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REASONABLE ACCOMMODATION

January 15, 2018

What is a reasonable accommodation? A reasonable accommodation is a modification or adjustment to a job, work environment, or the way things usually are done that enables a qualified individual with a disability an equal employment opportunity. An equal employment opportunity means an opportunity to attain the same level of performance or to enjoy equal benefits and privileges of employment as are available to an average similarly-situated employee without a disability. The ADA requires reasonable accommodation in three aspects of employment: 1) to ensure equal opportunity in the application process, 2) to enable a qualified individual with a disability to perform the essential functions of a job, and 3) to enable an employee with a disability to enjoy equal benefits and privileges of employment.

Reasonable accommodation is assistance or change to a position or workplace that will enable an employee to do his or her job despite having a disability. Under the ADA, employers are required to provide reasonable unless doing so would pose a SPECIFIC undue hardship.

What medical information can employers ask for when an employee requests accommodation? Under the ADA, employers must limit the scope of a medical inquiry in response to an accommodation request. When the disability or need for accommodation is not obvious, an employer may require that the employee provide medical documentation to establish that the employee has an ADA disability, to show that the employee needs the requested accommodation, and to help determine effective accommodation options.

How can and FCE(Functional Capacity Evaluation) help? It is the employer’s obligation to decide which accommodation would work best and whether the accommodation poses an undue hardship. When an employer has job-related reasons to require fitness examination of an existing employee, the employer should utilize the FCE process. The examination should be tailored to the injury that the employee sustained at the workplace ONLY and NOT medical conditions unrelated to the work injury and should address the ability of the employee to perform essential job functions as well as outline any specific hardships.

For more information visit the Job Accommodation Network, funded by a contract from the U.S. Department of Labor.

Definitely worth it!!!

December 2, 2016

I was referred to Industrial Health after a work place injury lead to shoulder surgery. I lost strength and stamina sitting on my couch to recover; the extra goodies I was eating didn’t help. The staff at Industrial Health slowly worked with me to build up my energy, and muscles. I never felt like I was being pushed beyond my current capacity. This was most definitely not torturous. Best of all, after 4 weeks I feel ready to go back to work and have no fear that my work day will result in unbearable pain. Industrial Health tailored the activities to my specific job description and I actually had fun. The facility is large, airy and clean. I cannot praise the team there enough. They were always positive and encouraging and I never felt judged. That is important, because being on worker’s comp, can be a daunting and somewhat humbling experience, with a lot of hoops to jump through. I highly recommend Industrial Health. I love those guys!!!

Injury Prevention Programs

August 29, 2016

Injury Prevention Programs (IPP), which are explained in this recent news article, can be exceptionally valuable to workers and employers, alike. Injuries in the workplace happen, but many can be prevented through the utilization of an IPP. While IPPs can be implemented in any industry, the most common uses are in the industries of highest physical demand, such as firefighting, military, and law enforcement. As this article explains, a Fire Department recently employed a physical therapist to assess each new recruits’ current level of physical conditioning, This is accomplished through “a series of measurements…beginning by measuring his or her vitals and continues with assessing everyone’s range of motion, form and flexibility…then continue to strength and stamina assessment.” Where applicable, work simulation tasks can also be employed. Using a firefighter as an example: carrying / throwing / climbing a ladder, crawling, ceiling rips, etc. The combination of all these measurements and tests can then been used, on an individual basis, to construct a conditioning program to address biomechanical issues that present themselves as high risk for injury.

Ultimately, the best way of treating an injury is prevention. To reiterate, injuries are inevitable but there are programs available, such as an IPP, which can help reduce the frequency of injury; ensuring a stable, healthy workforce and, in turn, unburdening the Workers’ Compensation system and reducing costs to the employee, the employer, and state.

