Workers Compensation - Physician Your Return to Work Decision is Not Clear, Are We On the Same Team?

Dear Dr. X – I really don´t understand the note I received from your office, can the employee come back to work or not? What do you mean he has a five pound lifting restriction – he doesn´t lift anything all day!

This scenario plays out at countless companies on a daily basis, the frustration of getting treating physicians to join the return to work team. The key question for employers, did you explain your return to work goals to the physicians who treat your injured employees? Are we asking physicians to be mind readers? Or are we allowing our employees, who may have their own agenda, to determine their return to work options?

Workers Compensation is a team sport – everyone has to work for the same goal on the same team – unfortunately medical treatment often creates a disconnect between the goal of the employer – return to work; the goal of the employee – stay at home a little bit longer and the goal of the treating doctor – fill out volumes of paperwork so he or she can get paid and keep everyone happy in the process.

It is remarkable to review statistics that compare the length of time an employee is off work due to non-work–related injuries and the length of time they are off work due to a work-related injury. If you compare diagnosis, prognosis and treatment, the work-related disability statistics are significantly higher. If you remove the fact that the injury happened at work, most individuals would recover and resume their regular duties very quickly. Adding the workers´ compensation component creates a sudden extension of symptoms, treatment and a distinct delay in the amount of time required to return to an active lifestyle.

We all know that even when you are on a team, individuals play with their own self interest – this is no different in workers compensation. The significant difference between team sports and workers compensation – someone has to pay when treatment decisions delay the injured workers ability to access appropriate timely medical treatment or when the employer can not get appropriate information to get the injured worker back to work timely.

How do you get everyone to work on your return to work team?

The first step for employers – stop pretending that your goal is not getting the employee back to work as soon as possible – return to work is not a secret! Everyone who works for your company should understand your company´s return to work policy, the minute they start working for your organization. Keep the policy simple – "If you´re injured we will make every attempt to bring you back to work, until you are able to return to your pre-injury position."

The second step – get the physicians who treat your employees to understand the same message. One of the realizations that most employers fail to acknowledge, they are not in the room when their employees seek medical treatment. Imagine yourself as the injured employee. What would you tell the doctor that would keep you off work? If you do not provide the treating doctor with adequate information to evaluate the employees ability to return to work – you´re giving the doctor a crystal ball, then complaining when he doesn´t see the same vision you do.

The third step – having a pre-determined injury management strategy that is consistent, cohesive and tactical. Everything starts on the ground floor; do your employees understand their role in the return to work process? Do you have a policy that you can follow every time an employee is injured? Or are you willing to cast blame on the treating doctor for your failure to plan for the inevitable injury that will occur at your company. Effective return to work programs start the day you hire your first employee not the day the file the Notice of Injury.

Forth step – understand your job site. If you don´t have clear job descriptions it is not the doctors´ fault that you don´t know what the employee did before the accident. Frankly, there is no excuse for not knowing the job demands and communicating that information to the treating physician. The job description dispels any myths or misinterpretations about the job requirements. A very specific job description is an essential part of the return to work process.

Every employee who sustains an injury with your company should take a copy of their pre-injury job description to the initial appointment. If the employee is referred to a specialist, a copy of the job description should be sent to that doctor. Provide an area on the Job Description Form that asks the doctor to confirm receipt and asks him or her to address the likelihood of the employee returning to this position immediately. If the employee can not return to the position immediately ask the treating physician to give you an estimated return date.

Fifth Step – document and consistent follow through. Return to work should not be left up to your insurance carrier; it is the employers´ responsibility to make sure the employee returns to work or stays at work after the injury – not the adjuster, treating doctor or ancillary provider – it your job to make sure it happens. Use the restrictions given by treating physicians to as a tool to find the employee a job – focus on what the employee can do versus what the limitations are. Let´s not forget one other thing – human resources. Workers compensation does not mean employment rules go out the window your lack of HR polices is not the physicians fault. Follow through means that you get all the stakeholders on your return to work team to read the same playbook.

Finally, we have to stop accepting poor performance and rewarding the behavior with money. If you go into a department store and you get bad service, do you keep shopping there? Workers compensation is the only consumer based process that accepts mediocre service and rewards that type of service with a constant stream of business. What do I mean? For many years I worked as an adjuster and during those years I encountered numerous physicians who did not cooperate with my request for medical treatment status, refused to return my phone calls and admonish me to get the work status from the dictation attached to the bill. These physicians continued to stay on the approved provider list and year after year we sent them more patients or allowed the employee to select them, without doing anything to correct the disruptive relationship. Why did we do this? I guess we expected a different result – no we need to complain.

Employers have a responsibility to insure that their employees receive adequate timely medical treatment. Timely, is the key word – waiting weeks for treatment authorization can delay or eliminate the return to work options. Employers also have an expectation that treating physicians will make every attempt to work with the employer to safety bring the employee back to work.

Physicians we recognize that when you went to medical school they did not prepare you to handle the nuances of the workers compensation system, with a little effort we will educate you on the process, because we have to collectively work towards the same goal – getting the injured employees back to work successfully.

Clearly we have a lot of work to do to make this relationship productive. Everyone has a vested interest in making sure injured employees receive exceptional medical treatment – that results in their rehabilitation from the injury and their speedy return to gainful productive employment. Treating physicians are the most important factor in the return to work process. The relationship that you develop with your authorized treating doctors will often determine if your employees return to work or remain off work. We have to make every effort to create a team that works towards the same goal.