The Missing Link in Return to Work Best Practices

I recently received an article via email covering the “4 Best Practices in Workers’ Compensation Claims Management.” It covered:

1. Early Intervention - the importance of filing claims in a timely manner.
2. Proactive Communication Among All Stakeholders – including the injured worker, employer, insurance carrier, workers’ compensation claims adjuster, nurse case managers, medical providers, risk managers, and brokers. (OMG, I need a CRM just for one claim)
3. Utilizing Return-to-Work Programs – i.e., getting people back to work even if it means placing them in a non-profit outside their primary company
4. Data-driven decision-making – using AI, machine learning, and analytics to spot trends that can lead to hazard reduction or identify cases that might “be a problem” in the future.

While ErgoScience agrees that all of these are indeed best practices, we believe the article overlooks one primary best practice – using return-to-work/fitness-for-duty physical abilities testing to determine the injured worker’s return-to-work physical abilities.

Why is Return-to-Work Physical Abilities Testing Important?

Think about it…how is the typical return to work decision made by physicians? Do they do any objective testing? Do they even know the physical requirements of the job?

Here’s the sad truth:

Most return-to-work decisions involve a very subjective process. No testing. No objective measures – just guesswork based on the intuitive opinion of a physician who has likely never seen the patient’s job description.

And then we wonder why workers are reinjured when they return to work. Or why they stay out of work twice as long as necessary. Just because medical healing is complete, doesn’t mean that functional recovery to perform the job requirements follows suit.

How many injured workers would really need alternative temporary duty work if their physical abilities were actually tested?

How many injured workers are placed in temporary duty positions that are appropriate for their abilities?

If they’re just placed in a sedentary temporary duty position, how do they progress to a medium or heavy-duty job? Last time I checked, sedentary work never moved anyone forward from a physical perspective.

We can’t answer any of these questions because return-to-work/fitness-for-duty testing is so seldom done.

How would it work?

Very simply, in fact.

1. Adjusters and case managers would use those “proactive communication skills” mentioned above to advise the treating physical therapist as to the timing of the upcoming return-to-work physician appointment.
2. Adjusters and case managers would also send the job description to the physical therapist.
3. The treating therapist would identify the 4-5 most difficult aspects of the job and put together a 20-minute return-to-work/fitness for duty screen.
4. The injured worker would be tested as part of one of the final therapy visits.
5. The test results would be faxed to the physician prior to the return-to-work appointment.
6. The physician would use those test results to make an objective, informed decision regarding return to work.

Six simple steps that would stop the guesswork, stop the bad decisions, and be a cost-effective solution to the problem.

Why is return-to-work testing so seldom done?

I can’t for the life of me figure out the answer.

Is it because someone, somewhere, in the universe decided that physicians had magical, intuitive powers to determine the physical functional abilities of patients? We wouldn’t accept that for any other diagnostic decisions.

Is it because physical therapists only want to treat and resolve musculoskeletal disorders and don’t want to be bothered with testing the patient’s physical abilities to perform work?

Is it because case managers and adjusters don’t want to be bothered with the extra communication about return-to-work appointments and job descriptions?

Is it because insurance carriers don’t want to pay the extra $50 that would be required to the test?

Or is it just that we all do what we’ve always done? Which is not in the best interest of injured workers.

The omission of this best practice indicts us all.

So, in my view, the article, although valuable, left out a key best practice in workers’ compensation case management: Conduct Return-to-Work/Fitness-for-Duty Physical Abilities Testing.