The complexities of managing a workers' compensation case has turned into the ultimate challenge for all those involved in disability management. Federal and state labor laws, civil rights laws, health and safety regulations, medical privacy, opioid use and current workers' compensation reform issues make resolution of these cases difficult and trying for everyone.
Finding a method to resolve a case quickly, effectively and fairly with consideration to both the employer and the employee's needs is critical.
What Disability Management Is ?
The current state of disability management offers a better-defined process that includes ergonomics. Disability management is the active process of minimizing the impact of an impairment (resulting from injury, illness or disease) on the individual’s capacity to participate competitively in the work environment. It is a proactive process that enables labor and management to assume joint responsibility as proactive decision makers, planners and coordinators of workplace- based interventions and services. Disability management promotes disability prevention strategies, rehabilitation treatment concepts and safe work-return programs. In addition, it is designed to control the personal and economic costs of workplace injury and disability especially when it is integrated into an organization's policies, procedures and strategies.
What Disability Management Is Not.
Disability management is not only about claims management or the distribution of medical and cash payments. It is not just vocational rehabilitation or an expensive approach to control injury and disability costs. It is not an approach that relies solely on outside consultants. Nor is it a process that excludes the employer or the employee while offering a canned approach that is passive in nature or relies on the advice of attorneys. Disability management is an essential part of business. It is a critical responsibility for the employer today and closes the loop on injury prevention should it fail. It is part of the continuum of work health management.
Integral to the process of disability management are its' players. Key participants are the injured worker, the physician, the employer and supervisor, the RN or case manager, the physical and/or occupational therapist, the vocational rehabilitation specialist, the insurance adjuster and possibly an attorney.
In today’s work injury management process, an ergonomist is also likely to play a critical role as well. Each exists to assist in resolving the case for the injured worker. Each offers multiple solutions to the problem that must be carefully coordinated with all involved parties in a timely and effective manner. Documents and reports are shuffled between providers, each trying to determine the fate of the injured worker and how the case will resolve.
The Occupational Bond and Ergonomics
The most important goal in disability management is the restoration of the occupational bond between the employer and the employee. It is this goal that should be shared by all the involved parties. The occupational bond is the mutually beneficial relationship between the worker and the employer. It is multi-dimensional involving the physical, psychological, social and environmental aspects of work. The occupational bond is the worker relating to the employer through the daily routine of going to work, producing and socializing. It is part of our everyday adult lives and provides a fulfillment that is unmatched by most of life's rituals.
Ergonomics, in turn, is the relationship between the worker, the work tasks and the work environment. As such, ergonomics becomes the critical link in restoring the occupational bond between the employee and the employer and a necessary part of the disability management process. Therefore, the Ergonomic Worksite Analysis provides essential information for the key players to make sound return-to-work decisions in managing the worker's case. The EWA becomes a critical working document by which all involved parties can formulate the disability management plan.
Benefits of Ergonomic Worksite Analysis
The ERGONOMIC WORKSITE ANALYSIS (EWA) establishes the relationship between the worker and the worksite by assessing the physical relationship between the worker, the work tasks, the tools and materials used and the work environment. When performed correctly as part of workers’ compensation and disability management, the EWA accomplishes the following:
(1) Establishes the critical and essential job tasks
(2) Determines the physical demands required to perform the job
(3) Identifies the generic ergonomic risk factors of the job
(4) Recommends modifications to reduce hazards and the risk of re-injury
(5) Satisfies some if not all the current state regulations and federal OSHA ergonomics guidelines: worksite analysis, hazard prevention and control, training and medical management.
Another major benefit of using the Ergonomic Worksite Analysis is the ability to "match" the information obtained from the EWA with a work or functional capacity assessment, used often in managing workers' compensation cases. These tools allow the key players to match the workers' current work capacity with the required work capacity to perform the job in question.
The EWA allows for accommodation and modifications to be made in the work environment as well as facilitate goal setting for early return-to-work or transitional work program development. This, in turn, helps to protect the employability of the injured worker by complying with the ADAAA in the employment of the qualified disabled worker through reasonable accommodation and worksite modifications.
Components of the Ergonomic Worksite Analysis
Since the Ergonomic Worksite Analysis is a relatively new tool used in the disability management process, the components may vary from evaluator to evaluator and the type of work performed i.e. office, manufacturing, healthcare, etc.
