Sarasota, FL (WorkersCompensation.com) – There’s a move afoot in Washington state to get injured workers back to work sooner through vocational recovery. The idea is to make workers employable, rather than doing an employability assessment. Four years into the program, it seems to be working.
“At the last count our change in our required reserves were in the neighborhood of about $15 billion. That’s gone down now by a little over $2 billion; most of it is credited to the changes in the vocational referral process and vocational recovery,” said Vickie Kennedy, Assistant Director for Insurance Services at Washington’s Labor & Industries. “When you look at the workers that were projected to become long-term disabled in 2012, if you take those workers and compare them to those injured in 2019 it’s about 900 fewer workers that are not going to stretch into long term disability. So those are both the lives and the dollars involved.”
Kennedy was among the panelists on the latest ‘Hot Seat’ webinar on WorkersCompensation.com, Building a Better Workers’ Comp Outcome Through Vocational Recovery.
As the speakers explained, working with vocational rehabilitation counselors as early as possible is key to helping injured workers move forward in their recoveries and avoid getting stuck.
“Work disability is developmental in nature and the more time that goes on the more disability is able to develop,” explained Ryan Guppy, Chief of Return to Work Partnerships at L&I. “Work disability develops the day the person is not working.”
One of the goals of Washington’s Vocational Recovery Project has been to reduce the time between injury and referral to vocational providers. While that timeframe has been drastically reduced since the program started, efforts continue to shorten it. Right now, it’s an average 58 days from the time the person is injured to the time they are working with a vocational provider.
“If a person gets injured on January 1, they’re not going to have a vocational provider assigned to them at the earliest until mid-March,” Guppy said. “That’s a lot of time for somebody to sit at home and develop catastrophic thinking and other factors that compound the disability problem.”
One of the biggest barriers to returning injured workers is the industry’s focus on cost containment, rather than work disability. But changing that mindset actually saves money, as Washington has seen.
“Having the focus on work disability is a game changer because it allows us to talk about the true issues that are really driving duration, which contributes to cost,” said Jason Parker, President and Senior Work Disability Consultant of Centrix Disability Management Services. “Once people understand what we are talking about, once they understand there’s this separate bucket to deal with, there’s this kind of ‘oh I think I understand what we’re talking about.’ I think everybody understands it intuitively, but we just haven’t had a mechanism or vehicle to talk about it.”
Another barrier to RTW, and an issue that is a cornerstone of Washington’s success is who is actually making the decision about when the worker will return to work.
“There’s this notion that the provider or physician is the ultimate decider, and that’s just not the case,” Parker said. “The worker is the ultimate agent of change. I think our biggest barriers and our failure in duration is our inability to engage the worker and create an environment that allows them to make the decision to return to work.”
Differences from Advocacy Based Claims Model
Washington state’s program has been likened to advocacy based claim management. While it includes some aspects of that model, it is not the same.
“While I believe that insurers and claim managers should be taking a softer, gentler approach and customer service is always important when we’re working with people, it’s not the solution to solve the work disability problem,” Guppy said. “We’re looking at the literature on work disability prevention, we’re looking at the AMA guides on workability and RTW, we’re looking at the handbook of work disability prevention, and we’re looking at things from behavioral economics and motivation to figure out what’s really at the core of why this person is stuck. Being nice to them on the phone and providing them with a panacea of different options is important, but that will not activate somebody towards getting back to work.”
“Customer service is not a proxy for engagement,” Parker added. “It’s not that you shouldn’t be nice, you shouldn’t be friendly you shouldn’t be helpful, but you need to be doing this other thing as well that Ryan’s been talking about, this engagement of this worker. Why are they stuck. Being friendly, being helpful and returning calls within 24 hours is not going to solve pain catastrophizing or perceived injustice disability beliefs.”
Engaging every injured worker and having them be the lead in their recoveries is not always possible, the speakers said. But the idea is to create an environment that supports the worker so he is allowed to make his own decisions.
“I think part of what we can do is we can train case managers, we can change how to talk to a worker, how to engage the worker in those discussions and uncover some of those barriers the worker is having.” Parker said. “We often talk about the worker being stuck; not malingering, not faking but just stuck. And part of that training is about how do we get whoever is interfacing with the worker, whether that’s a healthcare provider or case manager or vocational rehabilitation counselor, is somebody has to be able to navigate through the complexity of this.”
Employers also need to be educated about the process, as they can be impediments to RTW. Parker said an effective strategy is to show the employer that pushing back on RTW causes harm.
“People are at two to three times the risk of developing comorbid conditions, mental health; a 20 percent increase in mortality,” he said. “So we leverage off the employer in terms of ‘by you not taking action, you are actually creating harm. And there is harm of allowing unnecessary disability to develop.’ And that’s part of how we try to get them on board.”