A Tale of Two Accommodations

It was the best of accommodations, it was the worst of accommodations….

All apologies to Charles Dickens for stealing his famous opening line but over a very short time period several years ago, we were sent two claimants who fell at the extremes of what can happen during workplace accommodations following a workplace injury.

In both cases, accurate job descriptions could have prevented these issues.

The first of the two cases was an employee at a county run mental health facility.  Unfortunately, we evaluated this claimant after they were injured in the position that was used as an accommodation after their first workplace injury.  The employee’s second injury was a reinjury of their right rotator cuff, which had been injured in the first injury.  At the time of the employee’s first injury, she worked as a Certified Nurses Assistant.  While transferring a patient, she suffered a tear of her right rotator cuff for which she underwent surgical repair of the rotator cuff.  She attended physical therapy for approximately 3 months following surgery.  At the conclusion of physical therapy, the claimant was accommodated through placement in a different position after the treating physician suggested that she was not able to safely return to her previous position as a CNA.  An FCE to determine her physical abilities at the end of treatment was not performed.  The employer chose to accommodate the employee by offering her a position within the housekeeping department of the facility, specifically in a position that was responsible for distribution of clean linens and collection of dirty and/or used linens.

Within 4 months of being switched to the housekeeping department, the employee was lifting a bag of dirty linens into a tall rolling cart when she tore injured her right rotator cuff for the second time.  She underwent a second surgical repair and was sent for an FCE after completing physical therapy.  She provided a consistent effort during the FCE and qualified at the light work level (20 pounds occasional, 10 pounds frequent, negligible constant).  In both cases, the employer did not have customized job descriptions for either of these job titles.   

The Dictionary of Occupational Titles places the CNA position and the linen staff for housekeeping in a hospital at the medium work level (50 pounds occasional, 25 pounds frequent, 10 pounds constant).  While lacking a customized description that accurately and objectively defines the minimum essential physical demands, a cursory look at the DOT entries would indicate that this accommodation was a transfer to a position with a similar physical demand level as the position that the physician had recommended against.  Having measured the physical demands for both positions at several facilities, while the overall tasks performed are different, the forces required to push, pull, and lift in performance of tasks is similar.  Employees working in linen services in most hospital facilities face overstuffed bags of dirty linens that have to be lifted to shoulder height or above when placing in laundry carts as well as several other physically demanding tasks.

The second case started off slightly different.  He had been sent for an FCE due to injuries sustained in a vehicle based accident at work.  Based on the customized job description that was provided by the employer, his FCE results indicated that he did not meet the essential minimum physical and postural demands of his position.  The employer identified a variety of tasks that could be performed by the employee in an accommodation based on his demonstrated physical abilities during the FCE.  They asked us to perform an onsite visit to measure the physical demands and postures of the tasks that would be offered as an accommodation to the employee.   As we were evaluating tasks, the supervisor showed us the equipment on which the employee had been injured.  As we were looking at the equipment, I dug into my notebook where I had a copy of the provided job description. 

The onsite equipment did not match the job description that we had been provided with for the test.  The equipment used for the employee’s job title provided ground level access with handrails and required only an 8 inch step to climb onto the equipment.  The job description had indicated a step height of 22 inches.  We brought this to the attention of the supervisor who looked at the description that I had brought with me.  He realized that they had been using a company wide description that did not accurately reflect the equipment at each of the sites.  The description had been based on a location in another state. 

We continued to evaluate the proposed accommodations but we also measured the demands for the position that the employee held at the time of injury.  After collecting all of the data, a review of the employee’s FCE performance versus site specific equipment measurements indicated that the employee could return to his full duty position with no restrictions.  Fully documented addendums were sent to the case manager and the treating physician.  The treating physician returned the employee to full duty.

While the second case had a successful outcome for both the employer and employee, the case could have been resolved about 1 month earlier had the provided job description been accurate for the specific worksite.  In the first case, a second injury with subsequent surgery may have been prevented if the accommodated position had been validated against the individual’s physical abilities.  In both cases, accurate job descriptions could have prevented these issues.

Friday Five – 9/13/19

This is a slightly different Friday Five.  I’m not going to post a check of what is new in the research in the areas of ergonomics and safety.  This week will be a quick recap of what I think were five important takeaways from the conference that I attended yesterday – “Everything You Wanted To Know About New Jersey Workers Compensation” which was hosted by John Geaney from Capehart Scatchard and Millenium Seminars.   If  you aren’t following John’s blog on workers compensation, you should be.

“Recovery on the job” – Trudy Mandia from AtlantiCare

I tweeted about this yesterday.  I hate the term “light duty”.  So many people get wrapped up with the word light with a lot getting it confused with the term “light work” which is considered to be a job with an occasional lift, push, pull, carry demand of 20 pounds.  Everyone tends to get wrapped up on the restrictions on an individual when they hear “light duty”.  Over the years, I have been on a mission to reframe the term as modified duty which is not so wrapped up in the restrictions on demands.  But, I love the term that Trudy talked about from AtlantiCare’s standpoint.  They no longer use the term light duty and have replaced it with “Recovery on the job” with the focus being on an individual’s current abilities and not focusing on what they can not currently do.

“Make sure that it isn’t boxes just being clicked”

Dr. Dwyer from Premier Orthopedics mentioned the reminder that with so many medical records being generated by different EMR packages, sometimes practitioners can end up clicking through.  Make sure that the physicians and therapists are being accurate when they are completing medical records in an EMR system and that they are also indicating both active and passive range of motion of the injured body part at all visits.

“Make sure that your employees know how long light duty will last”

This topic came up across multiple discussions through out the day because it is that important.  This is something that we tell clients that we meet with when we are talking about both regular job descriptions and tasks that might be available for modified duty.  Leaving an employee in a modified duty position for an indeterminate length makes some employees want to remain in that position for the remainder of their employment and also makes it easy to argue that the “modified duty position” is essential if an employee is left in that position for a prolonged duration of time.

“Job Descriptions”

Another topic that was mentioned several times because as John said yesterday, good job descriptions are the building block for creating a workers compensation program.  I’ve written about customized job descriptions multiple times on this blog, but members of yesterday’s panels provided reminders that good, solid, accurate job descriptions allow:

  • The physicians and physical therapists do their jobs to get the injured employee back to the essential demands of the position.
  • Allow physicians, employers, and case managers to possibly get an injured employee on modified duty when it becomes appropriate and helps to allow for progression of modified duty over the treatment timeline
  • Is necessary for having an effective interactive dialogue when the issues of accommodations comes up.
  • Need to accurately reflect current essential postural and physical tasks that are performed.

“Communication”

The issue of communication came up in several panel discussions during the day.  Communication between the employer, the case manager, the physician, the physical therapist, and the employee is key in moving towards a successful end state for an injury claim.

  • I was glad to hear that having a bilingual staff member to help with the communications process with injured workers at the Tropicana has made a big improvement in their program.  I know that in the provision of FCEs, we have been grateful when a translator has been provided if a claimant does not speak English but provision of a translator is not a common occurence.  Having a translator can make things go much easier and quicker when everyone is on the same page.
  • Make sure that you communicate your modified duty program guidelines to your injured employee when it is offered and put it in writing.  This helps to make sure that everyone is on the same page.

This is just a small sampling of some of the important topics that were discussed during the course of the day.  These one day conferences are a great opportunity to learn from the speakers, the attendees as they ask questions/make comments, and during the breaks to learn from the vendors and the attendees.

atlantic-city-beach-patrol-boat-82-quin-bond

(A photo I took during a previous conference in Atlantic City but yesterday’s weather conditions were similar)