Case Management

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Return-to-work (rehabilitation) case management has been in practice since

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the 1940s, when huge numbers of wounded soldiers returned from active duty in World War II.

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ergonomics

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is the process of adapting the work environment to meet the wellness needs of employees

covers physical stresses to environmental factors, such as those that can affect hearing, vision, and general health (eg, poor air quality).

advocates physical capacity testing to ensure that workers can safely perform essential job functions required in their particular job settings, especially if the work is physically demanding

assesses the job to determine if certain components can be modified or eliminated by job redesign to prevent injury and promote wellness

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An Independent Medical Exam (IME)

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is performed by a physician and is completed as a means to receive a second and objective opinion pertaining to the injured worker's employability and overall medical/psychological status.

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Maximum Medical Improvement (MMI)

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is a medical term used to indicate when an injured worker has reached the maximum available benefit from current treatment modalities and should be a part of the case management re-assessment, particularly when a patient/client has been involved in the care plan for a stated period of time.

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MMIs are not indicated

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for a client who has successfully participated in an early return-to-work program.

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Impairment Ratings

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are determined and assigned by the treating physician.
is the percentage of permanent injury to the worker
are useful in litigation to assist workers' compensation claims professionals in determining an appropriate financial settlement.

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Functional Physical Capacity Evaluation is

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a series of tests performed by the physical therapist
determine an injured worker's limitations in performing normal activity related to the injured worker's job functions.

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A Work Hardening program is

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a rehabilitation program that imitates the injured worker's actual job function.
enables the injured worker to prepare for re-entry into the actual work setting.

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A Vocational Rehabilitation Assessment is

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often completed by a hired certified/licensed rehabilitation professional

on behalf of the injured worker

identifies the injured worker's demographic information (eg, age and past work history), the worker's literacy and intellectual level, the level and magnitude of the injury on the worker's ability to function in the workplace, and the worker's transferable skills (for different job).

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A Psychological Evaluation

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can be utilized to determine the injured worker's ability to rationalize, understand, differentiate situations, synthesize information received, etc., as necessary, in all aspects of the workplace (job description, social interaction, etc.).

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Sedentary Duty

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is usually defined as lifting no more than 10 pounds and occasionally lifting or carrying objects such as documents, ledgers and light tools.

mostly sitting

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Light Duty is

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usually defined as lifting up to a maximum of 20 pounds with frequent lifting and/or carrying articles weighing up to 10 pounds.

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Medium Duty

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is usually defined as lifting up to a maximum of 50 pounds with frequent lifting and/or carrying objects weighing up to 25 pounds.

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Heavy Duty

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is usually defined as lifting up to a maximum of 100 pounds with frequent lifting and/or carrying objects weighing up to 50 pounds.

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Very Heavy Duty

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is usually defined as lifting in excess of 100 pounds with frequent lifting and/or carrying of objects weighing 50 pounds or more.

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A Reemployment Status Review

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is a term used to define the responsibility of the carrier to track and monitor the reemployment status of the injured worker.

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The carrier of A Reemployment Status Review

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is encouraged to use medical care coordination as well as a current reemployment assessment in determining the ability of the injured worker to return to gainful employment.

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A Reemployment Assessment

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is a term used to define a comprehensive assessment utilized to determine the employability, readiness for employment, and the medical status impacting employability of the injured worker.

is typically completed by certified vocational specialists or rehabilitation case managers who are authorized in their respective states to perform reemployment assessments.

States may dictate when, and how often, a reemployment assessment shall occur. However, the carrier should individually consider the provisions of a reemployment assessment when it is in the best interest of the employee and will expedite the reemployment of the injured worker.

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Medical Care Coordination

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may be different from reemployment services in a workers' compensation setting.
is typically completed by rehabilitation registered nurses, who concentrate on medical care coordination to achieve maximum medical improvement (MMI) for the injured worker, which will enhance a return-to-work status.

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rehabilitation services

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can be completed by vocational counselors, certified rehabilitation specialists, and others.

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Case Management Issues Related to Reemployment:

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• Obtaining job descriptions from the employer
• Continuous proactive communication with the primary care physician and/or specialist, employer, and patient/family
• Timely vocational assessments and reemployment status reviews (as dictated by the individual state laws)

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The primary emphasis on vocational placement

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is always on transferring the skills possessed by the client into a new job position that will utilize and maximize the abilities of and opportunities for the client.

