Lost time and complicated claims may benefit from vocational rehabilitation services.
A vocational case manager is different than the case manager that your MCO provides for each claim.
Injured workers may participate in vocational rehabilitation when they become medically stable and often have a barrier preventing him/her from returning to work, even with restrictions. Services included in a vocational rehabilitation may include services such as additional restorative treatments, flexible return to work programs, employer incentives and job modifications, or tools as well as a host of other vocationally directed services.
Benefits of Vocational Rehabilitation
Services approved in a vocational rehabilitation plan have their costs as well as the wage replacement during their provision charged to the surplus fund, controlling the impact of the service on the employer’s premium. Employers with employees returning to work in a transitional work program may also be eligible for an employer incentive which could reimburse the employer for up to 50% of the injured employee’s wages while in a vocational rehabilitation program. Employers also benefit when an experienced worker remains productive so the costs associated with hiring and training a new employee are reduced or eliminated.
When Should a Referral to Vocational Rehabilitation be Made?
In most cases, the MCO will request the referral to a vocational rehabilitation provider when the claims manager identifies an injured employee that may benefit from services and he/she is medically stable. Referrals can also be made by employers, the injured employee, physician, attorney, physical therapist or a third party administrator. Some considerations which may indicate a referral to vocational rehabilitation could be beneficial include:
- The physician is reluctant to give restrictions
- The employee has a non work related illness or injury which results in a longer recovery time
- The employee requires additional physical therapy
- The physician is reluctant to release the injured worker to return to work or provide facilitation to do so
- The employer can accommodate restrictions but the physician will not release the injured worker to return to work
- The injured worker is in acute therapy and may be ready to progress to active physical therapy
- Receipt of a treatment request from the physician for work conditioning or work hardening services
- The injured worker has exhausted light duty availability with the employer
- The injured worker no longer has a job to return to with the employer (due to either termination or because they cannot accommodate permanent restrictions)
- The injured worker has received a Permanent Partial Disability (PPD) award and has documented job restrictions
- Physician has given the injured employee permanent restrictions
- Injured worker is having a difficult time staying on the job.
- Returning to work with the original employer is questionable.
Return to Work Incentives (through Vocational Rehabilitation Services)
A vocational rehabilitation case manager (VRCM) may use Return To Work Incentives when negotiating a return to work with an employer. It is expected that the employer will retain the injured worker at the successful completion of the incentive as long as business conditions allow. The VRCM is responsible for these negotiations with the employer, the injured worker and other parties where appropriate and must meet BWC rehab policy guidelines.
Types of Return to Work Incentives include:
- Employer Incentive Contract
- Gradual Return to Work
- On the Job Training
- Work Trial
- Job Modifications
- Tools and Equipment
Employer Incentive Contract (EIC): An EIC is a method of returning an injured worker to work, while compensating an employer for a loss in productivity and hours worked due to the allowed conditions in the claim. The contract is set up so that as the injured worker’s productivity increases, the payments to the employer decrease over the course of the entire incentive program. An EIC can be used for injured workers with temporary restrictions trying to return to regular job duties or to overcome fear of RTW and/or can it be used for injured workers with permanent restrictions who are learning how to perform a new job.
Gradual Return to Work (GRTW): This program allows an injured worker to return to work on a graduated basis typically building up from four (4) hours per day to a full-time work status within a 13 week maximum. The employer must agree to provide wage statements that specifically indicate the days and hours worked per pay period. The employer can pay the injured worker’s full salary and be reimbursed for hours not worked as specified in the GRTW plan. Or, the employer can pay the injured worker for strictly the hours worked and the injured worker then receives compensation from BWC for hours not worked.
On-the-Job Training (OJT): On-the-Job training allows an injured worker to obtain or upgrade vocational skill through actual work experience. This training must be provided under the close supervision of an experienced person skilled in the job. The duration of the program cannot exceed the Specific Vocational Preparation (SVP) timeframes identified in the Classification of Jobs (COJ). The reimbursement to the employer cannot exceed 50% of the injured worker’s weekly wages when averaged over the OJT period.
Work Trial: A Work Trial program permits an injured worker to attempt a return to work in the original job, or at a new job with either the same employer or a new employer. It allows an employer to test, evaluate and observe the worker at the actual job prior to hiring. A work trial can last a maximum 4 weeks during which time BWC pays the injured worker compensation (living maintenance).
Job Modifications: A Job Modification is the removal or alteration of physical barriers that may prohibit an injured worker from performing the essential job functions and prevent the worker from returning to work or maintaining current employment. It may change the physical demands of the job thus allowing the worker to perform their essential job functions without restrictions. Coordination among the employer, injured worker, physician of record and other professional is required to ensure the suitability of the modification. An actual on-site job analysis or ergonomic study is necessary to begin the process of Job Modification. The recommendation for the Job Modification comes from the Occupational or Physical Therapist or Ergonomist who has performed the job analysis/ergonomic study. Payment for the modification can be issued to the employer or to the provider of the modification.
Tools and Equipment: This service provides tools and /or equipment (i.e., chairs, etc.) necessary for employment to the injured worker once he or she has obtained a job or has an approved rehabilitation plan that requires specific tools and equipment. The tools and equipment are the property of BWC and may be reclaimed should vocational rehabilitation plan prove to be unsuccessful If the injured worker has maintained employment for 90 days, the tools and equipment are released to the injured worker