Workplace Disability
Management
Steven R. Pruett, Ph.D, CRC
SERNRA Conference
May 16, 2005
Private Sector Rehabilitation
 Rehabilitation
Counselors have been
employed in the private sector
performing rehabilitation services for
various insurance related settings since
the 1970’s.
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Workers’ Compensation
Managed Care
Private Insurance Rehabilitation
Economic Rationale

For Vocational Rehabilitation services
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
Return of the claimant to gainful employment
thereby reducing payment of lost wages.
For medical case management
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Facilitate the treatment and recovery of the
claimant for a quick and safe return to work.
Reducing costs by curtailing unnecessary or
unrelated medical treatment and reducing
compensation for lost wages.
Disability Management

The rising cost of health care and disability
at the work place in conjunction with a
competitive business economy provided the
impetus for cost containment strategies with
large companies in the United States.
Definitions of Disability
Management
“Disability management is a workplace prevention
and remediation strategy that seeks to prevent
disability from occurring or, lacking that, to
intervene early following the onset of disability,
using coordinated, cost-conscious, and quality
rehabilitation service that reflects and
organizational commitment to continued
employment for those experiencing functional
work limitations.”
(Akabas, Gates & Galvin, 1992, p. 2)
“Disability Management means using
services, people and materials to (a)
minimize the impact and cost of disability
to employers and employees; and (b)
encourage return to work for employees
with disabilities.”
(Schwartz, Watson, Galvin & Lipoff, 1989, p.1)
“A proactive and systematic workplace
strategy to enhance organizational health
and to promote employee’s wellness by
providing preventive and remedial services
to minimize the economic and human costs
of disability.”
(Lui, 2000, p.5)

The first disability management programs
appeared in late 1970’s and early 1980’s
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Burlington Industries
AT&T
3M Corporation
Sears
Goals: Humanitarian & Economic
Evolution of Disability
Management

During the 80’s and 90’s a growing number of
employers were implementing DM programs in
the workplace
(Breslin & Olsheski, 1996; Habeck, Leahy, Hunt, Chan,
& Welch, 1991; Shrey, 1995)

DM programs began hiring many different rehab
professions
–Rehabilitation
counselors
–Occupational health nurses
–Other occupational health professionals
Scope of Practice in Disability
Management

Commission on Disability Management
Specialist Certification (CDMSC)
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1991 Essential work role & function categories
 Case
management & human disabilities
 job placement & vocational assessment
 rehabilitation services & care
 disability legislation & forensic rehabilitation

Habeck’s (1996) two-level concept of
disability managers (DM & dm)
Scope of Practice

DM (Level I)
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
System, administrative oriented
Practice & knowledge domains are predominately
managerial and fiscal.
dm (level II)
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Service oriented
In addition to those cited in the 1991study practice &
knowledge domains include: disability management
concepts, principles of insurance, benefit plans,
ergonomics, managed care concepts, and business
practices and operations.
Currier, Chan, Berven, Habeck & Taylor (2001)
Scope of Practice
 Chan
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et al. (2001)
sole focus on practice & knowledge
domains of level II disability managers
 Practice
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domains
Managerial/Consultative
Vocational Counseling, Assessment, and Job
Placement/Job Development
Disability Case Management
Early Return-to-Work Intervention
Scope of Practice
 Chan
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et al. (2001) continued
major knowledge domains
 case
management techniques
 psychosocial intervention skills
 vocational aspects of disability
 managed care
 managed disability
 human resources
Scope of Practice

New study (2003) by CDMSC
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12 experts in the field of DM
3 day exploratory fact-finding meeting on
current status of DM
 Educators,
employers, practitioners & adminstrators
 consensus based model
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Current practice based on 3 primary domains
 Disability
case management
 Disability prevention & workplace intervention
 Program development, management & evaluation
Scope of Practice (A sample CDMSC finding)
Disability Case
Management
Disability
Prevention
Perform comprehensive
individual case analysis
& benefits assessment
using accepted practices
in order to develop
appropriate interventions
Implement disability
prevention practices (i.e., risk
mitigation procedures such as
job analysis, job
accommodation, ergonomic
evaluation, health & wellness
initiatives, etc.) through
training, education, and
collaboration in order to
change organizational
behavior and integrate
prevention as an essential
component of organizational
culture
Program
Development
Analyze workplace
practices (e.g., benefit
design; policies and
procedures; regulatory
and compliance
requirements; employee
demographics; labor
relations) using a needs
assessment to establish
baselines and design
effective interventions
Scope of Practice (A sample CDMSC finding)
Disability Case
Management
Disability
Prevention
Review disability case
management
intervention protocol
using standards of
care to promote
quality care, recovery,
and cost effectiveness
Develop a
comprehensive
transitional work
program through
consultation with all
relevant stakeholders in
order to facilitate
optimal productivity and
value in the workplace
Program
Development
Present the business
rationale for a
comprehensive disability
management program
using baseline data, best
practices, evidence-based
research, and
benchmarks and cultural
and environmental
factors to secure
stakeholder investment
and commitment.
DM Core Competencies

