An Overview of Case Management
2013 East Central Iowa
Safety & Health Conference
Kirkwood College
February 26th, 2013
Karl Schewe BA, MBA
Purpose
• To ethically and legally:
– Help participants prevent workplace aggravation
of non-work-related medical conditions
– Minimize OSHA Recordability and Lost Time for
work-related medical conditions
Process
• Discuss the ethical & legal framework for nonwork-related Return to Work
• Present a Job Requirements form that can be
used to help facilitate medical clearance
• Discuss the ethical & legal framework for
OSHA Recordability
• Present case-management strategies and
tactics
• Keep in mind that your company policies
have bearing on what you can and cannot do.
Expected Outcome
• That participants who need them will come
away with some practical ideas and tools to
help them with case management for both:
– Employees returning to work from non-workrelated medical care that could affect their job.
– Work-related injuries and illnesses
Return to Work from a non-workrelated medical absence
• Why do we need to manage this?
If you significantly aggravate it,
you own it.
A significant aggravation simply means
something aggravated it to the point that it
triggered OSHA Recordability.
Return to Work from a non-workrelated medical absence
• How do we approach this issue?
– Ethical considerations:
• Treat others the way you would want to be treated.
• Be fair and consistent.
– Legal considerations:
• Know your company’s HR policies.
• HIPPA – You are only interested in fitness for duty.
• ADA - Are the restrictions temporary or permanent?
Return to Work from a non-workrelated medical absence
• Have a system:
– What is “Fit for duty”?
– Identify your job requirements ahead of time (see
handout).
– Help the personal physicians to have some “skin in
the game”.
– Communicate the expectations to employees.
– Have supervisors give notice if someone appears
to not be fit for duty.
Return to Work from a non-workrelated medical absence
• Be consistent in how you apply your system:
– If you differentiate between work groups, be
consistent within each group (salaried vs. hourly).
– Temporary vs. permanent restrictions
Return to Work from a non-work-related
medical absence
• Questions???
Work-Related Injuries & Illnesses
• Why do we need to manage this?
– Patient Care
– Worker’s Compensation costs
– Company metrics
• Recordable cases
• Lost Time cases
Work-Related Injuries & Illnesses
• Ethical Considerations:
– Patient care is #1
• It’s the right thing to do.
• Conditions can worsen.
– Your company’s name is on the line.
• Legal Considerations:
• OSHA requires accurate recording.
• You must be able to demonstrate good faith and defend your
decisions.
• OSHA Recordability normally tracks with Worker’s
Compensation but not always.
Work-Related Injuries & Illnesses
• How do we approach this issue?
– Know the regulations:
•
•
•
•
29 CFR 1904 (See handout for parts of it.)
OSHA Record-Keeping Handbook
Letters of interpretation
Consider a phone call to OSHA. (Ann Jackson in Iowa)
– Is it work-related?
• Watch out for special cases such as:
– Parking Lots
– Secondary injuries from personal events
– Workplace violence
– Does it trigger Recordability or Lost Time?
Work-Related Injuries & Illnesses
• Case management strategies:
– Know your care providers:
•
•
•
•
Do they know the regulations?
Do they care?
Do they know you?
Beware of conflicts of interest (WC tends to pay on time and
sometimes pay more).
– Know your supervisors:
• Do they know the regulations?
• Do they know you?
– Ensure that employees know that they must report
incidents promptly.
Work-Related Injuries & Illnesses
• Specific steps that will help:
– Work with Occupational Medicine providers & ER
physicians.
• Assure them that patient care comes first.
• Verify that they know the regulations.
• Educate them on your workplace exposures, and also
the exposures that you do not have.
• Discuss multiple visits vs. “what if” prescriptions.
• Clarify restricted duty opportunities.
• Specific steps that will help (continued):
– Educate your supervisors
– Accompany the employee to the clinic or ER.
– Educate your employees
– Never forget that patient care comes first. Never
compromise your credibility or integrity by being
unrealistic or unethical. Do the best you can, and
realize that sometimes a situation simply is what it
is.
Work-Related Injuries & Illnesses
• Specific tactics - Patient care comes 1st!:
–
–
–
–
–
Pain meds vs. ice & OTC ibuprofen
“What if” antibiotics vs. follow-up visits
Butterflies or Steri-Strips vs. stitches, staples, or glue.
Rescinding a prescription
“Use as tolerated” vs. specific restrictions, but DON’T
CHEAT.
– Rigid vs. non-rigid means of support
– ER – Time off vs. follow-up with company doctor
Work-Related Injuries & Illnesses
• Questions???
Purpose
• To ethically and legally:
– Help participants prevent workplace aggravation
of non-work-related medical conditions
– Minimize OSHA Recordability and Lost Time for
work-related medical conditions
Process
• Discuss the ethical & legal framework for nonwork-related Return to Work
• Present a Job Requirements form that can be
used to help facilitate medical clearance
• Discuss the ethical & legal framework for
OSHA Recordability
• Present case-management strategies and
tactics
• Keep in mind that your company policies
have bearing on what you can and cannot do.
Expected Outcome
• That participants who need them will come
away with some practical ideas and tools to
help them with case management for both:
– Employees returning to work from non-workrelated medical care that could affect their job.
– Work-related injuries and illnesses