9/30/2010. Section of the IIC Act s Rules Governing Practice Before the Industrial Commission

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Kelley Gardner
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1 Aegis Rehabilitation Consulting Services, Inc. Mary Szczepanski, RN, CCM Rehabilitation Consultant 1. Late Referrals for Medical Case Management 2. Light Duty Return to work program 3. Lack of communication 4. Attorney Involvement 5. Heavy Physical Demand Level/FCE 6. IME choice/specialty 7. Vocational Rehabilitation Section of the IIC Act s Rules Governing Practice Before the Industrial Commission 1

Lack of communication 4. Attorney Involvement 5. Heavy Physical Demand Level/FCE 6.

2 ILLINOIS WORKERS COMPENSATION COMMISSION REHABILITATION PLAN ATTENTION. The employer, in consultation with the injured worker, shall prepare a rehabilitation plan when the employee has been unable to work for more than 120 continuous days or when it can be reasonably determined that the injured worker will be unable to resume his or her regular, pre-injury duties. The plan shall be updated at least every four months while the employee remains incapacitated or until the case is closed by the Commission. A copy of each document shall be given to the injured worker. See Section of the Commission Rules. Section Vocational Rehabilitation a) The employer or his representative, in consultation with the injured employee and, if represented, with his or her representative, shall prepare a written assessment of the course of medical care, and, if appropriate, rehabilitation required to return the injured worker to employment when it can be reasonably determined that the injured worker will, as a result of the injury, be unable to resume the regular duties in which engaged at the time of injury, or when the period of total incapacity for work exceeds 120 continuous days, whichever first occurs. b) The assessment shall address the necessity for a plan or program, which may include medical and vocational evaluation, modified or limited duty, and/or retraining, as necessary. c) At least every 4 months thereafter, provided the injured employee was and has remained totally incapacitated for work, or until the matter is terminated by order or award of the Commission or by written agreement of the parties approved by the Commission, the employer or his or her representative in consultation with the employee, and if represented, with his or her representative shall: 1) if the most recent previous assessment concluded that no plan or program was then necessary, prepare a written review of the continued appropriateness of that conclusion; or 2) if a plan or program had been developed, prepare a written review of the continued appropriateness of that plan or program, and make in writing any necessary modifications. d) A copy of each written assessment, plan or program, review and modification shall be provided to the employee and/or his or her representative at the time of preparation, and an additional copy shall be retained in the file of the employer and, if insured, in the file of the insurance carrier, to be made available for review by the Commission on its request until the matter is terminated by order or award of the Commission or by written agreement of the parties approved by the Commission. e) The rehabilitation plan shall be prepared on a form furnished by the Commission. (Source: Amended at 30 Ill. Reg , effective June 22, 2006) The Act specifically addresses not only Vocational Rehabilitation in this section, but Medical Management as well specifically states that the plan should include an assessment of the medical care necessary for the petitioner to return to work. If rehabilitation is necessary, the plan should address the need for a medical evaluation and modified duty (clearly medical management activities). Employee/Petitioner v. Employer/Respondent Case # WC Attach the most recent medical report and provide an assessment of the medical care necessary for the petitioner to return to work. Is rehabilitation necessary for the employee to return to work? Yes No Explain below. If rehabilitation is necessary, address the need for each of the following: Medical evaluation Vocational evaluation Modified or limited duty Retraining Other Signature of petitioner Date Signature of person completing this form Date Name of petitioner (please print) Name of person completing this form (please print) IC31 12/ W. Randolph Street #8-200 Chicago, IL / Toll-free 866/ Web site: Downstate offices: Collinsville 618/ Peoria 309/ Rockford 815/ Springfield 217/

determined that the injured worker will be unable to resume his or her regular, pre-injury duties.