Industrial Health, a specialized Workers’ Compensation physical therapy practice servicing Washington, D.C., Northern Virginia and surrounding areas within Virginia. Programs include Physical Therapy, Functional Capacity Evaluations (FCE), Work Hardening, Work Conditioning, Work Simulation, Impairment Rating, Permanent Partial Disability Rating, and Injury Prevention Programs.

Three Types of Functional Capacity Evaluations (FCE)

July 6, 2016

There are three types of Functional Capacity Evaluations, or FCEs. These three types are: Baseline, Job-Specific, and Medical Legal. Here at Industrial Rehab. we offer all three! Regardless of which type would suit your client’s need, FCEs are useful to not only test the client’s current functional tolerances, but also their Effort and RPDR (Reliability of Pain and Disability Reporting).

Written by Industrial Health, a specialized Workers’ Compensation-only physical therapy practice which services Northern Virginia , Alexandria , Arlington , Springfield , Sterling , Loudoun , Fairfax , Tysons , Vienna , Falls Church , McLean , Dulles , Chantilly , Leesburg , Ashburn , Herndon , Reston , Centreville , Winchester , Front Royal , Manassas , Gainesville , Warrenton , Rappahannock , Fauquier , Orange , Culpeper , Madison , Charlottesville , Stafford , Woodbridge , Dale City , Fredericksburg , Falmouth , Garrisonville , Manassas , Gainesville , and Prince William ; and offers programs including Physical Therapy , Functional Capacity Evaluations ( FCE ) , Work Hardening , Work Conditioning , Work Simulation , Impairment Rating , Permanent Partial Disability Rating , Injury Prevention Programs

Workers’ Compensation Case Study – Outcomes

June 1, 2016

The Workers Compensation Research Institute recently published a multi-year case study which examined a variety of case-related factors, as reported by injured workers, including Return to Work, Earnings Recovery, Access to Medical Care, and Recovery of Physical Health. Injured workers from 15 States, including Virginia, were polled and their responses were compiled and presented through a State-by-State comparison. Overall, Virginia fell near the middle of the pack and a brief summary of the results are presented below. While reading through this case study, the reader should keep in mind that there are not only differences between the States, but also from within States – something this study does not touch on. For example, in Virginia the cost of care is much higher in the northern reaches as one travels closer to Washington, D.C. and are substantially less as one studies the mountainous regions in the west and south. Of course, this study is meant to paint a broad, interstate picture of the Workers’ Compensation system and, to that, it does very good job. While Virginia’s system is not the best, being near the average is nothing to be ashamed about. It should be clear that improvement can be made and, here at Industrial Health, we strive to continually provide high standards of care that surpass our competition. Our goal is provide safe, quality physical rehabilitation to injured workers – most of whom want to get back to doing their job. For those few who burden this great system by malingering, we make great efforts to cleanse the Workers’ Comp system of these cases. This ultimately helps to keep costs low and injured worker satisfaction high.

KEY FINDINGS FOR VIRGINIA*

Virginia workers reported outcomes that were often in the middle of the range of outcomes observed in other study states.

Recovery of physical health and functioning: We found that the average recovery of physical health and functioning was similar across the 15 states in our study.

Return to work: Injured workers in Virginia reported rates of return to work in the middle of the range of the study states. Thirteen percent of Virginia workers with more than seven days of lost time reported never having a return to work that lasted at least one month predominantly due to the injury as of three years postinjury, and 16 percent reported no substantial return to work within one year of the injury. In the median state, these figures were 14 percent and 17 percent, respectively. Note that 15 percent of Virginia workers responded that they had a second absence from work due to the same injury—a rate that was in the middle of the range of states. The number of workers who responded that they returned to work too soon was also similar to the median study state.5

The median Virginia worker had substantial return to work about 11 weeks after the injury. This measure was in the middle of the range of study states.

Earnings recovery: 6 Seven percent of injured workers in Virginia reported earning “a lot less” at the time of substantial return to work compared with the time of the injury. This was similar to what we observed in the median of the study states (8 percent).