Case management within DM is an essential
element for dealing with a workplace disability
(Akabas et al., 1992).
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In general, rehab nurses and occupational health nurses
have adequate medical knowledge & skills, but may
lack understanding of the interaction between disability
and work.
VR counselors & rehab psychologists generally have an
adequate understanding of disability and work, but are
likely to have limited knowledge specific to medical
problems (Rosenthal & Olsheski, 1999)
DM Core competencies

Case management
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Haw (1996) found that only 4% of nursing
programs provide coursework in case
management
Chan, McMahom, Shaw, Taylor, & Wood
(1997) found only 20% of master’s level RC
programs had one or more course in case
management.
 CORE
requires some case management courses, but
rehab case management is related, but is not
equivalent to disability case management.
DM Core competencies

Habeck et al. (1994) found some evidence
for a natural fit between the background &
skills of RCs and DM work practice.
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Employers found RC had necessary but
insufficient knowledge & skills to work
effectively with DM programs and employers
RCs in DM expressed frustration with
inadequate pre-service training to meet work
demands
DM Core competencies

Shrey (1992) noted traditional RC paradigms
overemphasize characteristics of injured worker
while ignoring significance of the environmental
factors.
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Traditional rehab programs have focused too much on
reactive, provider-based clinical models.
RCs in DM must be able to develop active partnerships with
employers to enhance employment of injured workers while
advocating for interventions in the workplace.
RCs must be able to conduct ergonomic and disability
prevention programs, including workplace safety programs
& EAPs
DM Core competencies


Very few academic programs provide a
comprehensive DM curricula.
Only a few CORE accredited master’s degree
programs offer an emphasis in DM
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Generally CORE programs train students to provide
counseling and support to individuals with disabilities
using private non-profit and public VR systems as
models.
Concepts necessary to DM have not been emphasized
in these models.
DM Core competencies

CDMSC requirements are changing due to
changes in the profession of DM
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Emphases on prevention has made job analysis,
reasonable accommodation and ergonomics into the
mainstream of practice.
Early intervention has brought greater focus on medical
management and requires knowledge of high quality
medical care with an occupational perspective.
Additional changes will most likely be in work
organization and management structure
(Caulkins, Lui, & Wood, 2000)
Emerging Practices in DM

Changing Demographics
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Hursch (2003) projects:
Number of older workers will increase substantially over
next couple of decades. 18.4 million workers over 55 in
2000 will reach 31.9 million by 2015 (US GAO, 2001).
 Proportion of older workers will increase from 13% to
20% by 2020 (Purcell, 2000). Fewer younger workers
entering workforce to replace positions vacated by
retired workers.
 In 2000 30% of the older population was in the work
force. By 2015 this will increase to 37%. (Purcell, 2000)

Emerging practices in DM
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Changing Demographics
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Older workers are needing health insurance and
additional finances to support desired lifestyles.
Holistic approaches needed for work and life planning.
Older workers are heterogeneous
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differing in health, financial and career needs
Longer healing times may be needed, but many older
workers are loyal, skilled and careful workers, who
have fewer work-related injuries. They are also less
likely to have family problems. (Douglas, 2000)
Emerging practices in DM

Changing Demographics
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Recent census data indicate African Americans,
Hispanic Americans and Asian Americans
comprise approximately 33% of the US
population.
By 2010 it is estimated that European
Americans will be a distinct numerical
minority.
Workplace will be even more diverse requiring
greater cultural sensitivity.
Emerging practices in DM
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Outcome orientation
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Accountability and accuracy driven by business
competition and rising disability costs.
Many companies lack tools for effective outcome
measurement.
Employer Measures of Productivity, Absence and
Quality (EMPAQ) (in development by WBGH)
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Industry-wide, consensus-based standardized “health related
lost-time measure”
Comparative & predicative analyses
Establishment of meaningful goals, measurement criteria, and
evaluation of outcomes that cover the overall benefits of DM.
Emerging practices in DM

Prevention
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DMs work closely with occupational health teams:
ergonomics, risk management, EAPs
Optimization of communication across corporate
“silos”
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understanding of differences in expertise
Job Analysis, job accommodation, job modification &
ergonomics
Assistive Technology
EAPs
Emerging practices in DM
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Response: how to avoid employee absences.
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Too frequently a referral for VR does not occur
until MMI is reached and claimant cannot RTW
Catastrophic injuries  immediate referral
injury that has potential to limit RTW should
result in a expedited referral.
In-house monitoring of claims can promote this
type of referral.
Emerging practices in DM