3 Lower average medical case costs Matheson and Brophy, 1997 concluded that average cost of lost time back injury cases was $12,518; Their mean costs in their study of modified duty/early intervention was $4408 Median costs for workers who returned to modified duty before any lost time was noted to be $2459 Higher levels of return to regular full time work. Absence from work for more than a few weeks has been found to be an important predictor of eventual inability to return to work for persons with low back pain Lower levels of attorney involvement May be an attempt by injured worker to cope with prolonged involvement with Worker s Compensation. Anderson, et al, in J Occup Rehab, 1996 showed that in cases requiring an IME, 78% were litigated with 150% greater medical costs than non litigated claims. A literature review of modified duty programs by Krause, et al, J Occup Rehabilitation, 1998 identified the following: Facilitated eventual return to regular full time work. Rate of RTW for injured workers on modified d duty is double (100% increase in RTW rate) Modified return to work programs reduce the number of lost days in half Modified duty is cost effective Interdisciplinary team approach to disability management: Employer-based with clinical interventions that have a tie-in to work place. Open communication with Interdisciplinary team: Employer, Employee, physician, therapist and claims personnel More likely to enhance injured worker s motivation to return to work. Employees may need to be educated with regard to their understanding of their rights. Educated about medical and vocational aspects of their case Treatment plans Time frames for MMI and RTW 3

Absence from work for more than a few weeks has been found to be an important predictor of eventual inability to return to work for persons with low back pain Lower levels of attorney involvement May

4 Medical/Vocational Rehabilitation is called for under the Act and attorneys do not dispute this. There are significant disputes over who picks providers of Med/Voc due to findings by state courts that Voc Counselors are 8a (doctor or medical) providers. The Act specifically says, however, The employer or his representative will prepare the plan for vocational rehabilitation. Some attorney s deny and delay early intervention for the medical/vocational rehabilitation of the injured worker. As has been demonstrated, it is in the injured worker s best interest to receive these benefits. According to the Dictionary of Occupational Titles the Heavy Physical Demand Level is defined as: H-Heavy Work - Exerting 50 to 100 pounds of force occasionally, and/or 25 to 50 pounds of force frequently, and/or 10 to 20 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Medium Work. 85% of all job titles listed in DOT are MEDIUM level or Less Occupations that present special problems and require every Case Management Tool: Ironworker Sprinkler Fitter Pipe fitters Construction Carpenters Laborers Requires voc/med management plan immediately If there is no light duty, training should be automatically considered especially for the following medical interventions: Rotator Cuff Repairs Lumbar Fusions Extensive DJD with possible multiple surgical interventions (with joint replacements) Does the specialty fit the injury or diagnosis? Could an early IME be helpful in establishing a differential diagnosis for optimal care? Does the IME doctor have all of the records, films and diagnostic studies that he will need to make definitive diagnosis, prognosis, treatment recommendations and return to work estimate? Does the IME have all of the vocational information including modified duty opportunities, job analysis and vocational plan? Did the IME become the treating surgeon? And where do you go when the case does not resolve? 4

The Act specifically says, however, The employer or his representative will prepare the plan for vocational rehabilitation.

5 When to introduce voc rehab and training: If the employer does not provide light duty to its injured employees. If the employee works in a heavy or very heavy category job such as construction industry jobs (they typically do not have light duty and the jobs are in most cases heavy) If the employee has undergone an extensive surgery that will require extensive post operative rehab and the operation makes it more likely that the person will not return to their previous work. Training should consist of the following: Enhancement of worker s demonstrated skills/capacities at time of injury Local resources such as Community College, on-line training or short term private school should be identified. Costs of 1 year (30 c.h.) program at Joliet Junior College: Construction Estimating - Certificate of Completion - TE333 Course Sequence Total of 16 Semester Hours Required Courses - 20 Semester $103/hr=$ $1000 or about $3000 total Worker s comp requires return to work. Retraining therefore is not necessary if the person is at MMI and possesses transferable skills at the restrictions level. Retraining is done to provide skills to return to work. Placement is still required after retraining is completed. 5

undergone an extensive surgery that will require extensive post operative rehab and the operation makes it more likely that the person will not return to their previous work.

MONEY WELL SPENT: YOUR DEFENSE ATTORNEY AND YOUR VOCATIONAL SPECIALIST

MONEY WELL SPENT: YOUR DEFENSE ATTORNEY AND YOUR VOCATIONAL SPECIALIST Presented and Prepared by: Gary L. Borah gborah@heylroyster.com Springfield, Illinois 217.522.8822 The cases and materials presented