VR Insights - June 2019: To Refer or Not to Refer?

Realizing a referral for vocational case management is an expense to the file, especially once the new rules went into effect that capped an injured worker’s temporary total disability benefits, when is it cost effective to assign vocational case management services? As a vocational expert and not a claims adjuster, my view naturally is established within the rehabilitation mindset of returning an injured worker to a productive lifestyle, whereas as an adjuster you are more cost-sensitive with regards to the reserve that has been set for the claim. With that said, when does the assigning vocational case management become a benefit to the injured worker, but also a resource to the claims handler in resolving a file?

Once an injured worker has reached maximum medical improvement and released to work with restrictions, the hope of every adjuster is the insured will have the flexibility to accommodate the physician issued restrictions and make a job offer for an appropriate position. Unfortunately, unless an employer is sensitive to a potential rate increase due to a rise in their experience ratio, most small employers either do not have the ability to create such a position, or, fairly or not, are reluctant to bring back an employee that they view as an exploiter of the system. Regardless of the reason, not bringing back an injured employee creates potential long-term claims issues for the adjuster.

Naturally, if an injured worker has reached maximum medical improvement with a permanent partial impairment rating issued and the insured is reluctant to bring that individual back, the ideal resolution option is to come to a financial settlement agreement. To quote the old saying, sometimes the “best laid plans of mice and men often go awry.” If a settlement can’t be reached, what next? In my experience of over 30 years providing vocational case management services to injured workers within the workers’ compensation system, the longer an individual does nothing they actually get good at it…and workers’ compensation beneficiaries actually get really good at doing nothing.

With that in mind, once the injured worker (or his/her attorney) has decided a quick resolution to his/her claim is not in his/her best long-term financial interests, the initiation of vocational case management might be the incentive to move the claim forward. My father used to call it the mule theory, sometimes to get a mule’s attention you need to take a 2x4 board and hit the mule on the butt to get it to move. Getting an injured worker’s attention is half the battle, so, assigning vocational case management tends to be that 2x4 board.

Once an injured worker has reached maximum medical improvement and released to work with restrictions, he/she needs to understand that looking for work is a full-time job. In short, previously they had been paid while recovering from their injuries, but now they are being paid to look for work. By assigning vocational case management, the rehabilitation professional will establish the ground rules in the Individual Written Rehabilitation Plan (as required by the NCIC RULES) and hold the injured worker accountable. Not only are injured workers required to apply to the qualified employment leads provided by the rehabilitation professional, but they are also obligated to submit applications on their own. Without going into case law, the North Carolina Industrial Commission has ruled there is a differentiation between appropriate and inappropriate job search conducted by the injured worker. A rehabilitation professional can monitor and document what is appropriate job search versus inappropriate job search, i.e. conducting a bona fide job search as opposed to simply going through the motions.

Another benefit to assigning vocational case management services - keeping the injured worker busy. Remember my earlier statement, when someone does nothing long enough then they actually get good at it. One would think it is not unrealistic to ask an injured worker to be accountable for at least a portion of an eight-hour workday. This may involve job applications, GED/ABE programs, computer training, and volunteering. The NCIC has ruled that volunteer opportunities that may lead to employment are an appropriate vocational option.

In closing, to refer or not to refer, I think that question has been answered.