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Who and What You'll Deal With if an Employee is Hurt

April 1, 2000
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Related Topics: Workers' Compensation, Workplace Violence, Safety and Workplace Violence, Featured Article, Compensation
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The ability to effectively communicate with the various professionals involved with your injured employee's claim, medical treatment, recovery and return to work is an essential skill of the supervisor. Your primary role in this regard is a source of critical information about the nature of the employee's job, including any skills and abilities that are essential for successful performance.

To help you understand your responsibilities, it is important that you understand the various roles and perspectives of the professionals that you may be required to deal with during your employee's illness/injury.

Claims Coordinator
This individual (who may also serve as the Return-to-Work Coordinator) will be your key contact throughout the process. He/she will have the overall responsibility to ensure that your employee receives the workers' compensation benefits and services that are legally required. In most cases, the Claims Coordinator will serve as a liaison between you and the Insurance Carrier claims adjuster, the treating physician, and the vocational rehabilitation specialist.

Personnel Transactions Specialist
A Personnel Specialist will be involved in requesting and monitoring benefit payments made for IDL and TD. The Personnel Specialist is available to advise employees about benefit levels and payment schedules.

The Insurance Carrier Claims Adjuster
The adjuster is the person who has the responsibility to monitor all payments made directly to the employee or to the employee's physician, physical therapist, and vocational rehabilitation counselor. The claims adjuster will communicate directly with the employee's physician and make a determination regarding the appropriateness of the treatment being received by the employee and the general prognosis for the employee's return to work.

The adjuster may need a variety of different kinds of information from you, including the exact nature of the injury, the names of witnesses, the employee's duty statement and work history, and opportunities for light duty assignments.

Treating Physician and Medical Examiner
The term "treating physician" here is used to describe anyone who, by law, can render medical treatments to your employee. This may include a medical doctor, a chiropractor, an acupuncturist, a psychologist, or a physical therapist. This doctor will control the primary care of your injured worker.

It is unusual, but not inappropriate, for you to have direct contact with a treating physician. Most of the time, however, your communication to the physician will be through the Claims Coordinator or Claims Adjuster.

There are also physicians who serve as professional medical examiners in workers' compensation cases. There are three different types of medical examiners: an Agreed Medical Examiner (AME), an Independent Medical Examiner (IME) and a Qualified Medical Examiner (QME). As a supervisor, you do not need to know the circumstances under which each of these specialists may be used in a case.

However, you need to understand that it is not unusual for other physicians and medical specialists, besides the employee's treating physician, to be involved in making medical assessments about the extent of the employee's illness or injury. These medical examiners typically are asked for a "second opinion" in cases where there is some dispute over the treating physicians findings or assessment of the prognosis or prescribed treatment of the injured employee.

Vocational Rehabilitation Counselor
The Vocational Rehabilitation Counselor (VRC) is the person at the Insurance Carrier who has the responsibility to coordinate the provision of all vocational rehabilitation benefits for an employee.

Qualified Rehabilitation Representative
Not every case will involve a Qualified Rehabilitation Representative (QRR). Such professionals are generally only involved when the employee is seriously injured and will need some special skills assessment or retraining in order to return to his/her current job or another job. The QRR will be extremely interested in the specific job duties that the employee is expected to perform and any requirements that may be needed to accommodate the employee in order for him/her to resume these job duties.

This information will be needed so that the QRR can develop a comprehensive rehabilitation plan for your employee to return to work. Only if the employee's disability clearly precludes return to the normal and customary duties, will the vocational rehabilitation plan be directed to other types of employment.

Return-to-Work Coordinator
As indicated, earlier, this individual will work for your employer and may be the same individual as the Claims Coordinator. The role of the Return-to-Work Coordinator is to assist the employee and the supervisor to explore all alternatives for light duty, job restructuring and reasonable accommodation, so that the employee can return to work as soon as it is medically feasible to do so.

Applicant's Attorney
The "applicant's attorney" is the injured employee's attorney. Generally speaking, you will not be communicating directly with the employee's attorney. When an employee is represented by an attorney, communication becomes very formal and it is handled by the staff at the Insurance Carrier.

