WCC Mandatory WCC Mandatory TrainingTraining

20062006

Team workTeam work

……. . The whole is greater than The whole is greater than the sum of the partsthe sum of the parts

Team Members:Team Members:

!! ClientClient!! Claims Representative/Defense Claims Representative/Defense

CounselCounsel!! Plaintiff AttorneyPlaintiff Attorney!! Medical Case ManagerMedical Case Manager!! Vocational Case ManagerVocational Case Manager!! Vocational EvaluatorsVocational Evaluators!! PT/OT and other Medical ProvidersPT/OT and other Medical Providers

Cannot effect successful return to Cannot effect successful return to work efficiently ifwork efficiently if

!! One person working aloneOne person working alone!! Parties working at oddsParties working at odds!! Parties not working in concert Parties not working in concert !! Parties not experiencedParties not experienced!! Parties without expertise in the Parties without expertise in the

needed areaneeded area

Rights of the Client According to Rights of the Client According to The American Nurses Association The American Nurses Association (1988)(1988)!! A fair and comprehensive assessment A fair and comprehensive assessment !! To have access to needed health and social To have access to needed health and social

servicesservices!! To be treated with respect and dignityTo be treated with respect and dignity!! To self discriminationTo self discrimination!! To privacy and To privacy and !! To a grievous procedure To a grievous procedure !! ConfidentialityConfidentiality!! To know the cost of services To know the cost of services !! To be notified of any changes of servicesTo be notified of any changes of services!! To withdraw from the case management process To withdraw from the case management process

Client Rights from the Maryland WCC Voc Rehab Plan Client Rights from the Maryland WCC Voc Rehab Plan followfollow……..

Maryland WCC Rehab Plan Maryland WCC Rehab Plan Client RightsClient Rights!! 1. This plan is an agreement, which outlines each 1. This plan is an agreement, which outlines each

partyparty’’s responsibility.s responsibility.!! 2. The Insurer will pay rehabilitation benefits. 2. The Insurer will pay rehabilitation benefits. !! 3. The time frames agreed to by the parties can be 3. The time frames agreed to by the parties can be

extended if necessary by the parties. extended if necessary by the parties. !! 4. I do not have to accept any employment offered to 4. I do not have to accept any employment offered to

me unless I agree that it is suitable employment.me unless I agree that it is suitable employment.!! 5. 5. The Insurer may stop benefit payments if the The Insurer may stop benefit payments if the

Insurer determines that rehabilitation services are no Insurer determines that rehabilitation services are no longer necessary.longer necessary.

!! 6. 6. If my benefit payments are stopped for any reason If my benefit payments are stopped for any reason with which I do not agree, I have the right to request with which I do not agree, I have the right to request a hearing.a hearing.

!! 7. I have a right to be an active participant in my 7. I have a right to be an active participant in my rehabilitation.rehabilitation.

!! 8. I have a right to confer with an attorney regarding 8. I have a right to confer with an attorney regarding the terms of the rehabilitation plan.the terms of the rehabilitation plan.

Claims Representative/Defense Claims Representative/Defense CounselCounsel

The role of claim adjusters and defense The role of claim adjusters and defense attorneys in the rehabilitation process is to attorneys in the rehabilitation process is to know and understand the parameters of know and understand the parameters of the law and to ensure its accurate the law and to ensure its accurate application. application.

Maryland law requires employers/ insurers to Maryland law requires employers/ insurers to provide rehabilitation services under provide rehabilitation services under specific guidelines. specific guidelines.

Under these guidelines, claim adjusters must Under these guidelines, claim adjusters must procure professional rehabilitation services procure professional rehabilitation services which are reasonably necessary to secure which are reasonably necessary to secure suitable gainful employment. suitable gainful employment. Good Practice ManualGood Practice Manual

Claims Representative Cont.Claims Representative Cont.

!! The role of the adjuster is to investigate The role of the adjuster is to investigate whether or not an injury is compensable. whether or not an injury is compensable. To qualify for compensation of an To qualify for compensation of an occupational injury or disease occupational injury or disease ––

!! The employee must have an accident that The employee must have an accident that causes an injury during the course of causes an injury during the course of employment. employment.

!! The injury must have occurred in the The injury must have occurred in the course of employment. course of employment.

!! The employee must be exposed to the The employee must be exposed to the disease during the course of employment. disease during the course of employment.

!! The injury must be unexpected and usually The injury must be unexpected and usually traceable to a definite time, place, and traceable to a definite time, place, and cause. cause. Excerpted from an article in the Excerpted from an article in the Nursing SpectrumNursing Spectrum

Insurance Company Cont.Insurance Company Cont.

