Posts Tagged ‘return to work’

RTW resources from Australia

Friday, March 14th, 2008

The RTW Knowledge Base Website is a free service from Australia providing research based information and links to external resources on work disability prevention. We received a notice about this site from Mary Wyatt, an Occupational Physician based in Melbourne Australia. She offered a good overview of the site’s features, so we will take the liberty of using her description of the site:
The Return to Work Knowledge Base was developed by ResWorks (a small Australian nonprofit) with the support of the WorkSafe Victoria RTW Fund. The site has been endorsed by the Australasian Faculty of Occupational & Environmental Medicine.
The website is designed to help with return to work. The site includes:

  • Research papers translated into plain language. The articles can be browsed in interest group collections – employee, employer etc. Alternatively all articles can be seen via the ‘View all Articles’ tab. On the summary pages the article title is the link to the full text. A search facility is available on all pages.
  • Resources – links to useful information on work disability such as patient handouts, work disability reports, treatment guidelines. The link to the Resources Page for each group is at the top of the left navigation menu on the summary pages. Most links are to patient handouts, guidelines, or reports on the topic. Other links are to webcasts or videos relevant to the field.

Research is often difficult to access and for most people research is hard to read. The site translates individual research papers into a format that can be understood and houses the information in a readily accessible format. Topics include consequences of being off work in the long term, medical issues, workplace factors, system factors, and people issues.
There are two broad ways the site can help:
1. Increasing peoples’ knowledge and understanding of the area through reading the information provided on the site.
2. Influencing others. Many working in this area practice best evidence care. However it can be difficult to influence others with a less enlightened approach. The site is designed for sharing of information with the ability to send links to colleagues or print articles (eg for patients, HR managers, supervisors).

Workplace disabilities are on the rise

Wednesday, May 16th, 2007

Unhealthy worker lifestyles and an aging work force may portend trouble on the horizon for the nation’s employers. A recent article in The Wall Street Journal points to the disturbing trend of long-term worker disabilities that are accelerating at a rapid pace. This comes at a time when employers may be facing labor shortages with the impending retirement of the large boomer population.
The WSJ article uses data from The 2006 CDA Long-Term Disability Claims Review (PDF), an annual study issued by the Council for Disability Awareness. Some of the salient points from the study:

  • More than 500,000 individuals received long-term disability insurance payments from CDA member companies in 2006 – 4.4% more than 2005.
    CDA member companies paid in excess of $7.2 billion in long-term disability insurance claims in 2006, a 7.5% increase over benefits paid in 2005.

  • 33% of individuals receiving long-term disability insurance benefits did not qualify for Social Security Disability Insurance, and 95% of reported disabilities were not work-related.
  • 6.8 million disabled workers received payments through SSDI in 2006, 4.4% more than in 2005 and 51% more than the 4.5 million disabled workers receiving payments in 1997.
  • The rate of disability for women workers is growing faster than that of their male counterparts. Since 1997 the number of women covered under SSDI has grown from 16% to 47% of covered workers compared to a 9.9% growth rate for men, while the rate of disability for women workers has grown more than 60% compared to 32% for male.

For the last two decades, there have been numerous attempts to cobble the various disability programs together and serve them under one roof: 24-hour coverage, disability management, and absence management, to name a few. Often, for all but the largest self-insured employers, these attempts have been less than successful due to complex state-by-state regulatory environments, in-house management silos that administer programs differently (risk management vs human resources), and differences in program incentives, disincentives, and benefit structures. One area where workers comp has made huge progress and serves as a model for non-work related disability programs is in the area of return-to-work programs. For many, migrating RTW to disability has been slow going – often because it is a voluntary employee financed benefit, so the urgency hasn’t always been there. But with the converging forces of aging workers, a less healthy population (increased obesity, diabetes), and a tight labor pool, the sense of urgency may be growing.
The WSJ article discusses the ways that many large employers are making workplace accommodations to retain workers:

“American Express says it has altered the company cafeteria at its Greensboro, N.C., call center to accommodate wheelchair-bound workers, enabling them to access microwaves and bus their trays on carts. Company employees who rely on public transportation because of medical reasons, such as paratransit transportation, can get flexible work schedules to accommodate their needs.
At General Motors Corp., a joint program with the United Auto Workers union helps disabled workers find new positions within the company that are more amenable to a worker’s ailment. Under this so-called Adapt program, disabled workers meet with company doctors, ergonomic representatives and others who review the employee’s disability and try to match that to available jobs. Workers who install windshields, for instance, but who develop problems that restrict how high they can raise their arm, could be moved to door installation instead, since that job doesn’t require workers lift their arms above their shoulders, GM says.”

