Worker's Compensation

What is worker’s compensation?

a form of insurance providing wage replacement and medical benefits to employees injured during the course of employment

what complexities conribute to worker’s compensation?

different terminology, different rules by state, unique stakeholders, decentralized decision making, secondary gains, restricted patient choice, unique treatment goals/expectations

what are the 2 options for employers to cover expenses of employees who get hurt at work?

get an insurance policy, set aside funds as needed aka self-insurance and use a third party administrator (done by large coorporations)

who is financially responsible for covering medical expenses and compensating for lost wages f you are injured at work?

your employer

reporting requirements for worker’s compensation

worker must report injury within 120 days, insurance carrier gets 21 days from notice to accept or deny claim (may require independent medical exam)

what is the flow of steps through a worker’s compensation claim?

injury reported→ claim filed→ medical evaluation→employer investigates claim→ adjuster assigned→ ongoing care authorized and organized by adjuster→ work restrictions managed by employer

responsibilities of the adjuster

coordinate referrals, timely care and payment, resources identification, disability prevention

PT responsibilities in a workers comp case

understanding MOI, understanding job, orienting patient and treatment plan towards full return to work, identifying recovery barriers, communicating with stakeholders

injury rates at work are now going down, why?

work form home and automation

most costly injury types for workers compensation

motor vehicle, burn, fall/slip

workers comp patients are ______ to receive PT than commercial health patients

45% more likely

what is not covered by workers comp?

self inflicted injury, employee violation of the law, things not caused/aggravated by work

how is work classified?

by physical demand level

how does an injured worker get to PT?

referred from physician, authorized and scheduled by adjuster, follow ups scheduled by practice

differences that can occur w/ workers comp PT

claims denied, patient refuses treatment, patient non-compliant

barriers to recovery

perceptions of high physical demands at work, stress, lack of social support, job dissatisfaction, inability to modify work, poor expectations of recovery, fear of re-injury, perceived injustice

what is an insurance provider entitled to monthly reports about in worker’s comp cases (this doesn’t violate HIPAA)

attendence, progress, prognosis/return to work, only for current course of injury

what is typically the goal for PT in worker’s comp cases?

return to prior functional status at work

how can sub-maximal effort be identified?

performance consistency: ROM, strength function, physiological response to pain, observation

strategies for worker’s comp PT

focus on function, communicate clearly, objectify whenever possible

what is the purpose of advanced work rehabilitation?

to help progress an injured worker’s tolerance of job specific physical stresses, emphasize work-related function and reconditioning

an objective measure of function compared to physical job demands that predicts potential to meet and sustain work tasks

functional capacity evaluation (FCE)

how long does the administration of an FCE take?

multiple hours to multiple days (avg 4 hours)

what situations require objective functional information?

patient plateaus, relayed RTW, discrepancy b/w subjective complaints and objective findings, disability determination/litigation, job placement decisions