In order to accomplish the goals identified, the following components should be included. These include identifying subjective functional issues and return-to-work goals for the injured worker, utilizing an established job or task description or identifying the purpose of the job, the essential and marginal tasks, the tools and materials used and any other pertinent issues of the job.
Time allocations from a well-documented source should be used to define the physical demands. This may also include interviewing the worker(s) and supervisor for consensus. The demands should include at a minimum, standing, sitting, walking, lifting (all heights), carrying, reaching, pushing, pulling, grasp/pinch, bending, reaching, twisting, kneeling, crouching, stooping, crawling and handling. Mental demands such as organization, stress requirements, interactions, and others may be included. These demands are likely to be important as well depending on the employee’s condition.
Generic ergonomic risk factors need to be assessed. Consideration and documentation of forceful exertions, awkward postures, localized contact stresses; vibration, temperature extremes, repetitive motions and prolonged static postures should be included in the EWA. The relationship between the worker, the risk factors and the demands should be established by measuring heights and weights, forces, repetitions counted, and postures recorded to perform the job so that critical return-to-work decisions can be made.
Risk Management Recommendations
the key players in the decision-making process. These include the following recommendations:
1. Engineering changes in work design,
2. Administrative modifications to the job,
3. Work practice modifications,
4. Medical management,
5. Training and education and
6. Purchasing suggestions.
Cost-benefit considerations and practical solutions are strongly encouraged for improved compliance in the disability management process. The solutions provided for the injured employee can often lead to improvements in working conditions for other workers. The report should provide both prevention and intervention strategies depending on the conditions in which it is performed.
Referrals, Service Provision and Reimbursement Issues
Referrals can come from any of the involved players, however the insurance adjuster, employer or MD/DC is most critical. The EWA is provided by a qualified person who understands the ergonomics of the workplace and possesses the skills and abilities to evaluate and document the components of the analysis. Such professionals may include but not be limited to a physical or occupational therapist, a certified ergonomist or a loss control specialist.
As ergonomics becomes more prevalent in the working world and its use more valuable to the workers’ compensation insurer, the insurer is encouraged to assure the evaluators sent to the employer are well qualified to perform EWAs. Core competencies in performing an objective assessment including professional interview techniques and skills to competently write a medical-legal report objectively and with validity to hold up in the courts, if needed. Providers of the service should possess the appropriate credentials to perform such an essential analysis such as CPE or CIE and include a healthcare degree such as a PT, OT or Occupational Health RN.
It is important to preserve the employee’s medical privacy, respect the EWA as a medical legal document and assure excellence in reporting.
Managing the Case with the Ergonomic Worksite Analysis
Managing the case with the EWA involves a few of the key players.
• The PT/OT defines the worker's current capacity through the functional work capacity assessment.
• The professional Ergonomist then performs the Ergonomic Worksite Analysis and submits the results to the physician, employer and insurer.
• The physician reviews the report in order to decide the criteria under which to release the worker to return to work and determines the appropriate work capacity limits. The physician also can match the employee’s capacities and limitations with the job requirements through a transitional work program.
• The employer or supervisor implements the recommended engineering, administrative and purchases required to perform the modified or accommodated work.
• The employee must be trained and educated in self-care through medical management and safe work practices regarding their condition and the job in question.
• The insurer works to close the case effectively once all decision and actions are made with satisfaction.
Not until we begin to use
the Ergonomic Worksite Analysis regularly will we realize the potential benefits this service has to offer be it physical, psychosocial or financial. The physician no longer must guess at the modified work limits. The employer can set re-employment goals for the injured employee based on a solid foundation of work performance tasks to minimize the risk of injury for the worker and others in the same job class and prevent re-injury of the employee once back on the job.
The employee is integrally involved in his/her rehabilitation plan and given back control through self-care and self-responsibility in the workplace. The insurance company can better anticipate claim costs and reserves necessary for the case and help to close numerous loop holes and reduce litigation.
The Ergonomic Worksite Analysis improves compliance with the ADAAA and other safety and labor issues. The Ergonomic Worksite Analysis is truly the critical link in the return-to-work process and an essential tool in disability management.