Concerns Regarding Rehabilitation Service Delivery

DATE:      May 4, 1999

TO:          All Interested Parties

FROM:     Bruno R. Czyrka, Deputy Director


Background

It has repeatedly come to our attention that some carriers are making referrals to bureau approved rehabilitation facilities, stipulating that only specific services, such as immediate job placement, be provided to the injured worker. In certain instances the rehabilitation providers have been instructed to deliver services without making direct contact with the injured worker. Some rehabilitation providers feel obligated to comply with the limited service instructions.

In addition, some carriers have allegedly required rehabilitation practitioners to verbally communicate with them prior to submitting written rehabilitation recommendations. The objective is to allow carrier input prior to finalizing the formal recommendations. As a result, some recommendations are either modified or eliminated at the carrier's request.

Discussion

It has been long standing bureau operation policy that rehabilitation practitioners who serve injured workers are to provide on each referral, regardless of the source of the referral, an unbiased, comprehensive evaluation of rehabilitation need, even though the referral may be made for a specific service. Following for your reference is a copy of our "Three-Step Memo" and "Do/Do Not Memo." (Revised 3/99).

At the time of bureau approval each facility is instructed to carefully review these documents and ensure that each of the professional staff members who provide direct rehabilitation services to injured workers receive copies of, and fully understand, these policy guidelines on rehabilitation as set forth.

In our voluntary workers' compensation system, it is absolutely essential that rehabilitation evaluations and recommendations reflect an objective, independent judgment of the need for and feasibility of rehabilitation services. We fully expect the rehabilitation practitioner to adhere to professional standards of conduct, and the need for independent professional judgment goes to the central core of appropriate professional conduct.

While we clearly recognize the importance of joint rehabilitation planning, and the value of and need for carrier contributions to the rehabilitation effort, that carrier input should never restrict the practitioner's independent, professional judgment in regard to recommendations.

 

" Three-Step Memo"

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Operating Policy

The Bureau of Workers' & Unemployment Compensation (BWUC), has legal jurisdiction over cases involving injuries sustained by employees covered by the Workers' Disability Compensation Act. The Vocational Rehabilitation Division is charged with the responsibility of insuring that each injured worker in need of rehabilitation services is provided such services in a timely and appropriate manner.

It is expected that rehabilitation practitioners working with workers' disability compensation recipients will:

1.   Provide to each injured worker, referred for or seeking rehabilitation services, an explanation of his/her rights and responsibilities under the Workers' Disability Compensation Act, including:

RIGHTS

    a.   The right to medical, surgical and hospital services reasonably necessary to cure or relieve the worker from the     effects of a work-connected injury or disease. Included are medicines, nursing care, and travel expenses incidental to such examination, medical treatment, or rehabilitation.

  1. The right to go to a physician of his/her own choice 10 days after beginning treatment with the company physician after giving to the employer the name of the physician and notice of intention to treat with the physician.
  2. The right to weekly compensation benefits.

·     For injuries occurring prior to January 1, 1982, payments are based upon two-thirds of the worker's average weekly wage, but not exceeding certain maximums or less than certain minimum, provided by law, due for as long as disability exists with a resultant wage loss.

·     For injuries occurring on or after January 1, 1982 , payments are based upon 80 percent of an employee's after-tax wages, but not exceeding 90 percent of the state average weekly wage.

  1. The right to partial wage-loss (differential compensation) benefits.

·         For injuries occurring prior to January 1, 1982, these weekly payments amount to two-thirds (in the case of a skilled worker returning to different work, 100%) of the difference between the average weekly wage at time of injury and the average weekly wage earned after returning to work, not to exceed the weekly compensation rate.

·         For injuries occurring on or after January 1, 1982, these weekly payments equal 80 percent of the difference between the injured employee's after-tax average weekly wage before the personal injury and the after-tax average weekly wage which the injured employee is able to earn after the personal injury, but not more than the maximum weekly rate of 90 percent of the state average weekly wage.

  1. The right to such vocational rehabilitation services, including retraining and job placement as may be reasonably necessary to restore an injured employee to remunerative employment.

f.    The right to a vocational rehabilitation hearing whenever the employer and worker cannot agree upon a rehabilitation program. The rehabilitation hearing officer will resolve the matter through conciliation and mediation, or will issue a decision outlining the rights and responsibilities of the parties. If either party does not agree with a decision of the bureau, he/she may appeal the bureau's decision to a magistrate for a determination of rights in accordance with normal BWDC operating procedures.

