The Physician’s Role in Recovery and Return to Work IAIABC WOKERS’ COMPENSATION COLLEGE 2009 DR J.W. MELENCHUK, CHIEF MEDICAL OFFICER, SASKATCHEWAN WCB. Overview. ACOEM position 2008 MD role in RTW MD role in assessment, monitoring and diagnosis
The Physicians Role in Recovery and Return to WorkIAIABC WOKERS COMPENSATION COLLEGE 2009DR J.W. MELENCHUK, CHIEF MEDICAL OFFICER, SASKATCHEWAN WCB
THE ROLE OF THE MD IN RTW:
In addition to the normal assessment and treatment physicians provide their patients, the treatment plan for an injured worker mustinclude a return to work component.
The extra responsibility this places on physicians is balanced by the assistance available from the workers compensation insurer (WCI) and employer.
The physician has a responsibility to maintain communication with the worker and the WCB about the extent of the workers injury and the expected recovery timeline. The physician also has a responsibility to provide to the WCI and to the employer (via the worker or directly with consent) information about any restrictions the worker may have because of the injury, and to update any restrictions as the workers condition progresses.
In almost all circumstances, restrictions should be provided unless the worker is hospitalized or house bound. The list of restrictions allows the employer to identify if appropriate work is available for the worker while they are recovering. The onus is on the employer to match work to the restrictions the physician has outlined.
Example of Medical Professional POLICY Support for RTW guidelines and timely reporting:
College of Physicians and Surgeons of Saskatchewan policy: Role of the Physician in Certifying Illness and/or Assessing Capacity for Work
ACOEM 2008 position paper
Other examples for timely reporting of injury and restrictions: CMA, AMA and the CMPA (Sept, 2008 Newsletter)
What does the medical literature show is best for the Injured Worker?
Recovery can best be achieved by active treatment at the primary level integrated with a return to work as soon as appropriate, and timely access to secondary and tertiary services, where required.
It is important to identify workers at the initial visit. The WCI may recommend that the Clinic/Outpatient Department post a sign in their waiting room asking injured workers to identify themselves to the receptionist or admitting clerk as having a work injury on initial and return visits.
We recommend that physicians carefully document the workers condition at the first visit and throughout recovery and fill out all WCI report forms completely. This information is valuable to the WCI, other health care professionals, and to the worker. Prompt reporting allows timely WCI decisions and prompt payment of benefits.
Extra care is needed at the initial visit(s) to ensure that the injured worker has an accurate perception of the prognosis for recovery.
An imagined catastrophic prognosis can become aself-fulfilling prophecy!!!!!!!
In most cases, return to accommodated work has a positive impact on the workers recovery. However, sometimes a workers injury or illness or the effects of medication prescribed for the injury or illness may impair their judgment and balance and pose a safety risk to the worker or others.
Physicians should consider such impairment when giving restrictions.
Medical Associations have stated:
If the medical condition of the patient and the nature of the work related tasks performed are likely to endanger the safety of others, the physician must place the public interest before that of the individual patient.
CMA Policy Statement and ACOEM position
In addition to the normal information about the recommended course of treatment and the expected recovery time, physicians need to advise injured workers about their restrictions/capabilities. With few exceptions, if a worker is not in hospital or house bound they could return to work if their restrictions can be accommodated. Rather than authorizing absence from work, the physicians should provide the injured worker with a list of restrictions resulting from the injury to be shared with the employer.
Once the worker shares the list of restrictions with them, the employer (RTW support) can determine, in consultation with the worker, and union (if any), if the workers duties can be modified or other accommodations can be made to allow for a safe return to work
Physicians should always assume that the employer with the assistance of their RTW planning support can and will accommodate, even if workers think otherwise.
If the employer cannot accommodate the workers restrictions, then an absence from work may be required. Physician monitoring is essential to update or modify restrictions as the recovery progresses to ensure optimal timing on RTW.
The advantage of this approach for both the worker and employer is that it encourages both to keep the dialogue open regarding accommodation. Continuing communication between the worker and employer is a vital part of successful recovery and return to work.
If the workers employer has a Return to Work program in place, the worker may bring a copy of a Return to Work form to be filled out. If the worker does not provide a form, the physician should list any restrictions the worker has on the WCI provided form or physician letterhead and give the list to the worker with instructions that it be given to the employer.
At each visit, this list of restrictions should be reviewed, and, as the workers condition changes, updates forwarded to the employer via the worker.
Be aware that Health Information Privacy Law in many jurisdictions has caused Medical Professional Associations to caution their members about direct contact with an employer.
Providing the restrictions (health information) directly to the worker to provide to the employer provides consent and is usually the quickest in implementing the RTW.
Many WCIs have RTW facilitators that can liaise with the employer and MD in setting RTW expectations.
Every work injury that needs medical attention must be reported to the WCI.
When the physician determines specialist and diagnostic services are required, WCI can assist. Where a waiting list exists for a service required by a worker, the WCI can help arrange an expedited service in many cases (i.e. MRI, CT scan or other diagnostic; day surgery; and appropriate specialist appointments.)
Requests for expedited services can be made either on a WCI report form or by contacting the Workers Compensation Insurer directly. WCI staff will forward requisitions for referral letters to the attending MD to be completed. An early response is encouraged and required to maximize treatment and RTW.
Most referrals from the attending MD to other consultants/services can be expedited via the WCI.
WCIs may not require a specialist referral to arrange expedited MRIs, CT scans and other diagnostic tests. A tick box may be provided on the Physician Initial and/or Progress Report.
Requests for unusual devices, treatment or diagnostic tests by any physician may require discussion with a WCI Medical Officer or WCI arranged Medical Consultant
If the injured workers recovery does not proceed as expected, the physician should contact the WCI to arrange for a multidisciplinary (team) assessment.
Many WCIs will have the regulatory ability to require the worker to present for an assessment when recovery/RTW is delayed from expected recovery timelines.