Access to care for workers’ compensation patients in dense and sparse population centers

Background: Workers’ compensation was originated to provide a no-fault, timely access to appropriate medical care. Unfortunately, we have found that the system fails the injured worker in certain environments. By implementing procedural roadblocks in the form of initial claim denial and delay methods, the injured worker finds himself/herself in a battle of attrition. By delaying treatment and compensation benefits, the injured workers are “starved out” of their access to care and often walk away from their claim or accept a payout without treatment. Methods: We performed a randomized, consecutive case-series where 300 hypothetical patients called medical offices to attempt to arrange a physician consultation. We analyzed the ability of a patient to gain access (an appointment) to a primary care (N=100), orthopedic (N=100) and neurology (N=100) physician after stating that they were injured at work. We analyzed two cohorts, one as an injured worker that was given a claim number (N=150) and the other that was injured at work but not yet given a claim number (N=150). Conclusion: This study demonstrates how difficult it is to gain access to care as an injured worker. An injured worker in a low densely populated area without a claim number was unable to gain access to a primary care doctor in our cohort (100% denial rate). Even a patient with an accepted claim number in densely populated Cook County, IL had a 52% chance of being denied access to care with an orthopedic surgeon while a patient without a claim number had an 84% chance of being denied access to orthopedic care.

Getting the Message Right: Evidence-Based Insights to Improve Organizational Return-to-Work Communication Practices

Purpose There is an absence of evidence-based guidance to support workplace stakeholders in the effective delivery of return-to-work (RTW) messages. Our study examines the specific RTW communication practices and their impact on the management of work disability. Methods Within two large and complex healthcare organizations, semi-structured interviews were conducted with workplace stakeholders (e.g., supervisors, union representatives, disability management professionals and workers’ compensation representatives) and workers who had previously experienced sickness absence related to an occupational injury or illness. For workplace stakeholders interview questions asked about their roles and responsibilities in the RTW process, and specific communication strategies and messages that were used at different phases of the RTW process. For worker participants, interview questions explored RTW experiences and the impact of communication on work re-integration. An interpretative descriptive approach was used to inductively examine themes from interviews to create ways of understanding phenomena that yielded applied findings. Results Forty participants were interviewed including workplace stakeholders and workers. Participants frequently described effective RTW communication as messages that were delivered by a workplace stakeholder that included the content required by an injured worker to navigate the organizational disability management process and utilized specific strategies to address the perceived attitudes and perceptions held by an injured worker regarding work re-integration. Workplace stakeholders described five specific communication strategies including relaying messages of support, optimizing the timing of communication, careful word choice, framing messages, and tailoring communication to the injured worker. Conclusion RTW communication is an active process that requires a strategic approach. Effective communication practices represent an important strategy for workplace stakeholders to address the barriers held by injured workers and foster early and sustained RTW.

Performing Medical Evaluations for Subsequent Injuries Benefits Trust Fund in California

Many states have benefit programs (e.g., special fund, second injury fund, subsequent injuries fund, special disabilities trust fund) for people with significant pre-existing impairment and/or disability who are injured. Each fund has different rules and regulations. Some of these funds provide benefits to the injured worker, while others reimburse eligible employers and insurers. Physicians need to understand the specific requirements of benefit programs in their states. Evaluating physicians who understand the uniqueness of these programs will be better able to provide valuable services. This article provides insights into one such program, the subsequent injuries benefits trust fund (SIBTF) in California. To be eligible for SIBTF benefits, the injured worker must meet an “overall threshold” and an “industrial threshold” of disability to qualify for benefits. If these thresholds are met, the injured worker may receive additional compensation based on pre-existing (labor-disabling) disability. The pre-existing disabilities can arise from any source, including congenital, developmental, or acquired disease, prior injury, war injury, non- industrial injuries, or prior industrial disabilities.

Supporting workers with lower back injuries to return to work: a meta-ethnography

Introduction Lower back injuries can prevent people from engaging in the occupation of work, which is considered to be beneficial to physical and mental wellbeing. Return-to-work programmes aim to support people to re-engage with work; however, the success of these can be varied. The aim of this review was to explore what factors facilitated a return to work for those in employment, and what the factors may be in preventing others from making a successful return to work. Method A systematic search of the literature identified 10 qualitative research studies, and a meta-ethnographic approach was then used to critique and synthesise the findings to provide a line of argument. Findings Interrogation of the selected studies brought about three third-order interpretations as follows: enabling injured workers to return to work safely; challenging negative assumptions; overcoming organisational barriers. Conclusion The study supports previous findings that emphasise consideration of wider organisational and psychosocial factors relating to supporting people to return to work, rather than focusing solely on the injured worker. Suggestions are made for the modification of current work practices, the need for a strength-based approach to rehabilitation and for occupational therapists who might work with people living with back pain.

Deeming Laws and Practices as Violations of the Rights of People With Work-Acquired Disabilities in Canada

The Ontario Network of Injured Workers’ Groups in Canada is leading a multiyear campaign called Workers’ Comp is a Right to reform the provincial workers’ injury compensation system and to fight back against regressive changes made to the system over several decades. At their Annual General Meeting in Toronto held in June 2019, delegates voted unanimously to make this submission to the United Nations Committee on the Rights of Persons with Disabilities as a part of the regular supervisory process under the United Nations Convention on the Rights of Persons with Disabilities. The subject is income deeming “phantom jobs” to injured worker claimants with income replacement benefits. The document illustrates how Canadian injured worker groups have activated a human rights lens and references international labor and human rights standards concerning social insurance and income replacement benefits for work-related injury and illness.