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Myths and misconceptions contribute to delayed recovery and poor outcomes for injured workers

In the workers’ compensation system, the exemplary medical provider renders excellent clinical care

February 18, 2020
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In the workers’ compensation system, the exemplary medical provider renders excellent clinical care and is equally adept at facilitating a patient’s earliest, medically appropriate return to work (with or without modified duty). In fact, the interests of both the injured worker and the employer are well served when a provider helps them agree that timely return to work is the paramount goal. Conversely, avoidable and excessive delays with returning a patient to work are highly detrimental for both. Some examples are given in the table below.

Advantages of timely and disadvantages of delayed return to work

Various common scenarios can lead medical providers to place patients on full work restrictions for an avoidably long period. This contributes to the adverse consequences noted above. Unwarranted assumptions, questionable assertions, and myths and misconceptions often create these circumstances. Several are summarized below with accompanying explanations and tips about how to mitigate their influence.

Patient assertions:

  • My employer doesn’t have light duty, so you have to take me off work. Injured workers might assume this is true or might assert it for secondary gain. It may seem reasonable, especially if the worker is employed in an industry such as construction. However, almost every type of employer should either already have or be encouraged to create modified duty opportunities. An actual conversation with the employer — either initiated by the provider or through Pinnacol’s return to work department (303.361.4000) — is the best way to verify and potentially overcome this barrier. Even if the provider is pressed for time in a busy clinical practice, the patient’s claim should never be accepted at face value. Addressing the issue on the front end can eliminate a great deal of wasted time and misunderstanding on the back end.
  • I’m in intense pain — more than you can imagine. I just can’t/won’t go back to work. This complaint can be very difficult to manage and is one of the most common heard from injured workers. While it’s important to be empathetic and provide analgesia when necessary, the provider should educate the patient as soon as possible after an injury about the goal of care. The goal is not the complete resolution of pain; rather, it is to maximize the restoration of function. Sometimes pain fails to diminish commensurate with the nature of an injury or is out of proportion to physical exam findings. If so, the provider should elicit and address psychosocial factors as quickly as possible while holding firm to the principle that a patient whose physical capabilities allow for modified duty should be required to work and that, indeed, this will be of significant benefit. Finally, pain by itself should not delay or be a primary influence on maximum medical improvement determinations.
  • If you make me go back to work, I’m sure I’ll hurt myself even more. This will be your fault. Injured workers often experience pain-related fear that can give rise to avoidant behaviors and heightened perceptions of musculoskeletal pain. Alternatively, some patients can be manipulative for purposes of secondary gain. Regardless, the provider should educate the patient, making it clear that improved function is the primary goal of treatment and that work duties need to be advanced as functioning improves. It is crucial to offer a sympathetic ear and assuage patient fears. The provider should encourage patients and help them understand that their longer-term outcome will be compromised if they don’t gently get back in the saddle as soon as medically reasonable.
  • If you don’t take me off work, I’m going to get a lawyer. The best response goes something like this, “If you want to get a lawyer, do what you think is best .... But it won’t change my approach to your care, which is to apply my best clinical judgment in order to facilitate your recovery and your return to work.”

Medical provider assumptions or perceived shortcuts:

  • Full-work restrictions and temporary total disability (TTD) will make the patient happy and get him/her off my back. Based on the principles described above, full-work restrictions should be provided only when there is no alternative and then for the shortest, most reasonable period of time. Jumping too quickly to TTD and maintaining full restrictions for too long can easily complicate a provider’s ability to return a patient to work later on. It can introduce significant delays in recovery and contribute to a more complicated dynamic with all stakeholders, especially the injured worker.
  • Full-duty restrictions are easier to specify than specific, detailed restrictions. While checking the “full-duty restrictions” box might save a few seconds at that moment, an inappropriate designation can add days, weeks and even months to an injured worker’s recovery.
  • I won’t treat an injured worker differently from how I treat my regular (not workers’ compensation) patients. On the one hand, this is reasonable. Of course, the same high standards of diagnosis and treatment applied to “regular” patients should be applied without prejudice to injured workers. The difference, however, is that in workers’ compensation, the physician also has a duty to the employer and must properly value and promote the significant therapeutic benefit associated with timely return to work. If “treating the injured worker the same” means giving inadequate attention to functional improvement and return to work, then this is fundamentally contrary to the principles of good care in the workers’ compensation system.

If you have any questions, please contact Dr. Denberg at tom.denberg@pinnacol.com, or contact our provider relations specialists at provider_management@pinnacol.com.

* RETURN TO WORK: A FOUNDATIONAL APPROACH TO RETURN TO FUNCTION. IAIABC Disability Management and Return to Work Committee, April 19, 2016. Accessed on Nov. 4, 2019.

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