These types of creative programs are always easier for the big guys to effect than the smaller employers, given the law of large numbers, but the large employers can also serve as laboratories for what works well and what doesn’t. And the climate may be right for moving the needle a little further in terms of a unified approach to disability management and stay at work/return to work programs.

News roundup: RTW, Ambulatory Care, Rhode Island shake-up, and more

Wednesday, April 19th, 2006

Today’s must-read list: Give disabled workers every reason to remain part of your work force – an article discussing a report by the American College of Occupational and Environmental Medicine (ACOEM) on the Stay at Work/Return to Work process. The report discusses the psychological, emotional, and economic impact of disability on the individual. Read the full report: Preventing Needless Disability by Helping People to Stay Employed (PDF).
Peter Rousmaniere’s column in Risk & Insurance this month – How to Avoid Getting Scalped – a look at Ambulatory Surgical Centers and their lack of transparency in billing practices. It’s worth a read.
Rhode Island – Looks like Ohio may have some company in terms of workers comp scandals. Business Insurance reports that Governor Carcieri is calling for the termination of Beacon Mutual Insurance Company’s CEO Joseph Solomon after a recent report detailed questionable practices and preferential pricing. Insurance Journal reports that Solomon and the VP of underwriting have both been suspended without pay, at least until a meeting scheduled for today. This is a big shakeup for an organization that writes about 90% of the state’s workers comp policies. Beacon Mutual was created by the state in 1991 as a nonprofit independent corporation.
Scaffolding – In Boston, work has resumed at the site of the recent scaffolding collapse. The state is considering proposals that would assign scaffolding inspections to the Department of Public Safety, as is the case with cranes at construction sites. This political football will no doubt be tossed around for awhile. Meanwhile, a new scaffolding collapse in Milton Keynes , UK has dominated the headlines this week … another worker killed. The BBC depicts the collapses in pictures. (via rawblogXport).
Employee Mutiny – You know things are bad when your work force quits en masse, leaving only a note on the door. Hospital Impact discusses this event, and raises other issues of employee morale and work force motivation in an interesting post that we found via Rita at MSSPNexus.

News roundup: blogs, RTW, meth users, ethics, and more

Monday, February 6th, 2006

Insurance weblogs. We are featured in an article about weblogs by Therese Rutkowski that appeared in the December issue of Insurance Networking News: Online Soapboxes Get Down to Business. Several of our fellow bloggers are cited too.
Returning to Work: Overcoming Injury and Achieving Success – an article written by Kurt Schuhl and Michael McMahon the January issue of Risk Management magazine.
Meth abusers cost employers millions – A recent study determined that each meth-using employee costs his or her employer $47,500 a year in terms of lost productivity, absenteeism, higher health-care costs and higher workers’ compensation costs.
Off-the-job injuries – A Stockton California police officer was denied workers comp for an off-duty injury he suffered while playing basketball. According to the court: “When an employee is injured during voluntary, off-duty participation in a recreational, social, or athletic activity, Labor Code section 3600, subdivision (a)(9) provides that the injury is not covered by workers’ compensation, unless the activity was “a reasonable expectancy of” the employment or it was “expressly or impliedly required by” the employment.”
The Weekly Toll. – Tammy at Confined Space reminds us all of the real reasons why we should be doing the work that we do – a grim reminder to redouble our efforts to keep workers safe.
Immigrant worker injuries – Our colleague Peter Rousmaniere points to a recent Massachusetts study that offers a breakdown of hospitalizations by medical diagnosis, job and ethnic orientation. The study shows a relationship between the type of job and the type of injury.
Drug dispensing by docs – Joe Paduda notes that workers comp prescription drug costs are driven by utilization and price. But are some docs compromised by a profit motive via on-site dispensaries now in vogue?
Looking out for the workers – RawblogXport reminds points to an item that paints a dismal portrait of the economic status of the American worker, who is working harder and longer for less pay. “For the first time on record, U.S. household incomes failed to increase for five straight years – and that record includes the Great Depression. And the minimum wage, adjusted for inflation, is actually worth less today than it was before the last increase was passed 10 years ago”
Is the U.S. economy strong? – In terms of wages and jobs, the U.S. economy is not as strong as it might appear, according to some recent economic studies, and as reported recently in the New York Times.
Ethics – According to a survey by theAmerican Management Association (AMA), pressure from management to meet unrealistic business objectives and deadlines is the leading factor for most unethical corporate behavior. The desire to further one’s career and to protect one’s livelihood are ranked second and third, respectively, as leading factors.
Scandal watch. Speaking of ethics, Business Insurance reports that an AIG settlement with the SEC and the NY AG may be pending. Meanwhile, Judy Greenwald speculates that there may be bigger fish to fry in the wake of recent indictments of senior execs at General Re Corp. and American International Group Inc.

How Long should a Disability Last?

