It was Tuesday afternoon and a long-time employee was delivering a heavy load as part of his daily routine working for a beverage distributor, but this time he injured his back going up a flight of stairs and suffered significant lower back pain. He was prescribed pain medication and physical therapy. He had worked more than 30 years with his employer and was proud of his ability to perform his duties. He had a work-related back injury in the past and was fearful that further aggravation would put him in a wheelchair. He was also concerned that if he returned to light duty, he would be expected to perform the same jobs that caused the injury. A nurse case manager was involved as a part of his employer’s return to work program and she helped the employer search for options to expedite a safe return to work. By coordinating with the case manager, the employer was able to place the employee in a different light duty job that allowed him to return to work less than two months after his injury and remain in the same job once he was released to full duty.
SUPPORTING A STRONG RETURN TO WORK PROGRAM
Returning to work after an injury or illness can be difficult depending on the circumstances involved. The keys to ensuring success include having a return to work program that is focused on teamwork and consistent communication between all parties – the employer, claims examiner, nurse, return to work and behavioral health specialists – and most importantly, the injured employee. This ensures that everyone is on the same page when the return to work goals and plans are being developed. The involvement of individuals such as a nurse and return to work or behavioral health specialist should be determined by systematic triggers and human expertise. Frequent communication keeps the employer informed of what’s going on and ensures the employee remains connected to their workplace – a vital part of the process.
In addition, communicating with everyone prevents duplication of effort and reduces the chances for confusion for the employer and injured employee. There really has to be collaboration among all parties to set expectations and to ensure everyone understands the return to work goals. If the nurse, examiner, and return to work and behavioral health specialists are all working on the same system, the team can coordinate with one another to ensure the right person with the right expertise is on the file at any given time – providing increased flexibility and shared accountability.
GETTING INVOLVED EARLY
We engage the injured employee by beginning the conversations immediately after the injury, so that the injured employee understands the company’s return to work policy and each person’s role in the process – including his or her own. This lets the employee know what will be expected and can reassure the employee that their employer is committed to helping facilitate a safe return to work. Also, the less time injured employees are off work, the higher the chances they will go back to work. It is very important to get all of the resources needed involved early in the claim so that a plan can be formulated. The overall process can be driven by a return to work specialist, a nurse or a behavioral health specialist, depending on the complexity of the situation. Early and frequent communication sets the tone for cooperation among all parties.
DRIVING RETURN TO WORK SUCCESS
Typically, a return to work specialist is a Certified Rehabilitation Counselor or a Certified Disability Management Specialist. Those two certifications focus primarily on vocational rehabilitation and return to work. For individuals who do not work any longer or do not have a job to go back to, the return to work specialist has the skills to assist with work site analysis and labor market surveys, and teach people how to compose a resume and prepare for a different job.
A return to work specialist engages in situations where a nurse is assisting with a claim and the restrictions are not progressing or the employee is not going to be able to go back to the same job, or if the doctor provides permanent restrictions. In addition, some larger employers with multiple locations may want the return to work specialist to assist if a particular location cannot accommodate the restrictions. A return to work specialist also helps with specialized projects for employers such as performing job analyses and writing functional job descriptions based on first hand observations. These descriptions have more meaning and more physical demands attached to them so they can be used to help facilitate a more timely return to work with the physicians.
When someone is injured at work, it is more meaningful for the clinical team to have consistent job descriptions. If an employer does not have a written job description for each employee’s position, the return to work specialist would have a basic understanding the employee’s duties and rely on a physical demand sheet that a supervisor or manager would complete. The sheet includes very detailed information such as the amount of weight pushed/pulled and the frequency, the amount of standing and climbing, etc. Sometimes customers that don’t experience lost time claims very often would need a return to work specialist to help them create job descriptions going forward should they have other injuries. Employers that do not have light duty positions have the option to arrange temporary light duty work for their employees at pre-agreed upon not-for-profit organizations. The expectation is that the injured employee would go to the not-for-profit in lieu of working a light duty job for the employer in order to qualify for their benefits. Being productive through positions like these can lead to a faster recovery and may help the injured employee avoid the depression that often accompanies being out of work.
ADDRESSING BEHAVIORAL HEALTH ISSUES
Engaging employees with a behavioral health specialist can help them work through issues that may prevent them from returning to work such as personality issues with co-workers or fear of being injured again. Behavioral health intervention is a valuable tool for those minor psychological concerns that impact whether somebody goes back to work or stays at work, as well as more complex mental health issues like post-traumatic stress disorder. For example, an employee may be worried that their co-workers and manager would be upset with them for being off work. A behavioral health specialist can help the person with anxiety. For a traumatic incident like a robbery, a behavioral health specialist will meet with the employees and help them work through their fears while they’re still on the job and prevent them from having to be off work.
ADVANTAGES OF INTEGRATING
Looking across the spectrum of workers’ compensation and disability programs, often the human resources department manages disability claims and the risk management department oversees workers’ compensation losses. With separate teams handling these cases, there may be communication barriers because they are not interacting with each other. Being able to see the overall picture of these programs offers advantages for employers. Housing disability and workers’ compensation claims management services on a single or highly interfaced system mitigates some of the communication barriers for employers.
With the Americans with Disabilities Act (ADA) and the ADA Amendments Act (ADAAA), the employer is required to make reasonable accommodations for employees who may otherwise be barred from productive employment as long as that accommodation is not placing an undue hardship on the employer. The ADA/ADAAA encourages employers to provide temporary or permanent accommodations for work-related injuries the same as it does for non-work-related return to work scenarios. Attempting to put silos around how the ADA and its amendments pertain to return to work and disabilities can be detrimental not only for the employee’s return to work success, but also for the employer from a legal perspective.
PUTTING THE EMPLOYEE FIRST
For some employers, having a multi-disciplinary team involved in the return to work process is part of their focus on advocacy. The primary objective for them is not just driving return to work or medical cost containment. It is also about connecting with the injured employee and making sure the employee, his or her family members, and the employee’s manager understand what to expect. Efficient communication across the injury management team builds trust for the employee, as well as a sense of accountability for his or her own recovery.