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The disability management specialist, upon referral, will review the client file and develop a basic understanding of the client. This is followed by contact with the following individuals:

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1. A claims adjuster or account manager to clarify expectations, coverage issues, etc.
2. A plaintiff attorney (if any) to obtain permission to meet with the client
3. The client to arrange for an initial evaluation/interview

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In the vocational placement Initial Interview or Evaluation, All factors impacting the client's return-to-work potential will be explored by the disability management specialist. In the vocational area, emphasis should be given to:

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1. The client's desire to return to work with the same employer
2. The vocational strengths, including transferable skills and limitations

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Physician and Employer Contacts: Outcomes are determined by the disability management specialist after conferring with the physician and the employer. One of the following outcomes will be determined:

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1. File closure, with no return-to-work potential
2. Beginning efforts to return the client to work with the same employer
3. Exploring the return-to-work potential with another employer if return to work with the same employer is not likely

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The Vocational Evaluation

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is a comprehensive process that systematically uses work, either real or simulated, as the focal point for assessment and vocational exploration.

incorporates medical, psychological, social, vocational, educational, cultural and economic data.

is not a labor market analysis.

is used for employability, identification of barriers to return-to-work, and identification of services for overcoming barriers.

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Validity Study

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Similar to how outcomes measures

can be a useful way to demonstrate the effectiveness of case management

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a validity study can be conducted to show

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whether return-to-work has increased;

whether medical and wage-loss costs have been lowered;

whether employee morale is higher;

whether Long-Term Disability (LTD) payments are lower.

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Health care providers in the disability insurance network must understand and be willing to

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ensure early intervention for the client, ongoing team communication, existing state and federal regulations governing disability and workers' compensation insurance,

knowledge of the employer's policies and procedures governing return-to-work

education in injury and illness prevention to achieve maximum wellness for the client and dependent populations.

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There are three fundamental components of a disability case management program, which include:

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Network Development for Effective Management

Outcomes Measurements

Validity Study

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The case manager's role in disability management is to integrate disability management and workers' compensation when necessary, and to manage all absent employees with:

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•Early intervention
•Quality medical care
•Customized transitional employment programs

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physicians should be

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providing medical information to the employer and to the patient's case manager
not making employment decisions.

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Customized transitional employment programs

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can be achieved by providing accurate information to the physician, who then can determine the client's appropriate workload and work abilities.

The case manager can then create modified job duties in a return-to-work plan.

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The employee population and services of disability management case managers would include:

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•Disease management and chronicity cases
•Occupational hazards
•Identification of controlled vs. unavoidable injuries
•Noncompliant employees
•Wellness education and self-care promotion
•Extended population (spouses, children)

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Demographic changes in the employment sector

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have increased and broadened the scope of those benefiting from disability case management services.

people are living and working longer.

baby boomer generation is beginning to have a major impact on the cost and magnitude of both occupational and non-occupational disability claims.

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One major impact on both non-occupational and occupational claims is

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the fact that recovery from illness and injury will be slower for aging baby boomers, resulting in prolonged medical care and extended loss of work time.

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disability payments cannot be

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collected under Short-Term Disability (STD).

only Long-term disability

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A major difference between workers' compensation case management and disability case management is

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the disability case manager cannot direct medical care, but he/she can control costs by facilitating the client's return to work, and can also request that the physician evaluate the functional level of the patient.

Requests are typically submitted with a statement to the physician that the case manager must have objective data in order to approve payments.

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Placeability, as opposed to employability, is

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the chance a person has of gaining employment.

equal to job readiness

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Placeability is determined by:

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• Job search
• Employer selection by the individual
• Job interviews

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The cornerstone of effective placeability is

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to train the client in job-seeking skills

Training would include such things as role-playing to assist the individual in preparing for job interviews.

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Employability is

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the person's capacity to do the requested job.

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Workers' compensation training programs are indicated if:

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• There is a good pre-injury work history
• The client is willing to consider a number of options in training
• There is absence of somatic complaints or over-restriction of post-injury activity
• There is a strong existing work ethic
• There is support from others for re-training/reemployment
• There is a willingness to relocate for a new job opportunity-
• Reliable transportation exists

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Vocational training and re-training programs are

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statewide programs available for qualified individuals

(Fla example):vocational re-training is administered through the Department of Vocational Rehabilitation, through funds obtained through the Impaired Drivers and Speeders Fund.

(Fla example):States also administer less extensive vocational re-training through state workers' compensation systems.

The difference is that workers' compensation-based vocational re-training will only be provided if the client cannot return to his/her pre-injury job, and no new position can be obtained based upon the client's current transferable skills.

workers' compensation training programs last from six months to two years, whereas state vocational-funded training programs may have greater duration and less restrictive qualifications.