Thursday, December 8th, 2005

One of the most important questions confronting disability managers is how long a disability should last. During Lynch Ryan’s 20+ years in the business, we have seen the loss of a finger tip turn into a permanent total disability, while the loss of three fingers resulted in only a month of lost time. One employee injures his back and is gone forever; another with a more serious back strain is back to work on modified duty within a week. What accounts for the differences? How many days of disability are medically necessary?
What are Disability Duration Guidelines?
If you study a lot of injuries, over a long period of time, you can develop a strong sense of how long a disability should last, ranging from no time lost to years and years of disability. The data can encompass many diagnoses and can take into account the occupation of the individual (sedentary to physically demanding) as well as co-morbidities (health problems that may impact the speed of recovery). The data can reveal optimum results (minimal time away from work), average and mean durations (the middle of the bell curve) and the outlyers on the wrong side (many months of what is often medically unnecessary disability). This type of data should be very useful for claims adjusters, nurse case managers, sophisticated employers and insurers in general for setting goals in returning disabled individuals to fully productive lives. There are a number of these data bases available; the Reed Group has one that is both comprehensive and user-friendly.
Like managed care, disability duration guidelines are a hot topic, one of the new buzz words in the world of cost control. A lot of people are now using these guidelines – but are they using them effectively? I doubt it. Our esteemed colleague, Dr. Jennifer Christian, head of Webility MD, has done a great job of listing the uses and misuses of disability duration guidelines in one of her “Ask Dr. J” columns, available here in PDF format.
What not to do!
Jennifer notes that people often simply match the guideline numbers with the current length of disability for a given situation. The adjuster tends to feel that there is no need to do anything until the mid-point has been reached. And of course, the red flags really start blowing in the wind once the claim approaches the maximum durations. As happens all too often in the world of insurance, this approach results in too little being done too late. You are shutting the barn door long after the horse has wandered into the field.
Aligning Incentives
Jennifer suggests that people focus on the optimal side of the distribution. Adjusters should set a goal of beating the best: returning disabled people to work faster than is normally expected for the given disability. In doing this, you ensure that the proper resources are directed with a laser-like focus on the situation. In Lynch Ryan’s experience, you have to treat every disability with a sense of urgency from day one. Too many things can and often do go wrong if you sit back and wait for a situation to resolve itself.
Jennifer acknowledges that the “worst case” number might be useful for setting reserves, but absolutely not for setting the agenda. She suggests that adjusters be rewarded for taking risks early on – for drawing upon the full range of options before the claim drifts toward long-term duration. With this strategy, you are likely to find yourself spending a little more in the short run and much less in the long run.
Jennifer’s column contains a lot of interesting detail. It’s well thought out and very comprehensive. If you are interested not just in using disability guidelines, but in using them well, this would be a good place to begin.

What is Disability Management?

Thursday, March 24th, 2005

At the heart of workers compensation is — or should be — the concerted effort to treat workplace injury and illness and get people back to productive employment. Sounds reasonable, but how do you do it? What exactly is “disability management?”
Our esteemed colleague, Dr. Jennifer Christian, host of the informative WebilityMD website, takes a shot at defining disability management, in response to a simple question from someone new to the field. Just click on her link for the February Q & A. We think her casual outline deserves wider notice.
Comp Benefits
Dr. Christian’s list begins with the effort to control indemnity losses. Over the past two decades, this effort has centered in state legislatures across the country. Once workers comp came onto the national radar screen, legislatures tried a variety of strategies to lower costs. These ranged from the highly successful Qualified Loss Management Program (QLMP) in Massachusetts, to Governor Schwarzenegger’s recent efforts in California (where a 10% rate reduction is finally in the offing). In the ongoing effort to cut costs, it’s always tempting to cut benefits, which many states have done. (We happen to believe that you control the costs of comp without cutting benefits — but that is fodder for another blog.)
Workers Comp and Medical Care
Dr. Christian looks at three areas related to medical care, not surprisingly, as she is Board Certified in occupational medicine. First, she thinks that vocational rehabilitation programs represent a missed opportunity in many instances. We agree. The problem may be in the current disconnect between the employer where the injury occurred and future employment. There should be a better way to tie voc rehab to real employment opportunities.
Dr. Christian next examines the need to speed up medical care, specifically, through the prudent use of nurse case managers. While recognizing the utility of nurse case management, she believes strongly that these services require more than just a conventional nursing background. The key is developing a strategy for every open claim — a strategy that maximizes the return-to-work probabilities.
In addition, Dr. Christian takes a very interesting look at her own profession. I especially enjoyed her laundry list of the ways doctors can be the problem: they can be incompetent, disorganized, enabling, erratic, inattentive, neglectful, inappropriate, corrupt, greedy and unethical. She singles out the “predatory physicians” who provide serial, unnecessary services to unsuspecting and often innocent workers. (This has been a huge problem in California.) Needless to add, she has much to say about the positive role of doctors in solving the disability problem.
“Delayed Recovery”
Finally, Dr. Christian focuses on what may be the single greatest cost driver in the entire workers compensation system: we often use the word “malingering,” — injured workers staying out of work longer than is medically necessary — but Dr. Christian has coined a more neutral and more compelling terminology: “delayed recovery.” Under delayed recovery, even though there is no medically necessary reason for people to be out of work, they do not return to work. These delays may stem from actions (or inactions) of the employee, the doctor, the employer or even the insurance carrier. And as injured workers drift on their own through the medical maze, they begin to lose their identity as workers. They often succumb to a “disability syndrome” and begin to believe that they are never going to be able to work again. Dr. Christian sees the need for a multi-disciplinary assessment, one that looks at more than just an injured body part. Through such an assessment, we can identify the people most at risk for delayed recovery and plan effective interventions so that the delays are minimized.
The Employer Role
Dr. Christian recognizes the importance of employer involvement, without which success in controlling losses will remain a distant goal. Educated employers know how to respond to injured workers. They secure first rate medical treatment and use temporary modified duty to accommodate medically necessary restrictions. Educated employers treat every injury with a sense of urgency, because they care about their people and because they understand the risks involved in a “delayed” recovery process.
Even though Dr. Christian’s brief paper is just the beginning of a working definition of disability management, there is plenty of food for thought for all of us. Every once in a while, we need to step back and refocus on the big picture. We need to redefine what we are trying to do in managing disabilities and the best ways for accomplishing our goals. Dr. Christian’s paper is an excellent starting point in this effort.