RESPONSIBILITIES

    a.   The obligation to notify the employer or insurance company of any wages earned during the benefit period.

  1. The obligation to submit to reasonable periodic medical examinations if required by the employer or the insurance carrier.
  2. The obligation to cooperate with reasonable rehabilitation efforts directed toward assisting the injured worker in returning to appropriate competitive employment, including an evaluation of vocational rehabilitation potential as noted in #2 below.

2.   Provide on each referral, regardless of the source of the referral, an unbiased, comprehensive evaluation of rehabilitation need, even though the referral may be made for a specific service. This evaluation/assessment shall include a direct, face-to-face interview with the injured worker to verify his or her current medical status, previous work history, etc.

3.   Follow a three-step approach to the development of each vocational rehabilitation program, exploring:

a.   First, return to work with the former employer, either to the same job or a modified job which is within the employee's capabilities to perform.

b.   Second, direct job-placement to appropriate alternative employment in the community and/or short-term retraining. Such retraining shall consist of up to fifty-two (52) weeks of rehabilitation training or, in certain cases, extended for an additional fifty-two (52) weeks, or portion thereof, by special order of the director after review.

c.   Third, self-employment ventures. Because of the very high risk of failure in launching a self-employment enterprise, this option should be considered only after other employment alternatives have been explored, evaluated, and found to be inappropriate. There must be documentation in the case record that it is not feasible to implement a vocational rehabilitation plan which would result in suitable employment for the client other than self-employment. A training program must be designed to prepare the client to adequately handle the operations of such an enterprise unless the previous work history and recommendations of reputable individuals who know the client's ability indicate such training may not be necessary. To determine this, the VR coordinator will be expected to make a survey of the marketing area in which the goods and services are to be offered. The business knowledge of the client must be adequate to perform those necessary and required ancillary activities involved in the independent business operation.

d.   These activities include maintenance of accounting records, preparation of income tax, etc. In every case in which a small business enterprise is contemplated, the case file should contain a carefully prepared analysis of the proposed venture. Preferably, opinions from organizations such as the Small Business Administration, the Department of Commerce and Labor, Chamber of Commerce, local trade associations, businessmen, and bankers should be obtained. A self-employment training program should be designed, implemented, and completed prior to the client's entry into such a venture.

PLEASE NOTE : It is understood that the job offered shall be consistent with the recommendations of available medical information and with the injured worker's future economic security. If, at any time during the course of the rehabilitation program, it becomes apparent to the rehabilitation practitioner that there are no reasonably attainable jobs for which the injured employee is qualified, recommendations for upgrading the employee's skills via short-term training should receive consideration.

For further information, contact the BWDC, Vocational Rehabilitation Division, c/o General Office Building , 7150 Harris Drive, P.O. Box 30016 , Lansing , MI 48909 . Telephone 517-322-1721 (voice) or 517-322-5987 (TTD).

(Revised 5/99; Previous 2/82)

Do's and Do Not's Memo

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Do :

  • Provide unbiased, comprehensive evaluations of vocational rehabilitation need/feasibility, including a direct, face-to-face interview with the injured worker.
  • Advise client of rights and responsibilities
  • Keep all parties advised of rehabilitation activities
  • Advise client to call carrier or BWDC regarding problems
  • Report on each workers' compensation case file to BWDC
  • Obtain necessary diagnostic information before proceeding with placement
  • Obtain medical clearance before client starts job

Do Not :

  • Initiate cost services prior to obtaining carrier authorization
  • Interfere with due process between employee and employer
  • Give legal advice to clients
  • Recommend attorneys to clients
  • Complete Form 104, Application for Mediation or Hearing, for clients
  • "Negotiate" or recommend redemptions to clients
  • Forget "3-Step" approach on developing rehabilitation plans
  • "Push" clients (thin line between propriety and impropriety)
  • Neglect appropriate job placement
  • Include subjective material in reports - avoid innuendos, trivia, etc.
  • Engage in claims investigative or adversarial activities

(Revised 5/99; Previous 5/85)