The power of the process
Consistently using the Official Disability Guidelines (ODG) in workers’ compensation return to work management is a good industry practice, but there’s power in taking a step beyond. Investing additional time to fully understand important factors about the person impacted by injury – and then using that information to foster the right experience tailored for the individual within guidelines – is a best practice and shows how caring counts in the recovery process.
Recovery is generally delayed when an individual with pre-existing personal health conditions has an injury on the job. It is important to document personal health conditions and modify the claims management strategy in order to best meet the injured employee’s needs. The term “comorbidity” is often used in connection with “personal health condition.” Common comorbidities that may impact healing time are diabetes, auto-immune disorders, obesity, cancer, smoking and age. When handling claims, it is critical to know the number of days before the individual can safely get back on the job. A comorbidity calculator combines multiple diagnosis codes and influencing factors to give claims examiners and nurses an evidence-based disability duration.
Successful return to work management must also include the following factors in order to properly guide each injured individual safely back to their pre-injury job:
- A documented plan with a return to work date on target with disability guideline calculations
- Routine identification of behavioral health concerns included as part of early investigations and documentation, helping to engage behavioral health services and mitigate recovery delays
- Treatment provider awareness of any pre-existing and unrelated medical conditions
- Diligent prescription drug oversight – claims examiners and nurses should document the use of opioids, muscle relaxants and drug combinations from one or multiple prescribers, as these can prolong recovery and return to work
- Strategic treatment planning and oversight by a clinician in order to keep full recovery on track
- A claims examiner, nurse or return to work specialist working in one system for continual clarification and confirmation of actions and shared strategies
Claims examiners and nurses should carefully educate the injured employee about the recovery experience and partner with them to set and support return to work goals. Provider education regarding evidence-based care and safe return to work will also help with treatment planning. In addition, claims examiners should use evidence-based decision support for accurate claim reserving.
With ODG as the driver and personalized planning as the catalyst, delivery of care takes on a much more holistic approach. Following this process can make us more impactful advocates as we help restore injured employees to their daily lives and pre-injury work safely, quickly and effectively.
Robin Moleski, RN, BSN, CCM – VP, Clinical Operations
Read more in the edge magazine: Communication and teamwork: Keys to a successful return to work