The Benefits of Addressing Ergonomics in Failed Return to Work Claims

Erroneous job descriptions and employer inflexibility are just two ways in which return to work efforts get thwarted, say industry experts.

“Effective return to work really starts way before an injury happens,” said Judy Sehnal, lead ergonomic consultant at The Hartford.

She said preparation and communication are key to keeping workers engaged.

Sebastian Grasso, president of The Windham Group, a company that specializes in failed return to work claims, said that after removing catastrophic cases, about 25 percent of workers’ compensation claims fall into a failed return to work scenario. He explained that about 70 percent of all lost time cases return to work between 30 and 45 days.

He provided a two pronged definition of failed return to work cases.

“A failed return to work, by our definition, is one of those cases that isn’t back to work within 45 days, and…the treatment has gone beyond the guidelines and there’s still no work release. The guidelines indicate that there should be some type of a work capacity. The treating physician won’t provide one. That’s the first part of the definition,” said Grasso.

Another aspect of failed return to work claims occurs when employers refuse to place injured workers back to work.

“The second part is when the treating physician has provided a work capacity and the employer has refused to take the injured worker back. They say they’ve got to be a hundred percent, they’ve got to be full duty, said Grasso.

According to a 2011 webinar hosted by Sehnal, a certified professional ergonomist, barriers to early return to work include the following:

• Employer requirement of 100 percent work capacity;
• Early return could create potential for workers’ comp exposure;
• Limited options – lack of flexibility and creativity;
• Ill-defined program parameters.

Generalized job descriptions are another barrier, experts said.

Job Analysis Essential

“When you think about it, job descriptions are created to keep a certain population from getting the job,” said Grasso. “Some of the things that we discuss with our customers is that job descriptions oftentimes are what are keeping the individual out of work longer than they need to be.”

He explained that because an adjuster or doctor don’t get to see the work environment, they may accept an employer’s refusal to allow an employee back to work.

“A physician is basing it on, number one, the job description, number two, the verbal description by the injured worker. Right, wrong, or indifferent, these injured workers can’t accurately describe weights, repetition, things like that that go on in the work environment. They just aren’t good at it. Period,” said Grasso.

Sehnal, whose company works with employers to provide functional job analyses that help identify key job requirements, said erroneous or vague job descriptions are fairly common.

“Certainly, accurate and…functional job descriptions are key to the return to work process,” said Sehnal. “They will clearly identify the physical and other functional capacities that are required to do the job which will help guide the medical provider in making a good decision on returning the injured worker back to work.”

According to Grasso, job descriptions tend to identify a peak physical demand for a job.

“It’s also important to understand that a lot of these job descriptions do not accurately represent what goes on in a work environment on a day to day basis. They may capture a maximum physical demand that has been buffered because they want to make sure the individual can do the job at the time of hire,” said Grasso.

As an example, he said an employee may only be required to lift 30 pounds occasionally, but an employer may list 45 or 50 pounds in the job description to ensure the employee can do it.

“It’s understanding how to overcome those obstacles with an employer from a business standpoint,” said Grasso. “…When we’re discussing these cases with our ergonomists throughout the country, when you’ve got a 15 pound lifting ability, what they find is that 70 percent or more of that job falls within that ability.”

That’s why on site job analyses are so important.

“It really is all about getting an objective set of eyes out into the work environment to see what sort of accommodations can be made,” said Grasso. “Oftentimes, employers are just too close to the situation to see the opportunities.”

Educating the Employer

Changes in ergonomics can be employed in all work environments, said Grasso.

“When we talk about ergonomics, essentially, what we’re talking about is making the physical work environment fit the individual to allow them to be as productive or more productive and allow them to recover when they get back to work,” he said.

Grasso said that where the injuries involved are musculoskeletal, ergonomic changes can be employed to make accommodations in the work environment.

“We’ve been working with a national carrier, and the average number of days out of work on the cases that we’re seeing is over 400. Our return to work success on those is 63 percent. When cases get over six months of lost time, there’s a pretty good likelihood that that person, that individual is going to have a difficult time getting back to their original employer,” said Grasso.

He noted that his company has successfully created ergonomic changes in salt mines in New York.

“We’re doing it in foundries. We’re doing it in trucking companies, retail, hospitals. Really, work is work, so the industry type doesn’t prevent us from having success, even though the assumption is that we can’t be successful in different work environments,” Grasso said.

“That’s why it’s important to have somebody in the work environment that can accurately describe what’s happening, what the risk factors were, and how you could identify accommodations, and that we also name the decision maker at the employer who is committed to making those changers so that doctor is really in a position now to make an educated decision versus basing it on inaccurate information,” said Grasso.

Identifying transitional duty opportunities in advance is invaluable, said Sehnal, who explained the nuance in using the terms light duty versus transitional duty.

“…There is a tendency to reference light duty when people out of work come back to work, that implies something easier or less demanding. There is a…perception that light duty is forever and transitional duty is more clear that it is temporary,” said Sehnal.

Grasso provided tips for workers’ compensation adjusters evaluating claims that could involve ergonomics.

“They can do some investigative inquiry. When we’re talking about musculoskeletal cumulative trauma type injuries, typically, these are things that occur over a period of time. Even though a case becomes lost time, it could be new to the adjuster,” said Grasso.

“The injured worker might have been experiencing pain eight months ago, didn’t say anything. Then, finally, his supervisor is aware of it, coworkers are aware, eventually files a claim two months later. Just because they’ve got pain, that’s the interesting thing, they can continue to work for a period of time. If an adjuster knows that someone has been experiencing pain for nine months, and they ask them how their employer responded, and they say, ‘I really don’t think they believe me,’ that sort of thing, that’s got to give you an indication that this is a case that could go the wrong way because of those sorts of psycho social factors.”

Soft tissue cumulative trauma as a result of a job may not be seen as an event.

“It’s something that’s been ongoing and accumulating. An employer doesn’t know how to respond, because there could be five or six other people doing that same job but no issues,” said Grasso.

Employers respond to acute injuries differently, he said.

“From an employer perspective, the acute injuries, sticking your hand in a machine, falling off a ladder, those are all real events,” Grasso said. “They’re actual events, so an employer can respond to those with compassion and then deal with that risk, ‘How did he fall off the ladder? How did they get their hand or their sweater caught in the machine? Was it a machine guarding issue?’”