This interesting paper, sourced by @Trinny61, presents the results of a representative statewide survey of employers in NSW re their willingness and ability to provide suitable duties to their injured workers. Findings indicate that most employers experienced difficulty in providing suitable duties to their workers with injuries, and that small employers (<20 employees) experienced more difficulty than large employers. Workers’ compensation bodies need to develop strategies to assist employers in this central task of occupational rehabilitation.
Workers compensation bodies need to develop strategies to assist employers with provision of suitable duties
Provision of Suitable Duties in Occupational Rehabilitation: employer perspective
The workplace based approach to occupational rehabilitation depends on the availability of, and employer willingness to provide suitable duties to workers with injuries who are either temporarily or permanently unable to perform their pre-injury work duties. Given the importance of suitable duties to the outcome of occupational rehabilitation, it is surprising that there has been no research that examines the feasibility of providing suitable duties from an employer perspective.
Accordingly, this paper presents the results of a representative statewide survey of employers in New South Wales, Australia. Findings indicate that most employers experienced difficulty in providing suitable duties to their workers with injuries, and that small employers (<20 employees) experienced more difficulty than large employers.
Workers’ compensation bodies need to develop strategies to assist employers in this central task of occupational rehabilitation.
Current workers’ compensation arrangements in Australia and elsewhere encompass prevention, compensation, and occupational rehabilitation. Their function is to restore the injured worker to the workplace in a safe and timely manner. The New South Wales, Victorian, and Comcare (i.e., scheme for Commonwealth employees throughout Australia) schemes emphasize workplace based programs, with the onus on employers to assist their injured workers to return to work. In these jurisdictions, employers are required to appoint a rehabilitation coordinator, whose function is to provide information to the injured worker, liaise with key personnel, such as the treating doctor and the supervisor, and negotiate suitable duties, workplace modification, and return to work plans if the injured worker is unable to return to his/her pre-injury occupation. Following the Grellman report (1), new legis- lation has been enacted (i.e., Injury Management and Workers’ Compensation Act, 1998) that places even more responsibility on employers to return workers to work as quickly as possible following injury.
One way of accomplishing rapid return to work is the maintenance of job attached status to the pre-injury employer. This is often best accomplished by the availability of suitable duties (2) . The provision of suitable duties is therefore a cornerstone of effective occupational rehabilitation. Aggressive return to work programs and the importance of the provision of suitable duties as a method of accomplishing early return to work has also been acknowledged in other workers’ compensation jurisdictions worldwide (3). The small body of evidence on the effectiveness of modified (i.e., suitable) duties has been comprehensively reviewed (4) , and results indicate that the provision of suitable duties facilitates return to work, reduces days lost because of injury, and is cost-effective. Of 13 studies included in this review, the odds ratios for return to work ranged from between 0.7 and 4.5 , and cost savings, as the ratio of preprogram to postprogram costs, ranged between 1.1 and 7.2 .
The authors concluded that employees with access to modified work programs returned to work about twice as often as employees not offered modified duties; and that lost work days were halved by the availability of modified duties. Savings in direct costs were calculated at between 8% and 90% . The wide variation in estimated cost savings is due to the fact that some calculations took program costs into account, while others did not .
To date, very little research has been reported on the degree to which employers are either willing or able to provide suitable duties to their injured workers. Available evidence indicates that some employers, particularly small employers, experience great difficulty meeting this requirement of the legislation (5) . Small businesses employ approximately half of the work force (6) in Australia so this difficulty could potentially affect a large
number of workers. The aim of this study was to examine the attitudes and practices of a representative group of employers towards the provision of suitable duties to injured workers.
The majority of employers reported that they could provide suitable duties in most or all cases of work injury.
Finding suitable duties was perceived as difficult by over half of the employers surveyed. As expected, larger employers reported less difficulty. This study has demonstrated that the provision of suitable duties is an ongoing problem for a rehabilitation system based in the workplace. Employers who perceived the provision of suitable duties as difficult were most likely to cite the nature of the work as the reason for the difficulty; that is, they did not perceive that they could adapt their work to the needs of an injured worker.
