Nurse Case Manager Chronicles

The Power of a Job Description: Cut Claim Time and Prevent Reinjury

With a detailed and accurate job description at the ready, case managers can help treating physicians make better decisions about return-to-work options.
By: | May 25, 2018 • 5 min read

Even when you’re doing everything possible for an injured worker, a successful return-to-work transition can be jeopardized when a treating physician isn’t attuned to the ins and outs of the worker’s job.

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“It’s helpful for physicians to know the demands for a position,” said Trish Elizalde, a branch manager for Genex Services. Elizalde served as a case manager for 10 years.

“A job description helps a doctor visualize what the worker does on the job and it helps physicians facilitate return-to-work decisions that help get injured workers back to the jobsite while keeping them safe from reinjury.”

Playing an integral role in the healing process, physicians assess injured workers’ impairment, create treatment plans and administer care where needed. They also provide employers and other third parties with updated information on the worker’s progress.

If they lack the knowledge and understanding of a particular job, they could keep a worker at home unnecessarily, delaying the healing process. Worse, they might send a worker back to the grind too soon — the perfect recipe for a second serious injury and prolonged recovery.

It’s in the Details

It may seem like a small piece to the overall claims puzzle, but “job descriptions are huge,” said Elizalde.

By knowing what an injured worker does day-in and day-out, from lifting requirements to frequency of tasks, a physician is better suited to set restrictions while introducing an injured worker back to their job.

Trish Elizalde, branch manager, Genex Services

“An accurate job description assists the treating physician in making decisions about whether an injured worker is able to return to work in any capacity,” she said. “They welcome this information.”

A seasoned case manager, Elizalde said that nurse case managers (NCMs) gather this vital information from employers before conducting site evaluations, breaking down the physical aspects of a worker’s job.

“We strive to obtain a job description on every case. [Case managers] know the right questions to ask and what the physicians are looking for in terms of the physical demands of a position.”

Through this information, the hope is to gain enough insight to maximize and speed recovery. A thorough job description answers how much weight is lifted, how often and for how long. Do employees lift objects from the floor? Is it to waist height or overhead? How far does an employee carry an object, and do they use the assistance of a lifting device?

In addition to lifting, the form documents how long an employee sits or stands, if they bend or squat, or climb stairs or ladders.

“Most of our case managers have safety hats and boots in their car. They’re prepared for anything.” — Trish Elizalde, branch manager, Genex Services

“Some activities might be observed once while others might be observed over a longer period of time,” Elizalde said. “We estimate what percentage of their workday is engaged in a particular activity. We note if they worked with machinery, hand-held tools, operated motor vehicles or if they were indoors or outdoors in varying temperatures.

“The extent of the details we gather is to provide the best physical description of the job to ensure the injured worker’s safe return to work and to avoid further injury or exacerbate the current injury.”

Sometimes, however, the employer is hesitant to provide information.

“Employers want to know why we’re doing this,” she said. “Their biggest concerns are security and safety issues.”

Time constraint is the most common reason why an employer may not have a job description handy for a case manager, said Elizalde. And she understands why: “Employers are very busy, but we are finding that employers are becoming more engaged, and we appreciate that.”

There are also employers, she said, who understand the importance of an accurate job description and the value that it adds to a workers’ compensation program. These employers have “invested time to establish a bank or database of job descriptions,” over time.

Elizalde added, “Our case managers certainly try to provide information to employers about how job descriptions are used by physicians to make return-to-work decisions. If we feel the job description is incomplete or if there are questions regarding an aspect of the position, we contact the employer to ask additional questions or suggest an onsite visit.”

During a site visit, NCMs conduct an evaluation of an injured worker’s job requirements. They may speak with others doing similar tasks to see what the injured employee might be doing upon returning to work. Elizalde called this the “parts of the job not talked about” — that is,

 minúte details of a position that aren’t included in a broad job description.

However, said Elizalde, having a case manager enter an active construction site or power plant — where there is high risk of injury due to heavy machinery — can set employers on edge, with safety becoming a concern once again.

But getting in and getting that job description is vital to the process.

“Most of our case managers have safety hats and boots in their car. They’re prepared for anything,” she said.

Return to Work

Through the job description, physicians can learn the aspects of a job. Workers are often asked to review job descriptions submitted to their physicians as well, guaranteeing accuracy.

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In addition to getting feedback from the injured worker, NCMs make sure they are communicating with the employer during the road to recovery. Case managers work with the physician and employer to find temporary or partial duty tasks that injured workers can perform until they are ready to return fully recovered.

“We want to get the [injured worker] out of their house, get them moving, get them back to normal.” Elizalde said. “Some employers don’t even know that they can bring back a worker on modified duty.”

Much like the information NCMs provide to an adjuster, she said, case managers will update the employer on their worker’s status to keep them engaged in the claims process.

“We find that when an employer is engaged in the comp process, employees have better results. We’re happy to lend our expertise to assist employers in creating a job description when one is not available, as well.” &

Autumn Heisler is the digital producer and a staff writer at Risk & Insurance®. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

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That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

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Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]