Identifying the Essential Functions of the Job

Duty Statement/Job Description
It is unlikely that the duty statements that you currently prepare for your employees will be adequate to assist the workers' compensation professionals in the event that one of your employees is injured on the job.

General duty statements do not contain the level of detail about the physical/mental requirements of the job that would assist a treating physician or a vocational rehabilitation counselor to determine what, if any, job restrictions the injured employee may have when he/she returns to the job.

For example, the treating physician may need to know how much walking, sitting, lifting, typing, etc., is needed to perform the required duties. If a certain job can be done in various positions (either standing or sitting), then such information may be very helpful to the physician in determining if the employee can return to work.

If a certain task is absolutely essential to performing the duties and no physical variation is possible, then the physician will make a determination if the injury precludes performance of that task.

For example, if a police officer breaks his/her trigger finger and has restriction in the ability to shoot a gun, which is determined absolutely essential to successful and safe performance of the job, then the doctor will conclude that the employee is incapable of returning to duty until the finger is fully healed.

Only the supervisor can "paint a picture" for the treating physician so that he/she has a clear understanding of what it physically and mentally takes to get the job done. Therefore, you may be asked to assist in preparing special, detailed, job descriptions for employees who are injured. Your Claims Coordinator or the Claims Adjuster should be able to provide you with sample job descriptions and assist you to develop them as required.

Knowledge of the Job Demands
It may not surprise you to know that most supervisors have no idea what are the actual physical and mental demands of the jobs performed by their employees unless they have performed those jobs personally.

Therefore, it may be important for you to have your employees identify the physical and mental demands of their jobs BEFORE they are injured. This is especially important for employees who must lift heavy weights in the course of their duties (whether the weight is an object in the stock room, or a patient in a hospital).

Vision, hearing, and physical agility requirements may be equally important to successful job performance. Mental abilities such as good recall or organization skills are critical in some jobs, but not in others. In any event, you should know the demands of each of the jobs in your unit in sufficiently precise terms so that you can describe them with a reasonably high degree of accuracy.

For example ... "the employee must be able to walk approximately ten feet, moving (note: not carrying) a 30 pound box, 12-15 times each day" ... or ... "the employee must be able to type (sitting or standing?), from printed text, for 90 minutes straight without a break" ... or ... "the employee must be able to concentrate and verbally answer customer information requests, using data from a computer terminal, continuously for periods up to one and one-half hours."

Responding to Inquiries/Requests

Whether the inquiry related to the accident investigation or the employee's job duties, you should respond promptly to any inquiry related to a workers' compensation claim. In many cases, the time frames for response are set in State labor Code statute and delays can result in serious penalties against the employer. Delays can cost the employer many extra dollars in benefits and services that may not be necessary. In all cases, your input is essential to effective claims management.

Working with Employer Workers' Compensation Experts

As stated early, your employer has expert staff assigned to assist you with every aspect of the workers' compensation system. Work closely with them and provide them with the information and support that they need to do a good job for you, for your employee and for your department.

Of particular importance is your willingness to cooperate with the Return-to-Work Coordinator in designing a light duty assignment for your injured employee or possibly a permanent restructuring of a job to accommodate the employee's successful return.

You must attend all Return-to-Work Committee meetings where your employee's case is scheduled for discussion. It is essential that you maintain an open mind to suggestions that others have regarding ways in which you can modify physical layout or operating procedures in order to increase the probability of a successful injured employee placement.

Keeping the Injured Worker Informed of Progress

The only person who is more "in the dark" about workers' compensation than you are is your injured employee. Keep him/her informed regarding efforts that are being made to provide benefits and services. Let the employee know that you are working hard to make it possible for him/her to return to work as soon as possible. Keep all communication positive and sincere.

Record-keeping Requirements

At some point, it may become necessary for you to document your efforts regarding accident investigation and/or return-to-work efforts. Make notes regarding contacts with the employee, department staff, other workers' compensation professionals, physicians and counselors. In the event that you are ever requested to testify before the Workers' Compensation Appeals Board, your notes regarding dates, contacts, and actions will prove invaluable.

The information and forms contained in this feature are intended to provide useful information on the topic covered, but should not be construed as legal advice or a legal opinion.

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