, i.e., risks damage to tissues or delays healing).

Medically discretionary disability is time away from work at the discretion of a patient or employer that is:

  • Associated with a diagnosable medical condition that may have created some functional impairment but left other functional abilities still intact.
  • Most commonly due to a patient’s or employer’s decision not to make the extra effort required to find a way for the patient to stay at work during illness or recovery.

Medically unnecessary disability occurs whenever a person stays away from work because of non-medical issues such as:

  • The perception that a diagnosis alone (without demonstrable functional impairment) justifies work absence.
  • Other problems that masquerade as medical issues, e.g., job dissatisfaction, anger, fear, or other psychosocial factors.
  • Poor information flow or inadequate communications.
  • Administrative or procedural delay.

(Source: ACOEM Practice Guidelines, Cornerstones of Disability Prevention and Management)

**Urgency is required because Prolonged Time Away from Work is Harmful
Unnecessary prolonged work absence work can cause needless, but significant harm to a person’s well-being. While on extended disability many patients lose social relationships with co-workers, self-respect that comes from earning a living, and their major identity component – what they do for a living. Many key players in the SAW/RTW process do not fully realize the potential harm that prolonged medically excused time away from work can cause. Many think that being away from work reduces stress or allows healing and do not consider that the worker’s daily life has been disrupted. With these attitudes system-induced disability becomes a significant risk. Early intervention is the key to preventing disability. Research confirms:

  • People who never lose time from work have better outcomes than people who lose some time from work.
  • The odds for return to full employment drop to 50-50 after six months of absence.
  • Even less encouraging is the finding that the odds of a worker ever returning to work drop 50 percent by just the 12th week.
Recommendation:
  • Shift the focus from “managing” disability to “preventing” it and shorten the response time.
  • Revamp disability benefit systems to reflect the reality that resolving disability episodes is an urgent matter, given the short window of opportunity to re-normalize life.
  • Emphasize prevention or immediately ending unnecessary time away from work, thus preventing development of the disabled mindset, and disseminate an educational campaign supporting this position.
  • Whenever possible, incorporate mechanisms into the SAW/RTW process that prevent or minimize withdrawal from work.
  • On the individual level, the health care team should keep patients’ lives as normal as possible during illness and recovery while establishing treatments that allow for the fastest possible return to function and resumption of the fullest possible participation in life.
Current Initiatives/Best Practices: Many employers and some insurers now begin return-to-work efforts on the first day

** information taken from ACOEM’s Preventing Needless Disability Guideline.
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