Claim adjusters and defense attorneys Claim adjusters and defense attorneys actions are guided by statutory actions are guided by statutory requirements as well as the requirements as well as the contractual obligations set forth in contractual obligations set forth in the insurance policy.the insurance policy.

To the extent that these statutory To the extent that these statutory requirements and contractual requirements and contractual obligations are met, claim adjusters obligations are met, claim adjusters and defense attorneys have acted and defense attorneys have acted ethically. ethically. Good Practice ManualGood Practice Manual

Plaintiff AttorneyPlaintiff Attorney

The claimant's attorney has a critical role in The claimant's attorney has a critical role in the vocational rehabilitation process.the vocational rehabilitation process.

The claimant's attorney functions as both a The claimant's attorney functions as both a champion of rights of the client and champion of rights of the client and counselor to the informational and counselor to the informational and emotional needs of the claimant. emotional needs of the claimant.

He or she can help to shape the process into He or she can help to shape the process into the best possible chance for claimant's the best possible chance for claimant's return to suitable gainful employment. return to suitable gainful employment.

The plaintiff attorney can set the tone for how The plaintiff attorney can set the tone for how claimant works with other team members. claimant works with other team members. It is important to enlist his or her help with It is important to enlist his or her help with any problems. any problems. Good Practice ManualGood Practice Manual

Medical Case ManagerMedical Case Manager

““The Commission's regulations The Commission's regulations state that these case state that these case management services include management services include but are not limited to but are not limited to interviewing the worker for the interviewing the worker for the purposes of implementing and purposes of implementing and coordinating services with the coordinating services with the injured worker and the health injured worker and the health care providers.care providers.”” Good Practice ManualGood Practice Manual

The Maryland Board of Nursing Regulations The Maryland Board of Nursing Regulations Governing Worker Compensation Medical Case Governing Worker Compensation Medical Case Managers state that medical case management Managers state that medical case management for the injured worker includes but is not limited for the injured worker includes but is not limited to:to:!! Case AssessmentCase Assessment!! Implementation And Coordination Of Implementation And Coordination Of

Services With The Injured Worker's Services With The Injured Worker's FamilyFamily

!! Health Care ProviderHealth Care Provider!! Evaluation Of Treatment ResultsEvaluation Of Treatment Results!! Coordinating Community ReentryCoordinating Community Reentry!! Return To Work With The Employer Return To Work With The Employer

Of InjuryOf Injury!! Recommendations For Further Recommendations For Further

Vocational Rehabilitation Services Vocational Rehabilitation Services

The major functions which the The major functions which the RNRN--WCCM performs include:WCCM performs include:

!! Case ManagementCase Management!! Task AssignmentTask Assignment!! Life Care PlanningLife Care Planning!! AdvocacyAdvocacy!! Cost ContainmentCost Containment!! Ethical Decision MakingEthical Decision Making

Vocational CounselorsVocational CounselorsRehabilitation Counselors are committed to Rehabilitation Counselors are committed to

facilitating personal, social, and economic facilitating personal, social, and economic independence of individuals. independence of individuals.

Work with people, programs, institutions, and Work with people, programs, institutions, and service delivery systems. service delivery systems.

Rehabilitation counselors recognize that both Rehabilitation counselors recognize that both action and inaction can be facilitating or action and inaction can be facilitating or debilitating. debilitating.

May provide counseling, vocational exploration May provide counseling, vocational exploration and vocational assessment; evaluation of and vocational assessment; evaluation of social, medical, vocational, and psychiatric social, medical, vocational, and psychiatric information, job placement and job information, job placement and job development services, and other development services, and other rehabilitation services.rehabilitation services.

Must demonstrate adherence to ethical Must demonstrate adherence to ethical standards and must ensure that the standards and must ensure that the standards are enforced vigorously. standards are enforced vigorously.

CRCCCRCC

Vocational EvaluatorsVocational Evaluators

Vocational Evaluation is a specialty profession within RehabilitVocational Evaluation is a specialty profession within Rehabilitation. The focus ation. The focus is on identifying appropriate employment outcomes for individualis on identifying appropriate employment outcomes for individuals with s with disabilities utilizing a holistic approach. disabilities utilizing a holistic approach.

