ELIZABETH A. MORROW, Esq., special projects editor at cyberFEDS®, a sister publication of Risk & Insurance®
Returning government employees to work after they have suffered on-the-job injuries or illnesses can be a tremendous challenge, especially if federal agencies aren't equipped with the right tools or aren't using the tools they have effectively. Adding to that challenge is the mandate in President Obama's POWER initiative for agencies to increase
"the availability of job accommodations and light or limited duty jobs," and remove
"disincentives for FECA claimants to return to work."
Our sister publication cyberFEDS®
asked Dr. Marianne Cloeren, medical director of Managed Care Advisors Inc. in Bethesda, Md., to share her expertise in meeting these challenges.
Q: What do you see as the biggest challenges agencies face in their
One of the biggest challenges is the behavior of the individuals involved in the process. Behavioral challenges include management reluctance to bring back workers who are less than "100 percent" and a disability mindset that often sets in when an injured worker has been off for a long period of time.
Federal agencies have made great strides in establishing expectations for offering light-duty work for recently injured employees. This is more difficult when an injured worker has been gone a long time, since it is likely the former position has been filled. It may be hard for managers to identify or create new jobs that match both the qualifications and the physical restrictions of former employees who may be able to work in some capacity, but who may not meet all the physical requirements of the old job.
Q: Should agencies anticipate behavioral issues from returning injured workers as well?
For the injured worker who has been off for years, it is sometimes hard to accept the idea of returning to work, even if work can be identified that meets the employee's restrictions. Injured workers often fear reinjury, get debilitated over time, and may have additional medical conditions and chronic pain, which they may see as reasons they can't work. Sometimes chronic use of opiate analgesics (often inappropriate for the condition, based on medical standards) presents a challenge to reemployment.
Q: Aside from the behavioral issues, what obstacles stand in the way of a successful
Problems within the workers' compensation system itself, including a cumbersome procedure for obtaining second-opinion exams, determining the weight of medical evidence and making decisions based on the information. Because long-standing disability cases usually receive less case management attention than recent workers' compensation disability cases, it may go unnoticed that the medical documentation is stale, objective findings are missing, or there is no rationale supporting disability related to the accepted condition. Agencies need to scrutinize medical documents and update them as necessary.
Q: Medical opinions addressing an employee's ability to return to work are an essential component of the process. Have you seen situations where the medical
providers obstruct rather than pave the way for a smooth transition back to the workplace?
I don't think doctors are deliberately obstructive, but many misunderstand their role as patient advocates and think this means giving their patients whatever they ask for. They may not be aware that they are contributing to unnecessary disability. Most doctors--and this includes many of those asked to perform the second opinion and independent medical examinations by the Department of Labor--do not understand how to measure a patient's functional abilities, don't know how to address chronic pain in relation to physical abilities, and don't understand enough about the physical requirements of the job to be able to make meaningful recommendations.
Agencies can use industry benchmarks to understand the expected recovery time for given conditions, and need to be proactive in working with the treating providers. Use forms that push doctors to express details about a patient's abilities rather than restrictions. Inform the doctor about both the regular physical requirements and the light-duty assignment requirements. Establish the expectation of progression in work activities with the injured worker and the doctor unless a condition warrants permanent restrictions.
November 1, 2010
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