In a previous article, Dr Robyn Horsley gave us ten tips for approaching and communicating with an injured worker’s treating doctor.

In this article, Robyn takes us through some common scenarios to discuss with the treating physician.
 

Clarification of the medical certificate

“Sometimes the certificates aren’t descriptive enough,” says Robyn. This can lead to employers not quite knowing how to start RTW, or what actual duties to give an injured worker.

“Employers are usually pretty good at implementing a return to work program once they get information about the person’s abilities,” Robyn advises. “This often relies upon the doctor having more information about the workplace.”

“A certificate may not have adequate detail for an employer for two reasons: either the injured person hasn’t given enough information, or the consultation has been complex. That’s where the employer is in a position to send a more formal job description to the doctor.”

Robyn highlights the importance of sending a job description that clearly and plainly outlines the physical tasks involved in the injured worker’s job, as opposed to an HR type of job description which actually only describes qualities or KPIs required for a particular role. Once the employer provides a clear job description, the doctor is in a far better position to advise on suitable RTW duties.

Conflicting medical advice from the GP and insurer

 “It’s really important if [employers] get a completely different opinion from an independent medical advisor (IME) about a worker to not to assume that the GP is wrong. There are likely to be other factors present and the doctor may not be prepared to discuss those issues with the employer.” For example, psychosocial factors can compound case complexity and delay RTW, but may not necessarily be apparent to a claims manager, RTW coordinator or employer.

“Independent medical assessors are in a position where they’re often just asked to assess one aspect of the worker – who may have multiple claims – so they’re not looking at the worker holistically when they’re making decisions about return to work,” says Robyn.

“It is very valuable for independent assessment reports to be forwarded to the worker’s GP for review. Employers need to understand, however, that the independent assessment, although helpful, may or may not influence the opinion that the GP has about the management of his /her patient.”

In other cases, “GPs can be very busy, time passes and patients can remain off work longer than is necessary,” says Robyn. “An independent assessment saying that person is fit for work can sometimes be very helpful. So, it can work both ways.”

Conflicting medical advice can be difficult for employers to understand. The important thing to remember is that staying focused on RTW will save a lot of time and money.

“Many employers get caught-up in the diagnosis,” says Robyn. “But, what the condition is and whether it’s work-related is actually not their issue; it’s actually the insurance company’s issue.

“At the end of the day: once the claim has been accepted, that’s the end of it. The claim will be managed by the insurer in the way that they see fit, and what the employer has to do is to encourage and support return to work.”

If the employer takes their eye off the RTW ball by disputing that the injury is work-related, “it’s a disaster,” warns Robyn. “The injured worker knows that they’re not supported and it just militates against a successful return to work.” This scenario often ends up costing far more in protracted or subsequent claim costs.

Worksite assessments

When faced with conflicting medical advice, employers, case managers or RTW coordinators need to get someone in to do a worksite assessment to help get things focused back on RTW.

“It needs to happen really quickly,” says Robyn. “A worksite assessment will clarify whether the barriers are physically based or related to interaction issues with supervisors or colleagues.’

 Robyn says that the person treating the patient is “absolutely the best” one to do the worksite assessment. But the GP needs to understand that they will be properly remunerated for their time.

“A lot of doctors don’t understand that they’re going to be paid, or don’t know how to ask for adequate payment,” says Robyn. “There needs to be appropriate remuneration for the visit. Employers have to understand that the visit involves the travel to and from the workplace, and the time spent at the worksite, as well as a short report.

A rule of thumb is that a GP will probably see four to five patients per hour. Check the GP rates in your state to get a clearer idea of how much the doctor is usually paid for this time.

The employer also needs to make it clear that they don’t expect a large report following the worksite assessment.

“A lot of GPs see the worksite assessment reports being produced and feel quite daunted by them. They won’t go into the workplace because they think they have to produce that type of report,” says Robyn. “Tell them that all you want is some clarification about what the doctor thinks his or her patient is able to do in the work environment.”  The most suitable time for doctors is often early in the morning, lunchtime, or late in the day.


Worker ‘stuck’ on alternate duties

Sometimes, the injured worker can end up seeming ‘stuck’ on alternate duties. This stalls full RTW and threatens future claim issues. This situation can be caused by a number of factors.

“The doctor is often content because he/she feels they’ve done a good job keeping the patient at work.  They may not understand the implications of long term alternate duties for the business” says Robyn. “It’s important to remind the doctor that you want the best outcome for the injured worker, which means helping them progress to more comprehensive duties.  Again, a comprehensive job description of proposed upgraded duties or a worksite assessment may progress matters.”

Employers can also unintentionally stall the RTW process. Often, alternate duties can morph into an end-point without proper subsequent RTW goals. Employers need to be reminded that full RTW is the goal.

Injured workers should understand the importance of attempting to increase hours and/or duties despite any pain or discomfort they may have. Remember, there are many types of injury where pain is not a sign of further damage. Doctors may also need to be reminded of this.
 

Accompanying the employee to their appointment

An employer, case manager or RTW coordinator can show their support for the injured worker and their RTW by offering to attend treating consultations. This is a great step, but they must abide by some guidelines:

• Ask for employee consent;
• Tell the doctor before arriving at the consult; and
• Book a long appointment, to allow the doctor to see the patient before inviting the employer into the consultation.

“Very often the employer’s intention is positive,” says Robyn. “But if they don’t go about it the right way, it won’t be construed as being positive. Coming to see the doctor can be a really valuable thing to do, but it needs to be done taking account of another person’s workplace and work load.”

Dr Robyn Horsley specialises in Occupational Medicine at H.D.A. Medical - Suite 8,
200 Sydney Road, Brunswick Victoria 3056. Ph. (03) 9387 4588.