WCTL's Disability Management Blog

Workers' Comp Rehab programs & Graduated Return to Work PART1

THIS IS THE 1ST OF A 2 PART ARTICLE.  THE SECOND PART WILL BE FORTHCOMING

Secondary and Tertiary assessments are performed by the Workers' Compensation Insurer's contracted Rehabilitation Centers. These private organizations employ Physicians, Chiropractors and Rehabilitation Consultants, but the majority of care is left to the rehabilitation coordinators / physiotherapists. These programs effectively transfer care away from the Attending Physician to the rehabilitation facility which restarts the entire medical recovery process from square one.

Almost all assessments made by a Rehabilitation Center result in referrals to an 8-12 week tertiary care program (comprehensive rehab programs) in its own facility, followed by a  recommendation for Graduated Return to Work (GRTW). GRTW plans normally commence with a 2-4 hour a day placement with defined medical restrictions and gradually increase to full work hours over a 6-8 week period.

While GRTW plans are better than having no work approval, the principle of GRTW harkens back to the infancy stage of disability management theory twenty years ago.  Recent studies have indicated that GRTW programs are not meeting Full Return to Work (FRTW) outcomes (<40% of employees maintain FRTW status after having been discharged from these programs).  In fact evidence is showing GRTW may be extending average claim durations as Physicians, and rehabilitation providers commonly allow employees to determine their own timelines for FRTW readiness.  This is evidenced by the fact that 50 % or more of all employees engaged in GRTW programs do not meet their full return to work goal-dates.  Increasingly, employers are being forced to accommodate more temporary and permanent work placements.

Current medical data indicates that maintaining injured/disabled employees on sedentary or light duties at full hours, as opposed to a GRTW plan, is far more effective in achieving FRTW goal-dates and reducing average claim durations.

PART 2 COMING SOON!

Can you manage disability without the medical management component?

Many employers are trying to manage disability in their workplace without access to claimants' medical diagnosis or treatment plan.  A WCTL client recently received an arbitration ruling in their favour allowing them full access to medical information that was necessary to safely manage and oversee the recovery of injured employees and their safe return to work. The only precursor was that the medical information be handled only by a fully qualified Nurse or Physician.

Disability is a medical issue and requires medical expertise to manage. It is critical that Medical information be received and reviewed at the date the injury/illness is reported.  Medical information should be reviewed for Diagnosis, Treatment, Modified Work Start Dates and Full Return to Work (FRTW) goal-dates.

Regular medical contacts must be maintained with the employee, the treating Physicians and physiotherapists and other care providers to ensure that employees are progressing to established FRTW goal-dates. This information is necessary for OH&S to manage the recovery of the employee, assist the Attending Physician and hold the Insurer accountable to the timely recovery of the disabled employee. 

Diagnostic and Treatment information enables the Nurse and supporting Occupational Health Physicians to ensure that timely and appropriate medical interventions are occurring at critical junctures in a claim to facilitate the recovery of the disabled employee. The Occupational Health Nurse, Physician and Psychiatrist can provide valuable assistance to the Attending Physicians regarding Modified Work and particular treatment interventions which have proven effective.

Without Diagnosis and Treatment information, it is not possible to manage disability claims in a way that has a material effect on minimizing claim duration and associated costs.

Managing Disability - Why not leave it up to the GP?

While its difficult for the layperson to second guess a General Practitioner's (GP) care of an injured employee, it makes sense to retain an Occupational Physician to provide general oversight and ensure that the GP is accountable to the overall disability claims management objectives of the Employer.

A few cautions ....

• GPs do not receive adequate formal training in occupational medicine. As a result GPs do not understand Modified Work concepts and the underlying importance of Modified Work as part of the medical treatment plan to successful full return to work outcomes.
• The GP is and should be a patient advocate first. As a consequence, Physicians tend to leave/entrust Modified Work and full return to work decisions to the employee.
• GPs work under tremendous time constraints.
• GPs are frustrated with wait lists for testing, specialist referral, surgeries and treatment protocols under the current Health Care system. As a result, they are deferring more to the Workers' Comp. Insurer and Private Insurance Carriers hoping that they can better expedite medical interventions.
• GPs tend to exhaust conservative treatments such as rest, physiotherapy and rehabilitation rather than expediting testing and other proactive interventions.
• GPs do not fully appreciate the financial impact of disability on employers or on the Health Care system. GPs will approve $15,000.00 Graduated Return to Work rehabilitation programs with questionable outcomes but will defer a $ 700.00 back MRI due to cost concerns.
• Due to the shortage of Psychiatrists in the health care system, GPs are being relied upon to provide diagnosis and treatment of Mental Health illness which they are unqualified to do.