Access to care: Sixteen percent of injured workers in Virginia reported that they had “big problems” getting the services that they or their provider wanted. This was similar to what we observed in a typical study state. Thirteen percent of Virginia workers reported “big problems” getting the primary provider that they wanted. This was also similar to the median state, but somewhat lower than two states and lower than five other states in our report.

Satisfaction with care: About three out of four Virginia workers said that they were “somewhat” or “very” satisfied with their overall workers’ compensation medical care (78 percent). However, 14 percent said that they were “very dissatisfied.” This was in the middle of the range of states in our analysis.

*Source: Workers Compensation Research Institute, May 2016, http://www.wcrinet.org/studies/protected/exec_summaries/wrkr_outcomes_VA_2016-es.html

Written by Industrial Health, a specialized Workers’ Compensation therapy center which services Northern Virginia , Sterling , Loudoun , Fairfax , Dulles , Chantilly , Leesburg , Ashburn , Herndon , Reston , Centreville ; and offers programs including Physical Therapy , Functional Capacity Evaluations ( FCE ) , Work Hardening , Work Conditioning , Work Simulation , Impairment Rating , Permanent Partial Disability Rating , Injury Prevention Programs

Obesity: Nature vs. Nurture

March 10, 2016

Obesity is not simply an American issue according to this article published recently in the United Kingdom. Indeed, wherever in the world a surplus of food exists, obesity seems to follow. The question posed by the author is whether or not some people are genetically predisposed to weight-gain due to a more active survival mechanism to conserve energy. Certainly, it’s a logical argument that in historical times, when food was not as plentiful and/or meals were not regularly eaten, our bodies were programmed to store as much energy (calories), as fat due to the unknown time lapse to the next meal. That way, these excess calories could be used during lean times where food was not available. This argument is for “nature.”

The counter argument, “nurture,” can be summed up in the phrase used by the author, “eat less, move more.” The human body is nothing more than a machine, albeit incredibly complex. It requires energy, food – which provides calories, to fuel the bodily systems responsible for movement, cognition, and maintenance (cell reproduction). These actions require specific, stereotyped amounts of energy to perform. Therefore, higher levels of activity require greater amounts of energy. For example, an office worker sitting at a desk all day uses fewer calories to function than, say, an urban postal carrier who walks all day. Generally speaking, if these two workers were to intake the same amount of calories on a given day, the office worker would be more likely to gain weight due to the excess calories being stored as fat, because they did not expend the same amount of energy (in the form of movement) as the postal carrier.

Ultimately, both arguments are valid and therefore must be handled concurrently. Nature has provided a system in which our bodies are capable of functioning during times of food shortages. However, in this age of food surplus, it takes self restraint on the part of the individual to limit their caloric intake, especially if they know that they are not active. Calorie-rich foods, such as chocolate, do not need to be totally avoided but moderated. Surgeries such as gastric bypass and gastric sleeve may be effective in reducing weight, but at a cost. It may take more effort to control one’s weight through lifestyle modification (healthy eating, exercise), but this option carries less risk and is much less costly to the individual. Surgeries should always be treated as a ‘last resort.’ So, if you, yourself, are overweight and considering surgery, ask yourself, “Have I really tried to lose this weight on my own.”

Repetitive by Nature: Overuse Injuries in the Workplace

January 27, 2016

It is reasonable to assume that most physicians, case managers, and physical therapists have all dealt with an injured worker who is diagnosed with a repetitive-use injury; otherwise referred to as “Repetitive Motion Disorder” (RMD) by the National Institute of Neurological Disorders and Stroke. While RMD’s occur most frequently to the arm and hand, they can certainly develop elsewhere – the feet, knees, hips, and spine. Indeed, most occupations existing today involve some degree of repetitive movement and the reality is that, given enough time, RMDs are inevitable. The question therefore is this: how does the injured worker return to their occupation when it’s the very nature of the occupation itself which is the cause of the injury? The answer, as one would expect, lies in a greyish area between “easily” and “not going to happen.” The reason for this convolution? Well, one must look at the variables involved:

1) Time: The longer RMD is allowed to persist, the more permanent its symptoms may become. Recognition and Intervention are the first and, arguably, most important variables when considering the likelihood that the injured worker will return to their occupation.

