MMI: The ‘Cancer’ of the WC Industry

Nancy Grover

Sarasota, FL ( – Work disability is not the same as a medical disability, according to several workers’ compensation thought leaders. It is a separate condition that requires its own intervention. And once understood, it can explain ‘creeping claims.’

“This separate condition is what so many of us have seen cause an initially simple workers’ compensation claim to become a complex one,” said Vickie Kennedy, assistant director of Insurance Services for Washington state and chair of the International Association of Industrial Boards and Commission’s Disability Management and Return to Work Committee. Kennedy refers to work disability as “the virus of the workers’ compensation industry.”

During a recent webinar produced by the in partnership with the IAIABC, Kennedy and other panelists said the industry needs to take a worker-centric approach and proactively prevent work disability. By following the tips in a new ‘How-To’ guide, stakeholders can have a dramatic impact on advancing return-to-work efforts among injured workers.

Work Disability

Work disability occurs when a worker cannot stay at work or return to work due to injury or disease. But, according to some, there’s more to it.

“Work disability is the result of a decision by a worker who for potential physical, psychological, social, administrative, or cultural reasons does not return to work,” according to The Handbook of Work Disability. “While the worker may want to return to work, he or she feels incapable of returning to normal working life. Therefore, after the triggering accident or disease has activated a work absence, various determinants can influence some workers to remain temporarily out of the workplace, while others return, and others may finally not return to work at all.”

Factors that may lead the worker to avoid returning to work include such things as his concerns, perceptions or expectations, workplace conditions, medical factors such as comorbid conditions, and the attitudes of various stakeholders.

Since the worker makes a choice as to whether to return or not, stakeholders can significantly influence the decision the worker ultimately makes. Many workers’ compensation professionals may inadvertently put up barriers that lead to the worker’s decision not to return.

But they can also have a positive effect.

“Because we’re talking about a choice, and anytime there is a choice then you have motivational factors behind that, the literature is pretty clear,” said Ryan Guppy, chief of Return to Work Partnerships for the Washington State Department of Labor and Industries, “that engaging and activating the worker about what they think needs to happen through goal planning and goal attainment to enable them to successfully return to work or move thru the process is pretty critical.”

Once an injury or illness occurs, the idea of disability prevention is to minimize medically discretionary and medically unnecessary disability. The panelists said helping injured worker stay in, or return to the workforce should be based on four principles of work disability prevention:

1. Unnecessary delays, often caused by systemic problems

2. Unnecessary duration, which may be caused by medically discretionary and unnecessary disability which usually manifest as non-clinical risk factors

3. Confusing process, which creates uncertainty in the mind of the worker.

4. Unclear return-to-work expectations or plans


Intervening at the very beginning of a claim is crucial to helping the injured worker choose to return to work. But often stakeholders miss the mark.

“I don’t think most doctors, even some workers’ comp professionals – depending on their role, recognize how quickly long-term dis sets in,” Kennedy said. “You get a claim where a worker’s been off more than 6 months and the chance they will ever return to work drops astronomically. “

An injured worker’s personna quickly shifts from thinking of themselves as a worker and the career they are in to one of someone who is disabled, the speakers said. Many stakeholders instead wait until the worker has reached maximum medical improvement to intervene.

“Maximum medical improvement, I think, is the cancer of our industry,” Guppy said. “It’s really a terrible idea to use MMI as a trigger for intervention because you’re coming to the table way too late. By that point in time you not only a work disability problem, but you’ve got a worker who you’ve probably triggered a number of the most common psychosocial risk factors and/or behavioral health issues that now you have to unpack and you have to uncover and pay for help to get that person back on the pathway to consider return to work.”


A new publication from the IAIABC’s Disability Management and RTW Committee outlines specific steps industry participants can take to help injured worker make the decision to return to work. It is organized by stakeholder group.

Medical providers, for example, should be brought into conversations with stakeholders early and collaboratively.

“They don’t necessarily understand the systems, which are very different from general healthcare; the paperwork, things you have to answer, not being able to get treatment authorized in a way you’re used to – those are impediments that piss providers off and they get pissed at the systems, which isn’t fair,” said Marianne Cloren, MD, associate professor at the University of Maryland School of Medicine. “They may think they are taking it out on you, not really recognizing that some of the angry decisions they make wind up hurting their patients. The more we can educate them about the impact of those decisions made in frustration, the better.”

Simplifying things for providers and their offices to avoid frustration can go a long way in getting their cooperation, she said. Helping them understand that the medical must address multiple domains, such as engaging the injured worker and employer in the recovery plan to determine the underlying non-,medical factors of the work disability problem can help.

Employers are urged to “proactively focus on the safe and early return to work of an injured worker as a part of the worker’s healing process, thereby achieving better outcomes for them and the worker,” the publication states. Quick and consistent communication is vital. The employer should show concern for the injured worker and express they are a valuable part of the team.

“Your first conversation should not be an ‘investigation’ into the accident or what or who might be to blame,” it says. “Look for ways to modify the worker’s job. Set an expectation that you are confident that your employee can heal or recover while working.”

Reduced hours, adjustment to regular job duties, temporary projects, and other modifications are among the low- or no-cost ways to ensure the employee is working within the temporary work restrictions prescribed by the medical provider.

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