Know the importance of dialogue and strategies

Once an injury occurs, it is crucial to effectively manage medical treatment and return-to-work options.
“There are various resources available and knowing the crucial components of communication, treatment negotiation and return-to-work strategies should be understood,” says Todd Keserich, assistant vice president, client services at CompManagement.

Smart Business spoke with Keserich about strategies to assist injured workers back to work.

What are the first steps to take when an injury occurs?

Once an injury occurs, there are three important steps to take. Those include authorizing timely, medically appropriate treatment to resolve the physical injury; facilitating a return-to-work date as soon as functionally possible; and managing any barriers and costs to treatment.

What resources are available to an employer to manage a claim?

State-funded employers across Ohio are required to have a Managed Care Organization (MCO). MCO’s are responsible for the medical management of a claim. The case management of a claim includes an assessment and plan of care that includes a goal for return to work. The case manager will review the treatment plan provided by the physician, facilitate authorized services, monitor the progress of treatment, reassess return-to-work barriers if they should occur and review and monitor prescriptions issued. When making treatment decisions, MCO’s are required by the Ohio Bureau of Workers’ Compensation to conduct a process called utilization review. This consists of reviewing the Official Disability Guidelines, looking at what treatment has been approved and completed thus far, reviewing the progress of any current treatment, and examining diagnostic testing reports, as well as looking at the mechanism of injury, age of the injured worker and any comorbidities.

What is important to communicate?

It is important to work collaboratively with the medical provider to help establish the medical necessity of health care services and procedures according to evidence-based criteria or guidelines so that an injured worker may safely return to work. If an injured worker has limitations returning to work, transitional work and on-site therapy or vocational rehabilitation may be utilized.

Transitional work includes therapy that primarily focuses on using the injured worker’s functional work tasks to progress the worker to a target job. On-site therapy includes physical or occupational therapy services provided to the injured worker while on-site at work. Vocational rehabilitation is an individualized and voluntary program for eligible injured workers needing assistance in safely returning to work. Vocational rehabilitation emphasizes restoring or maximizing the injured worker’s abilities and minimizing long, debilitating absences from work. It focuses on returning the injured worker to the original employer, but if that is not possible, rehabilitation services can help the injured worker identify skills and abilities to secure a new job with another employer.

What outcomes should be expected if communicating effectively?

There are three main outcomes that should be expected if the communication is effective when actively managing claims:

  • Safe and timely return to work — This occurs when the process of assessing all information and communicating with all involved parties is effective.
  • Right care at the right time for the right reason — Reduces the overcrowded hospital emergency room departments and makes sure that treatment is timely to keep the injured worker from losing days away from the workplace.
  • Advocacy — Engages injured workers, explains the claim process, helps them through the process after a work-related injury occurs, calms their fears and answers their questions.

Why is advocacy so important today?

Advocacy is important because claims can be complex, the severity of claims is on the rise and more lost-time claims are occurring. There also is an increase in continuous trauma, an inappropriate use of opioids to treat conditions, comorbidity factors and psychosocial issues.

Insights Workers’ Compensation is brought to you by CompManagement