Special Intervention | Return to Work | Occupational Case Management | City of Austin

Over 50 percent of workers' compensation claims costs are indemnity pay-out. Modified duty can reduce costs while complying with a restricted work release.

Situation

On November 1, 2005, a shelf in a retail store fell, striking an employee on the right shoulder. She was seen at an emergency care center and returned to work in a light duty capacity with a prescription for physical therapy. After a brief attempt to return to work and one physical therapy session, the patient consulted an attorney and secured the services of a chiropractor.

On December 21, IMO was called to initiate case management. The attorney denied contact with the patient, so the case manager scheduled a visit with the doctor to review the medical file and the employer's modified duty program. Her restrictions were such that modified duty was possible as opposed to a light duty job assignment outside of her regular work area. They agreed to recommend a return to work in modified duty.

Solution

The case manager met with human resource personnel and the supervisor to review the ability-disability report and necessary accommodations required to return the patient to her regular position. On the first day back to the job, the case manager met with the patient to explain the case manager role and review job accommodations and identify safety issues.

Prior to the patient's next doctor visit, the case manager made a final report to the doctor regarding specific job tasks, the accommodations in place, a subjective report from the patient and other general observations.

Results

When a situation appears to be going from bad to worse, it often takes an unbiased opinion combined with professional expertise to bring about an effective solution. IMO's Special Intervention Assignment can properly and swiftly assess a situation so that a solution that is satisfactory to all involved parties can be implemented.

Only 30 days after turning to case management, the doctor granted a full return to work for an injured employee. IMO worked directly with the medical provider, employer and the injured employee in establishing transitional duty tasks that allowed the employee to return to full duty in a safe manner.

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Statistics prove that the longer an injured employee remains absent from the job, the more difficult it is to return the employee back to the work environment.

Situation

A carpenter's aide in Houston had back surgery on May 28, 2005, to repair spine constriction in his lower back.

In October of the same year, IMO was called to take action on the case. During the first appointment with the treating doctor, the case manager learned he was about to prescribe eight weeks of work hardening at the rehabilitation center. Believing this was an over-utilization of care, the case manager suggested that IMO's transitional return-to-work program would be a better alternative.

The doctor, unaware that this service was previously available, issued the prescription. He realized that the patient was capable to go back to work for job site training and that this program would provide medical and psychological benefits to the patient.

Solution

After receiving three weeks of conditioning/work hardening, the injured employee began the Transitional Return to Work Program. He worked at the job site twice a week for half a day under the supervision of IMO, the other half day he received treatment at the rehabilitation center. The development of his functional abilities became evident to the employee and the medical providers.

In addition, the employee's supervisor participated in the job site work training. He witnessed the abilities of the employee and learned ways to minimize the risks of re-injury. By the fifth week, the doctor recognized the patient's progress both at the clinic and work site and issued a work release where the patient worked four hours a day in week six, six hours a day in week seven, and full duty by week eight.

Results

Just as a runner returning to training wouldn't begin with the same schedule prior to injury, an injured employee shouldn't be expected to take on the same work tasks when returning to work. IMO's Transitional Return to Work Program provides the conditioning needed to build up to the abilities prior to the injury.

This program gave the doctor evidence of the patient's actual, not simulated, work abilities. The patient's time in the clinical environment was not over utilized and his work training at the job site gave him and his employer confidence to do his job and return to a productive lifestyle. These findings provided objective facts that resulted in a safe and timely work release.

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Incorporating true, functional work activity into the rehabilitation plan can reduce by half the cost of a typical work hardening program in half

Situation

On December 14, 2005, an employee of a package tank company was struck in the back by a metal gas tank. A referral to a neurologist confirmed disk herniation in his lower back, combined with sciatic irritation. He was not considered an immediate surgical candidate, nor did he want surgery, so he was referred to a physician for pain management. After receiving modality type therapy and two epidural steroid injections without results, IMO was called in to provide medical case management.

Solution

Because it was difficult to distinguish the root cause of his pain, the case manager and physician agreed that increased therapy progressing to work hardening would be appropriate. Problems continued however, and he was referred to a neurosurgeon. The neurosurgeon noted that the pain described was not congruent with herniation type symptoms. A bone scan ruled out the possibility of a fracture, leaving the neurosurgeon to believe he suffered a soft tissue injury.

With this information, the case manager recommended a work hardening program that included on-site intervention. On May 1, the case manager performed an on-site analysis in order to educate the treating medical provider regarding the required physical demand of the job. The case manager also coordinated with the employer to provide specific work materials for the therapist to use in the work hardening program. The patient began the program on May 9, and by June 5, he was back to full duty—just three and a half months after IMO took on the case.

Results

Work hardening is only as good as the tools and materials used in therapy. A 20-pound dumbbell and a 20-pound gas cylinder tank may weigh the same, but they require different techniques for lifting, due to size and weight distribution differences. Occupational Case Management goes beyond traditional case management by incorporating the work environment into therapy. IMO's dedication to specific, individualized care proves to be a more efficient and safer return to work program. IMO impacted this case by integrating medical and occupational plans. IMO incorporated relevant employer and work information into the rehabilitation plan. A typical work hardening program lasts eight weeks. This patient's program involved true, functional work activity and resulted in a full duty return to work within four weeks. The incorporation of actual work information allowed for an educated, safe release from the physician versus an estimated release with possible restrictions based on standardized testing measures.

Click here for a printable PDF of the Occupational case management study.

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Case history
In 2005, an employee at the City of Austin offices reported ongoing pain in the left arm and received a diagnosis of mild carpal tunnel syndrome. The employee had received eight weeks of therapy from the treating physician with limited success and a modified duty of activity as tolerated. The employee had previously not been able to return to work for several weeks due to pain. A referral was being made to an orthopedic surgeon for treatment and possible carpal tunnel surgery.

The CCM/OTR provided an on-site visit and ergonomic assessment. There was close coordination between the HR supervisor and the injured worker, with recommendations also made to the physician. The worker was able to return to work on a limited basis with the new modifications in place. The case manager then met with both the injured employee and the orthopedic surgeon and was able to review successful work site changes and recommendations. After an injection and further worksite changes, the injured employee had received a promotion and was able to vary her tasks even more along with additional fine tuning of body mechanics, posture and positioning and lifestyle changes for healthier living. CCM was able to close the file within 120 days and an MMI/IR was reached within that time of 6% with full duty release and no permanent restrictions.

Impact of IMO on the case file
As a result of IMO’s involvement, communication among all parties was enhanced, resulting in an early and cost-effective return-to-work outcome. Unnecessary surgery and any additional evaluations were avoided including functional capacity evaluations, etc., with no additional rehabilitation or therapy. Lost time from work and surgery was saved and the use of case management through IMO resulted in a full duty return-to-work of approximately 6-8 weeks.

Click here for a printable PDF of the City of Austin case study.

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