Transitional Work Programs (TWP)
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involve a combination of purposeful and
productive job duties, tasks, functions &
therapeutic activities for a worker with
functional restrictions.
Emerging practices in DM
(TWP)

DM coordinator’s involvement
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initiates early contact with injured worker to explain
program, discuss type of work, review benefits, answer
questions
Analyze available job duties & physical demands
consistent with worker’s residual abilities
Arrange for an objective worker functional eval
Reviews TWP program with medical staff or primary
physician & worker, including transitional work
assignments, clinical supervision, time frames, safety
precautions, and expectations for RTW.
Emerging practices in DM
(TWP)

DM coordinator’s involvement
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Collaborates with treating MD in discussing with
worker how the TWP involves safe work activities and
minimizes potential for reinjury
Discusses modified work duties with work supervisor
Monitors worker’s progress with clinical supervisor
during the structured period of transitional work &
keeps medical staff informed of progress or changes
Arranges realistic accommodations/assistive aides or
modified work if needed.
Updates stakeholders on the worker’s progress.
Emerging practices in DM
(TWP)

Post TWP planning
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DM case management monitors worker’s
performance, productivity & adjustment
following a successful RTW.
If needs are not attended to poor productivity,
increased absences or job loss can result.
Medical/disability management programs in the
1990’s returned many workers to work, but
60% of those that RTW had one or more injury
related absences that often resulted in job loss.
(Butler, Johnson, & Baldwin, 1995)
Emerging practices in DM
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Facilitating Adjustment and Coping
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Psychosocial interventions
 Reduction
of stigma for psychiatric disabilities
 Integration of psychosocial interventions requires
policies & procedures that define relationship
between VR and and mental health
 EAPs have traditionally not been involved in the
RTW process and may be unfamiliar with vocational
objectives, operations & services in the DM
program.
Emerging practices in DM
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Integrated Disability Management (IDM)
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Combining all disability related programs
 Worker’s
comp, group health, short & long-term
disability
 Motivated by pursuit of efficiency at all levels this is
an attempt to reduce duplication of services to
reduce benefit costs.
 24/7 model: Regardless of etiology or time of
occurrence of the health problem, health care and
RTW services are provided in a consistent and
coordinated manner.
Emerging practices in DM

IDM
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Definitions, interpretations, & applications are
not universal across employers.
Elements that are consistently rated as the most
effective in controlling disability costs:
 Common
case management
 Aggressive RTW policies or practices
 Responsible, internal, and active management of
disability issues; and identifiable, simple and
coordinated points for intake & claims reporting
(Watson Wyatt Worldwide and WBGH, 1999/2000)
Emerging practices in DM

Absence Management (AM)
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Many employers have moved beyond
integration-of-benefits to overall productivity.
Combining programs that involve work
interruptions:
 Medical, Worker’s
comp, disability
 Unauthorized time off, sick pay, FMLA
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Still a 24/7 model like IDM.
Emerging practices in DM
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AM implementation
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Formulate a leave of absence policy delineating length
of absence by category (e.g., severe health, pregnancy,
adoption, death in family, military)
Create a same-job protection policy for work-related
and non-work-related disabilities
Generate specifications on how an employee’s salary
will be replaced while he or she is on leave.
Ascertain how long an employee on leave will be
treated as an active employee.
Explain what happens if an employee discontinues
health insurance or other benefits while on leave.
Emerging practices in DM
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AM implementation
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Specify when COBRA will be offered to employees on
leave.
Explain whether an employee’s work will be reassigned
while s/he is on leave
Adopt a leave policy, consistent with workers’ comp
law which encourages employees to RTW
Make revisions to employee handbook that include
general information about employee rights and
responsibilities under FMLA/WC and similar laws and
leave policies.
Ritter (2000)
Emerging practices in DM
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Presenteeism
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Shift in focus from absence of employees, to present,
but lacking productivity due to chronic illness,
distraction from family care needs, personal problems,
etc (Stevens, 2003).
Chronic health problems such as diabetes, asthma,
depression, pain disorders & allergies can have a major
presenteeism impact.
Heath Productivity Questionnaire (Harvard Medical
School & WHO)
Work Limitation Questionnaire (Health Institute,
Division of Clinical Research at Tufts-New England
Medical Center).
Evidence-based DM practice

Entails
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Integrating DM practice expertise with best available
observable evidence regarding a specific disability
obtained by systematic research.
Case manager can then understand the accuracy of
vocational functional capacity, diagnostic evaluations
and base recommendations for prevention or
intervention strategies on empirical information &
reliable research findings.
(Rosenthal, Hursch, Lui, Zimmerman & Pruett, 2005)