national workers compensation & disability program

8/6/2019 National Workers Compensation & Disability Program

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An Integrated Approach

It is no mystery that there are significant costs and loss time associated with soft

tissue injuries in the workplace. Sprains and strains account for41 percent of all

workplace injuries and illnesses requiring days away from work.

The musculoskeletal disorders or MSDs as they are called in the Industry, are

difficult to assess and ultimately are handled differently by providers across the

country. With little standardization and consistency of care delivery, the outcomes

are varied from one provider to the next. The solution is the development of an

integrated approach that manages and reduces risk throughout the continuum of

care.


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Statistics

1. Employees out of work for more than 12 weeks with a work-related injury have less than

a 50 percent chance of returning to work. (Hartford Study)

2. Musculoskeletal disorders (MSDs) cost the U.S. economy between $13 and $15 billionannually ending in a total cost of employee disability which adds up to 6.3% of totalUnited States payroll (Watson Wyatt Worldwide and the Washington Business Group on Health, 2001).

3. An employee who files a Workers Compensation(WC) claim for lost time is twice aslikely to file another WC within 3 years

4. 26% of employees with a prior WC claim who remained employed with the same

employer are more likely to file another claim with employer5. The 2nd claim filed for this employee has more than a 50% chance of being a back injury6. Over the past three years, workers' compensation costs have increased an average of

50 percent and currently account for $.67 of every dollar spent on casualty insurance.

Average Industry wide costs per type of injury are as follows;Upper Extremity: The average days lost for an upper extremity injury is 61with an average cost of $14,700Back: The average days lost to a back injury is 32 with a cost for one ofbetween $18,900 and $24,900


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The High Risk Job

Every Industry has a job that is simply a difficult one that has historicallyrun an increased rate of injury occurrence. These jobs for the most parthave been reviewed from an ergonomic hazard standpoint, but they cannotbe easily changed.

This leaves the question, how do we be proactive and go about reducing

risk of injury in this type of environment. Quality care after injury is certainlyimportant, but are there other areas where we can minimize exposuregoing forward.

These injuries, and these high risk jobs make up forthe majority of the premium costs and need to be

looked at from all aspects.A general review of pastinjuries and claim duration will help to direct you to theHigh Risk Jobs in question.


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Ergonomic Assessments

Ergonomics is the scientific study of people at work.

The goal of ergonomics is to reduce stress andeliminate injuries and disorders associated with theoveruse of muscles, bad posture, and repeated tasks.

This is accomplished by designing tasks, work spaces,controls, displays, tools, lighting, and equipment to fit

the employees physical capabilities and limitations.

The easier it is to do a job, the more likely it is to see

gains in productivity due to greater efficiency.

Analogously, the safer it is to do a job, the more likely it

is to see gains in productivity due to reduced time off for

injury. Ergonomics addresses both of these issues bymaximizing the workspace and equipment needed to do

a job.


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The Job Demands Analysis

All programs for employee care begin with the details of the job demands. If job

demands are not clearly stated then in the course of evaluation, individuals may be

over or under tested, rehab will be misdirected and there will always be a potential

for re-injury upon return to the workforce.

The first place to start in the development of an integrated program for reducing

risk is to update and/or redo existing job demands, specifically for the high risk

jobs. They need to properly reflect essential and high risk duties of the work

environment. In accordance with the ADA and EEOC, the Uniform Guidelines on

Employee Selection Procedures states that a thorough job analysis is needed for

supporting a selection procedure.


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JDA / PDA

A Physical or Job Demands Analysis is a systematic procedure toquantify, and evaluate all of the physical and environmentaldemand components of all essential and non-essential tasks of a

job. JDA or PDA is a process of establishing what a job is in itsentirety, in a way that complies with the law. For the purpose ofemployee rehabilitation and return to work, a JDA/PDA is thecornerstone of the analytical process used to determinecompatibility between a worker and a specific job.

Without a properly constructed, recently reviewed JDA/PDA; therehabilitation professional has difficultly in the preparation of aworker for return to work, the Physician has limited ability todetermine work restrictions, the Functional Capacity Evaluationservice is rendered ineffective and the Post offer Pre EmploymentScreen is deemed non-compliant in relation to the ADA and EEOC.Needless to say, the first direction of any company in overall injuryreduction is to tie down their job descriptions.


