RTW Full duty, but still complaining of pain
Ronkate
1 Post
An employee was hurt at work and was out on worker's comp for two months until he was returned to restricted duty by the WC doctor. The restrictions were due to a back injury. The WC doctor recently returned him to full duty. We sent him to the company doctor for evaluation and because the employee was complaining of so much pain in the office, they refused to release him to full duty. The doctor is awaiting on results of final test, which will take about 2 days. In the meantime, we are not certain what our next steps should be if the company doctor does not release him to full duty. - would sure appreciate some WC advice and/or shared experience.
Comments
First off, don't debate if he is in pain, say you understand, but the doctors have decided that he is able to work, albeit in a little pain.
I would guess he wants to be home collecting WC without having to work. Work with the docs, keep him at work.
My $0.02 worth,
DJ The Balloonman
PS Don't let him know he is driving you nuts, keep smiling.
We have many ees that claim back related injuries due to the nature of our business. We put them in chairs wiping down walls, sweeping with long handled brooms, etc. Not many that we cannot find something for. Additionally, if the ee can perform work within the restrictions and chooses not to, W/C benefits may be suspended, since the company can offer compensable work. That usually brings ees back instead of sitting at home and collecting W/C benefits when it is not necessary.
My organization is in Florida, which may vary a little from your state, but we have seen similar situations--one going on now. A caveat is that back injuries are ominous injuries. They can be soft tissue, which can be hard to detect with objective diagnostic measures, or structural issues that are easier to detect, such as disk bulges, ruptures, fractures, etc. The back is also an area that is subject to degenerative change over time, and an employee may not know there is an underlying degenerative issue until he/she bends over at work and feels the pain. Even with restrictions, employees can't be policed 24 hours/day in their activities to ensure they operate within advised medical restrictions (i.e., may still be sitting, standing, shopping, etc. more than was advised). Further, medical professionals are subject to liability malpractice suits and will attempt to minimize their risk as well, which means you can expect conservative advice in some instances. Managed care networks are an attempt to control costs, so participating providers may not exhaust every available diagnostic measure to establish a clear baseline (i.e., MRI may not have been performed up front). In W/C situations, all of that spells a complex claim. Your worker may be trying to manipulate the system, and you should be savvy enough to try to pick up on that if that is the circumstance. If it is, there will be other indicators as well. However, just in case it isn't, do not set your company up as appearing ot have interfered with medical care or a rehabilitation process. Further, unless you are a medical professional, ask another medical professional to support or dispute an opinion with which you may not agree. W/C claims go to litigation quickly, so you should be building a good file. Rely on experts at every juncture.
There are lots of questions that can change the flavor of your situation:
1. Is the W/C Dr. part of a managed care network to which you are bound by your insurance arrangement? If so, you may have complicated your options by authorizing treatment outside the "network." Is he/she a specialist or general practitioner?
2. Is your in-house Dr. a specialist or general practitioner? He/she has basically overruled the W/C Dr. with a more conservative decision, but you asked for it when you referred the employee.
3. Are you obligated by statute to keep the worker actively working? If so, does your in-house Dr. understand that? What is your company policy on returning an injured worker to work? If both are favorable for getting the employee back to work, submit a list of essential job duties to the in-house Dr. (most recent stmt), ensure he/she understands that modified job duties are available, ask for confirmation on what the employee may or may not be able to do. If possible, custom design something to keep the employee working, and reduce wages to allowable limits if doing so is an option in your state. 4. Get an offer letter in the employee's hand confirming that modified work is available as a transitional step.
5. If the employee refuses work, your bases will be a little better covered, and you may be able to suspend the lost wage benefits for a period of time.
6. All of the above will probably take 2 days, and the medical results will be back. If the test is thorough enough, you will probably then have an answer to what you should do. But you still have the in-house physician's statement overruling the W/C physician.
Good luck. Back injuries can be hard to deal with.