2) Job Demand: An important step to resolving an RMD case is addressing the cause(s) behind the issue and, wherever possible, suggesting reasonable accommodations be made to their workspace to prevent re-injury. This can be accomplished through a Jobsite Analysis, which objectively studies and evaluates the injured worker’s occupational environment.

3) Course of Treatment: It is not possible to know how the injured worker will perform once back at work, so allowing a chance to “practice” can determine the feasibility of a full duty return-to-work. This is the function of Work Hardening – a long duration therapy program which is able to simulate (within reason) both the intensity and duration of the worker’s occupation. The results of this program can also yield reasonable accommodation suggestions that can allow the injured worker to make a successful transition back to full duty.

Ultimately, timely action and cooperation between the injured worker, their healthcare provider(s), and their case manager can mean the difference between temporary and permanent injury when RMD is the diagnosis. For more on RMD, click here.

Handling Workers’ Compensation Claims

January 13, 2016

Injuries occur, but when they occur in the workplace they may set in motion a series of events that can prove costly to both the employee and the employer. Mitigating this potential financial catastrophe should therefore be at the forefront of the employer’s list of priorities. The best practice to do so, however, is not to be adversarial. A recently published article by Ken Martin, of Property Casualty 360, emphasizes the proactive role the employer can play to reduce the costs of a Workers’ Compensation claim. Ultimately, prompt claim filing and continued monitoring of each injured worker’s status are logical ways to keep costs low, while ensuring a positive employer/employee relationship is preserved through this sometimes arduous process.

“I’ve been injured on the job. Will I be fired?”

December 30, 2015

Cases where an injured worker is terminated, a.k.a. “fired,” while still attending physical therapy or enrolled in a Work Hardening program do, unfortunately, exist. The important thing to keep in mind if you are an injured worker and are worried about losing your job is this: You cannot control the actions of your employer, so instead keep your focus on rehabilitating your injury as quickly, and safely, as possible. It should be common sense that the longer you remain off work, the more likely your employer will find a replacement. For occupations that require more specialized training and/or educational Degrees, the window of rehabilitation may be longer in duration. However, regardless of the time off from work, no job is safe after you have sustained an injury. Therefore, it is of the upmost importance that you, the injured worker, educate yourself. Ask questions and stay in contact with your case manager, employer, and physician. Strictly follow any rehabilitation program prescribed to you and avoid all activities that could jeopardize your recovering injury. If you have been terminated from your occupation, there are some considerations that can affect your case moving forward, stated very clearly in this article from 2013.

MET Testing and FCEs

October 21, 2015

A Metabolic Equivalent of Task test, or MET test, is an important component to any credible Functional Capacity Evaluation (FCE). When an injured worker has an extended absence from their occupation, their ability return in a safe and productive manner hinges not only on the successful rehabilitation of their specific injury, but also on the condition of their cardio-respiratory system. A valid MET test is important because a discrepancy between cardio-respiratory fitness and the energy required to perform the injured worker’s target job may prove to be a significant hurdle to clear. When considering occupations that demand high levels of cardiovascular conditioning, such as a Firefighter, the performance of a MET test is critical to ensure that their body is capable of safely meeting the challenge before returning them to their occupation. Following physical therapy, the injured worker may prove strong enough to return to work, but do they possess the stamina to successfully reintegrate into their occupation? MET testing can answer this question.

At Industrial Health, we incorporate MET testing into our objectively thorough, Matheson-based FCEs. With the valuable information gained as a result of the FCE, physicians and case managers are able to make more informed decisions regarding their injured worker’s return-to-work path.

For more on MET testing, click here.