Vocational Rehab Returns Seriously Injured To Work

Vocational rehabilitation is to return the seriously injured employee to:

1. The prior job with the employer or,
2. A new job with the employer or,
3. A new job with another employer.

Most jurisdictions have a section within their workers' compensation statutes mandating vocational rehabilitation for the injured workers who need it. 

Vocational Rehabilitation Starts with Job Restrictions

When the treating physician determines the employee has reached maximum medical improvement, the employee is then released from further medical care. However, suppose the employee's functional ability is below what the employee was able to accomplish prior to the work comp injury. In that case, the treating physician may determine the employee needs restrictions on future work activities to prevent the employee from re-injury.

In a typical claim of this type, for instance, a back injury, the treating physician assigns an impairment rating to the employee. For example, the employee had back surgery, and the physician determines the employee has a 20% permanent disability to the back. For the employee's safety, the physician releases the employee to return to work with a restriction stating the employee will not lift more than 25 pounds at one time. However, the employee's job routinely requires the employee to lift 25 pounds or more. This is the typical vocational rehabilitation case. 

Start Vocational Rehabilitation Timely

Experienced work comp claims adjusters know the earlier the injured worker starts in vocational rehabilitation, the higher the probability of success. The success rate is also higher for workers who return to work with the same employer. When the work comp claim status is such that the adjuster knows from the medical records that an impairment rating is probable, the adjuster should start then with vocational rehabilitation to return the worker to the former job. 

Primary Vocational Rehabilitation Activities

A trained vocational rehabilitation counselor works with the treating physician to establish the course of action necessary to minimize the employee's limitations on returning to work. Three areas the physician and the vocational rehabilitation counselor typically consider are:

1. Work hardening programs.
2. Functional capacity evaluations.
3. Ergonomic work station assessments.

The work hardening program prepares the employee for the physical requirements of the former job. The employee who for months has had no physical activity is not physically able to do the labor done before the injury, even if the employee was not injured. The work hardening program is physical exercise that mimics the work the employee did before. It is designed to gradually build up the employee's strength and endurance so that s/he can lift, pull, push or drag weight similar to what s/he was doing prior to the injury. The work hardening program can go on for weeks as the employee rebuilds physical endurance.

Functional Capacity Evaluation

A functional capacity evaluation is a one-time evaluation performed by a physical therapist after the employee completes all physical therapy treatments. During a functional capacity evaluation, the employee is evaluated doing simulated work. The therapist observes and scores the employee's ability to complete tasks similar to what the employee would do on the job. The purpose of the functional capacity evaluation is to give the insurer or the employer information on the employee's ability to do the work. In conjunction with the therapist, the vocational rehabilitation counselor can make recommendations on modifying the employee job and work environment to accommodate the employee's limitations.

An ergonomic assessment is used to prevent the employee from re-injury by improper lifting techniques or improperly placed equipment. The vocational rehabilitation counselor inspects the worksite and makes recommendations to protect the employee from re-injury. For example, the vocational rehabilitation counselor may recommend objects the employee might lift to be placed on a table rather than on the floor at the employee work site. Another recommendation might be for the employee to be accommodated with a stool to sit on while working rather than standing all day. 

Other Vocational Rehabilitation Services

If the employee's injury is such that regardless of the efforts of the vocational rehabilitation counselor, the employee cannot return to the prior employment, then other vocational rehabilitation services may be needed. Other services that can be provided include:

1. Counseling the employee in selecting a job suitable for them.
2. Labor market surveys and job search assistance.
3. Instructions in job-search techniques.
4. Vocational assessments to evaluate the employee's aptitudes, skills, interest, and physical capabilities.
5. Job training in a new vocation.
6. American with Disabilities Act accommodation assistance.

Summary

Some employers take the position that vocational rehabilitation for the employee is expensive. It is. However, vocational rehabilitation is far less costly than paying lifetime disability benefits to the injured worker who never returns to work. Properly utilized vocational rehabilitation can significantly reduce the cost of the larger work comp indemnity claims by returning the injured worker to a productive role.

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