Reducing medically unnecessary disability

Any regular visitor to Workers Comp Insider would know that we are not ones to minimize the seriousness of workplace injuries, and we bemoan the frequency with which work injuries occur. Essentially, we believe that if American businesses can aspire to total quality management and zero defect philosophies for parts and processes, they can do at least as well for their greatest asset, their people. Prevention is a key mandate that all of us in the industry should and must embrace.

That being said, a good part of our focus as a company has been on teaching employers how to respond to and manage work injuries if and when they do occur, with the twin goals of fostering maximum recovery for the employee and minimum cost for the employer. These are goals that should not be mutually exclusive if approached thoughtfully and with care, through good management, communication, and planning.

I was reminded, recently, of a survey of occupational doctors on the topic of lost time that was conducted by Dr. Jennifer Christian. In this survey, occupational physicians were asked to assess how many of the work-related injuries they treat typically require more than a day or two away from work for medical reasons. Most physicians placed this number at less than 10 percent; more than half of the responding physicians placed the figure at less than 5 percent.

So with an occupational medicine consensus being that between five and ten percent of all work injuries require time away from work for medical reasons - or one injury in 10 or 20 - why is it that, on average, about one injury in four, or 24 percent, results in absence from work long enough to become a lost-time claim? (Most states have a three to seven day waiting period before compensabilty benefits begin.)

Why do so many work injuries result in medically unnecessary time away from work? Dr. Christian put this question to the physicians, and the answers were telling. More than two-thirds of the physicians gave the following reasons:

• the treating physician is unwilling to force a reluctant patient back to work (the most common reason cited);
• the treating physician is not equipped to determine the right restrictions and limitations on work activity;
• the employer has a policy against light-duty work;
• the employer can't find a way to temporarily modify a job;
• the treating physician feels caught between the employer's and the employee's version of events;
• the treating physician has been given too little information about the physical demands of the job to issue a work release for the patient; and
• a conflict exists between the opinions of two physicians.

In these responses, we can see that a significant amount of time away from work occurs not because of medical necessity but because of either poor communication or poor planning. The good news is that these are issues that an employer can address and rectify. Dr. Christian suggests that reducing medically unnecessary disability lies in a physician-employer-employee triumvirate. Her thoughts on the topic are well worth a read.