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The Continuum ofCare

No one service will suffice in the continuum of care, instead you need to

be prepared to handle all situations that may arise with both the employees

in the High Risk Job and those coming in to it. Furthermore, you need to

ensure all aspects of testing and treatment are in tune with existing

legislation and that your approach is legally and ethically sound.


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Where do I start

One of the most common practices to reducerisk of injury is to review the work environmentfor areas that may be causing increased strainon the employees.

Start with reviewing the type of injuries found inthat particular job detail and then begin a

thorough review of equipment, tools andprocesses that may increase risk throughperhaps repetition, force, sustained posture orunique tasks such as twists or turns.

This is essentially the foundation for a more

formal ergonomic hazards analysis. If theenvironment cannot be changed then move onto the next phase of management.


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New Hires

New Hires can be effectively managed with the incorporation of a post offer pre

employment screening protocol. If not previously incorporated into your riskmanagement model, then a formal validation study needs to be completed andyou need to ensure both ADA and EEOC compliance. This evaluation qualifiesany pre-existing conditions that may hinder his/her ability level and alsoprovides a solid baseline of abilities to compare with if a future injury occurs.

Several factors affect employers' existing and future health and safety. As weare aware job applicants today are increasingly heavier, more out of shape,and we are dealing with an aging workforce. As the total number of qualified jobapplicants is reduced, hiring and retaining qualified and physically ableworkers is one of the greatest challenges that employers face.


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Post Offer Pre Employment Testing

This is an evaluation that is conducted following an offer of employment. Post-offer/Pre-employment Evaluations usually involve medical examinations. Physical agility testing and

drug screening are not considered medical evaluations; however, they may be componentsof the Post-offer/Pre-employment Evaluation.

Post offer screening is a valid and reliable tool for identifying applicants' physicalcapabilities. The physical capabilities of the applicant are then compared to the essentialphysical demands of the job. Legally, these tests must be applied consistently to allapplicants and applicants must be offered the job, prior to testing, on the condition thatthey meet the physical requirements of the job (ADA, 1990). A comprehensive post offerscreen includes the following components: Accurate Physical Job Demands Analysis(JDA/PDA), Clear acceptable criteria, Physical screen, Standardized objective test,Occupational and job specific test.

Benefits

1) The Evaluation identifies individuals that are a direct threat to their own health or safety,or to the health or safety of others at the work site.2) Identifies potential health or safety risks lowers the rate of medical and injury claims.3) Decreased medical and injury claims mean decreased costs.


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Validation and Legal Rights

Validation Studies

Aside from legal considerations, a properly-conducted validation study can helpan employer determine to what extent the information obtained from testing jobapplicants is predictive of future job performance, and accordingly what weightshould be given to the results of such tests.

Griggs vs. Duke Power. The Court's opinion stated "703 (h) authorizes theuse of any professionally developed ability test, provided that it is not designed,intended, or used to discriminate." "The Act does not preclude the use of testingor measuring procedures, but it does prescribe giving them controlling forceunless [401 U.S. 424, 425] they are demonstrably a reasonable measure ofjob performance. Pp. 433-436."


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Rehabilitation

Understanding that you most likely already have a relationship with aqualified Occupation Health Group or Urgent care Delivery Model, the

Physical Therapy component needs to be seen as a separate entity. It iswell established that combining the two components in the same entityresults in increased rehabilitation referrals and subsequently higher costsand loss work time.

Once defined as a provider of choice, the Physical Therapy program for

handling your employees MSDs needs to be driven by the job demandsanalysis. Start with functional restoration and then focus on simulatedessential work demands as are dictated by the job demands analysis. Thiscombined work simulation model helps to build endurance for activitiesconsidered to be high risk and subsequently allows for an expedited returnto a sustained and safe work environment.


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Baseline, Progress and Return toWork Evaluations

Rehabilitation Baseline Evaluations will display actual injury loss and help to

direct treatment while ongoing progress evaluations will display range of motionand strength changes of the employee. This method provides immediate realtime data to determine changes in treatment direction or for that matter anassessment of when the employee has reached Maximal Medical Improvement(MMI) or a return to work target (full duties and or transitional/modified duties).

