By MELISSA TURLEY, a writer in the Washington bureau of cyberFEDS®, which is produced by LRP Publications, the parent company of Risk & Insurance®
CHICAGO---The periodic rolls are a challenge for any workers' comp practitioner, as their insurance claims can languish for years or even decades.
But a federal government agency's efforts to stay in touch with the employee, push for updated medical information and to find a restructured job for the worker can be a wining situation for all parties involved, according to Barbara DeGray, nurse case management director for Managed Care Advisors, and Darryl Thornton, director of the Transportation Security Administration's Workers' Compensation Program. TSA is the winner of the third annual Theodore Roosevelt Workers' Compensation and Disability Management Award in the Federal Workplace.
"Taking two years to resolve a case is still better than 15 years of unnecessary compensation," Thornton said.
Agencies categorize cases as periodic when they anticipate extended disability. They must verify continued disability at least every year.
For instance, a 52-year-old male employee has lumbar strain, a herniated disc, and a torn ligament in the right knee. He also suffers from depression and hypertension. The employee underwent two surgeries, a knee replacement, hospitalization, counseling and physical therapy. He is also on medicine to treat his hypertension, as well as on Hydrocodone for his pain.
How does a practitioner go about sorting the work-related injury from the underlying conditions or ailments that developed while out on compensation? Thornton and DeGray said it's a matter of the practitioner or the supervisor touching base with the employee at least weekly to ascertain how he's feeling. The workers' comp specialist must also contact the Office of Workers' Compensation Programs claims examiner for documentation, including a second medical opinion.
Agencies can also directly contact medical providers. They can ask about other health conditions, because they can delay recovery, DeGray said. But workers' comp specialists must be careful with information and take steps to abide by the Privacy Act and the Genetic Information Nondiscrimination Act.
When assessing and analyzing information, consider:
--Did the treating physician provide a medically recommended work status?
--Was it based upon objective findings?
--Does it relate to the injury and/or accepted diagnosis?
--Are there multiple physicians?
--Is the injured worker at maximum medical improvement? Are permanent restrictions documented?
--Is the treating doctor's report credible?
Practitioners can request functional capacity evaluations to verify work restrictions. Re-employment might be possible with job modifications. If not, specialists should emphasize Office of Personnel Management retirement.
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Annual National Workers' Compensation and Disability Conference®
November 19, 2009
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