Return-to-work programs benefit by ergonomics

Tuesday, May 25th, 2004

Ergonomics Today features an article on how ergonomics is an important tool in a successful return-to-work program.

“According to Sheryl Ulin, Ph. D., CPE, Senior Research Associate Engineer at The University of Michigan’s Center for Ergonomics, applying ergonomics principals to return-to-work can help the injured worker return to a more productive state more quickly. The key, she says, is starting with an analysis that takes into account both worker and workplace. … Ulin’s experience shows that a successful return-to-work program incorporates worker, doctor and ergonomist. “If the medical professional writes specific restrictions, we may be able to look at other available positions and determine that [a different job] doesn’t have the [restricted] work-related risk factors,” she says. Even in situations where returning the worker to his or her former position is impractical, “we can still accommodate the worker,” says Ulin.

The article goes on to reference the experience of Dr. Barton Margoshes, Chief Medical Officer of CIGNA:

“Margoshes likes to try to get an injured worker back into his or her old job if at all possible. To do this, ergonomics is not only the key to workspace assessment, it also becomes an important factor in redesigning the workspace. “It’s not so easy to put people into another job,” says Margoshes. “In our case management, we do everything we can to help individuals return to their old jobs at their same employer. Unfortunately employers on their own don’t always think about how to modify the workplace ergonomically. We work with employer and employee to try to figure out how to adapt the workplace to make it fit,” he says.

Study shows active recovery fosters return to work

Thursday, January 29th, 2004

A recent study on lower back pain and return to work was conducted by a Dutch research team, and the findings were unsurprising to those of us who espouse the idea of an active rather than a passive recovery whenever possible. In the study, workers with nonspecific low back pain who engaged in a graded activity program returned to regular activities – including work – sooner than those who got “normal care.” On average, the active recovery path cut one month off a three-month recovery period, and follow-up studies showed no difference in the reinjury rate.

This study bolsters the case for employers to have a safe, progressive return to work program that eases injured workers back to their normal jobs. The study author comments:

“Athletes and other professionals are highly motivated, have high self-esteem, are not depressed, and have a strong motivation to keep doing what they always do,” he suggests. “Can we imbue the injured worker with some of the ideals and motivation of the injured athlete?” Based on the van Mechelen team’s study, the answer appears to be “yes.” Their program changes how disabled workers see — and cope with — their lower back pain.”

Dr. Jennifer Christian is an occupational physician who has worked in settings ranging from an insurer’s office to right on the shop floor. She often uses “the grocery store test” as a barometer of fitness for work. It goes something like this: If you worked in your family grocery store, would you be back at work, or would the injury or illness preclude that? Of course, it goes without saying that any worker’s return to work after an injury of illness must be planned carefully within physician restrictions.

The hidden key in both this study and the grocery store test may well center on that all-important word, motivation. If you are an employer, ask yourself this: would your employees be motivated to come back to your workplace?

By the way, if you ever have the chance to hear Dr. Christian speak at a national meeting or forum, do be sure to sign up…she is quite a forward thinker on workers compensation and disabilty issues.
And thanks to Judge Robert Vonada and his always excellent PAWC weblog for pointing us to this study.