Return to Work and or Fit for Duty evaluations need to be directed to a matchwith existing full duty requirements or transitional/modified duties as is directedby the employer. The purpose of this evaluation is to ensure a safe andsustained return to duties. There are two very important considerations in thisevaluation; first it needs to be relational to both the essential job demands andany previously designed post offer pre employment screen protocol andsecondly the protocol needs to be medically legally sound and designed insuch a way as to not over or under test the employee.


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Modified orTransitional Duties

These programs can be developed to allow for early re-entry into the work environment. It is well

documented that time on the job provides an expedited return to full function and also that the more

time off from the job the less chance the employee will return back.

Modified duty

Modified duty allows an injured worker to return to work or remain at work performing physicallyappropriate modified duties in relationship to his or her functional capabilities. Whenconsidering modified duty the employer will need to work with the physician of record and therehabilitation specialist to determine the best possible solution for each individual worker. Thismay include: Comparing the employees functional capabilities to the job requirement listed inthe analysis; Deciding to what extent the job can be modified; Identifying other modified-dutyopportunities on a limited or full-time basis.

Transitional work

Transitional work is a progressive, individualized, time-limited program focused on returning theworker with physical restrictions to the original employment site. Transitional work allows theinjured worker to perform productive work at the workplace under the direction of rehabilitationprofessionals. The program may include progressive conditioning, on-site work activities,education for safe work practices, work re-adjustment and Job Modification.


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Job Modification and/or Gradual Return to Duties

Job Modification

Job modification is the removal or alteration of physical barriers that may prohibit an injuredworker from performing the essential functions of the job. Successful job modifications are theresult of a cooperative effort involving these people: Rehabilitation case manager; Employer;Injured worker; Physician of record; Other professionals as appropriate. Job modifications aredeveloped and implemented keeping in mind the injured workers limitations, restrictions,functional capacity and physical capabilities. An example of a job modification might be thepurchase and installation of a power lift table for a mechanic with a back injury no longerable to lift.

Gradual Return to Duties

Gradual return to work is a program that allows an injured worker to return to work on agraduated basis building up from no less than four (4) hours per day to a full-time work statuswithin a 13-week period. The employer pays the worker for the hours worked and living

maintenance is paid for the hours not worked (or) the employer pays the full salary and isreimbursed for the hours not worked.


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Preventative Maintenance

One of our primary concerns is that of the aging workforce alreadyinvolved in the high risk job. With the existing workforce an evaluationqualified as a Preventative Maintenance evaluation can be developedand implemented. It is essentially designed to prevent injury and maintainthe worker on the job.

The purpose is to monitor patterns of degradation for both range of motionand strength of the employee in comparison to themselves versus the job.Example: Meat packer with extensive historical hand/wrist injuries: Testthe wrist range of motion and hand/pinch grip strength every threemonthsto review any significant changes in function.


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What else can we do?

Strengthening and exercise can be a positive factoreither on site at the employer or off site after hours at alocal clinical facility. As we are aware more and moreemployers are embracing the Industrial Athleteconcept and are incorporating programs during andafter the work day to assist the employees on high risk

lines in keeping Fit for Duty. Like an athlete they areinvolved in training their body to be able to effectivelyand safely manage their required tasks.

Education of the employee base in topics ranging fromtool handling and lifting to nutrition assist the employer

in keeping the wellness directive on track. Wellnesscoaching as part of this model provides increasedinterest on the employees part to participate.


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Communication is the Key

Throughout the entire process it is important to maintain and increasecommunication with all parties involved. From the Treating Physician to theOccupational Health Team and the Physical Therapist, communication isthe key to early re-entry into the workforce and ultimately positiveinteraction with the injured employee.

The primary goal with any risk management program is to minimize losswork days and to reduce overall direct and indirect medical costs. Byincorporating a program such as the one above, versus individual services,we ensure all aspects from Hiring to Retiring are accounted for in thecontinuum of care for the employee.


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Additional Resources:


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