Suitable duties are an integral component of the current workplace based rehabilitation scheme, yet half of all employers find it difficult to comply with this requirement. Overseas studies report similar difficulties. For example, in one study assessing the return to work experience of injured workers and factors affecting their decision to return to work, only 42% reported receiving modified work from their employers (8). It therefore appears necessary to explore other options for injured workers who are not ready to return to their normal duties but who are fit enough to perform some work. Currently, workers in this category are often advised by their treating medical and health practitioners not to return to work until they are fully fit to perform their pre-injury duties (9). This advice often prolongs the time lost from work and reduces the chances of a successful return to work.
A number of options are available to overcome the difficulty in providing suitable duties, particularly by small employers. For example, the WorkCover Authority could establish industry based working parties (consisting of employer, employee representative, occupational medical specialist, rehabilitation provider, rehabilitation coordinator) to identify a range of suitable duties for the most common injuries in each workplace. A database for suitable duties could then be established and a cooperative approach to the provision of suitable duties could be encouraged across similar industries in defined geographical areas.
The current legislation does not require employers with fewer than 20 workers to appoint a rehabilitation coordinator. This is problematic because it is primarily the role of the rehabilitation coordinator to negotiate suitable duties with the other stakeholders. To overcome this problem, the WorkCover Authority could establish a position entitled “district rehabilitation coordinator ” who would be appointed to provide services to between 10 and 20 small workplaces, depending on numbers in each workplace, in geographical proximity. District rehabilitation coordinators could locate suitable duties for an injured worker at any one of the workplaces within the “district. ” Each of the participating employers would pay a portion of the coordinator’s wage, not to exceed a prorated estimate based on premium calculations, and the short fall could be funded by the WorkCover Authority. Costs would hopefully be offset by savings in compensation payments accruing to the more rapid return to work that this system would hopefully bring about. The cost-benefit of rehabilitation has been demonstrated. For example, Ganora & Wright (10) reporte d direct benefit to cost ratios of injury management and rehabilitation in a company of 300 employers to be 12.6 to 1. Similarly, Anutech (11) estimated for that for the Commonwealth Rehabilitation Service, every dollar spent on rehabilitation produced a saving of nine dollars.
The opportunity to place injured workers in temporary employment outside the company where the injury occurred offers a viable option for reducing time lost and costs associated with occupational injury. An innovative program was reported by Perry (12) in which ill or injured workers were placed at workshops for the developmentally disabled. This program achieved both early return to work and injury cost reduction, while at the same time paying the injured workers their full wage, rather than a proportion of the pre-injury wage offered by the workers’ compensation system.
Cooperatives or employer networks could also be an effective means of assisting small employers to find suitable duties for their injured workers. An example of the utilization of an employer network is Telecom (now Telstra), that has, when necessary, outplaced their injured workers from small towns with private employers, such as service stations, as part of the workers’ rehabilitation and return to work plans (13). An example of an employer cooperative is the Electrical Employers Self-Insurance Safety Plan, a self-insurance group in New York, that consists of a group of small employers who may place their injured workers with any of the employers within the cooperative as a way of expediting a timely return to work (14).
Several recent studies reporting a range of interventions for low back pain have indicated that focus on return to work and timing the return to work in the subacute stage (i.e., 3-12 weeks after pain onset) have reduced time lost from work by between 30% and 50%. Employers who promptly offered appropriately modified duties demonstrated the most effective time and cost savings from this disability (15).
Provision of suitable duties need not be an albatross around the necks of employers, particularly small employers.
Creative solutions to equal opportunity for high quality rehabilitation to all injured workers, regardless of size of employer, and the nature of the work, are potentially available.
Currently, it would appear that injured workers from smaller organizations may be at risk for poorer quality rehabilitation services than their counterparts in larger organizations.
Article sourced by our start contributor @Trinny61, with thanks
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