In contrast to the brief assessment typically completed by VocatIn contrast to the brief assessment typically completed by Vocational ional Counselors, a vocational evaluation (career assessment) is more Counselors, a vocational evaluation (career assessment) is more comprehensive and includes assessment of interests, temperamentscomprehensive and includes assessment of interests, temperaments, , career awareness, transferable skills, work skills through real career awareness, transferable skills, work skills through real or simulated or simulated work, work behaviors, job seeking and keeping skills, achievemenwork, work behaviors, job seeking and keeping skills, achievement, t, aptitude, dexterity, learning style, accommodations and supportsaptitude, dexterity, learning style, accommodations and supports..

Vocational evaluators must adhere to ethical standards of practiVocational evaluators must adhere to ethical standards of practice for the ce for the profession in accordance with:profession in accordance with:

"" International Professional Association International Professional Association –– Vocational Evaluation & Career Vocational Evaluation & Career Assessment Professionals (VECAP)Assessment Professionals (VECAP)

"" National Certifying Body National Certifying Body -- The Commission on Certification of Work Adjustment The Commission on Certification of Work Adjustment & Vocational Evaluation Specialists (CCWAVES) & Vocational Evaluation Specialists (CCWAVES)

"" State Standards State Standards –– Division of Vocational Rehabilitation Services Career Division of Vocational Rehabilitation Services Career Assessment Services System (CAS)Assessment Services System (CAS)

Vocational evaluators are certified through CCWAVES. The CertifVocational evaluators are certified through CCWAVES. The Certified ied Vocational Evaluator (CVE) designation assures that minimum Vocational Evaluator (CVE) designation assures that minimum competencies are achieved.competencies are achieved.

MilestonesMilestones

Although Each Member Plays a Although Each Member Plays a different role and may have a different role and may have a different emphasis different emphasis –– in general, in general, the following apply:the following apply:

!! AssessmentAssessment!! PlanPlan!! Evaluation/ReEvaluation/Re--evaluateevaluate!! ResolutionResolution

AssessmentAssessment

An assessment is the process of collecting An assessment is the process of collecting and analyzing all the medical, educational, and analyzing all the medical, educational, vocational, social, legal, and economic vocational, social, legal, and economic information of an injured employee, information of an injured employee, including the injured employee's present including the injured employee's present physical and mental ability to participate in physical and mental ability to participate in rehabilitation services and determining the rehabilitation services and determining the appropriate rehabilitation services appropriate rehabilitation services reasonably necessary to return the injured reasonably necessary to return the injured employee to suitable gainful employment.employee to suitable gainful employment.

Good Practice ManualGood Practice Manual

When is Vocational Evaluation When is Vocational Evaluation (Career Assessment) Appropriate (Career Assessment) Appropriate

for an Injured Worker?for an Injured Worker?

!! If a clear vocational goal cannot be If a clear vocational goal cannot be identified using less intensive identified using less intensive assessment meansassessment means

!! If there are numerous complicating If there are numerous complicating factors affecting the individualfactors affecting the individual’’s s ability to return to workability to return to work

!! If a second opinion is needed in If a second opinion is needed in highly contested caseshighly contested cases

As each individual is unique, the assessmentAs each individual is unique, the assessmentprocess will vary depending upon his/her process will vary depending upon his/her particular circumstances. The following particular circumstances. The following hierarchy outlines the various levels of hierarchy outlines the various levels of assessment:assessment:!! Referral ConfirmationReferral Confirmation!! File ReviewFile Review!! Initial InterviewInitial Interview

Areas covered during the initial interview include:Areas covered during the initial interview include:a. Medical Informationa. Medical Informationb. Educational Backgroundb. Educational Backgroundc. Vocational Historyc. Vocational Historyd. Social d. Social ––e. Legal Informatione. Legal Informationf. Economic Circumstancesf. Economic Circumstances

!! Job AnalysisJob Analysis!! Assessment of Functional CapacityAssessment of Functional Capacity (PT/OT)(PT/OT)!! Transferable Work Skills AnalysisTransferable Work Skills Analysis (vocational case (vocational case

managers)managers)!! Vocational Assessment or EvaluationVocational Assessment or Evaluation (vocational case (vocational case

managers, vocational evaluators)managers, vocational evaluators)

Suitable Gainful EmploymentSuitable Gainful Employment!! WorkersWorkers’’ Compensation LawCompensation LawLE 9LE 9--670(c) defines 670(c) defines ““suitable gainful suitable gainful

employmentemployment”” as employment, as employment, including selfincluding self--employment, that employment, that restores the disable covered restores the disable covered employee, to the extent as possible, employee, to the extent as possible, to the level of support of the time of:to the level of support of the time of:

!! If an accidental personal injury, the If an accidental personal injury, the accidental personal injury; oraccidental personal injury; or

!! If an occupational disease, If an occupational disease, disablement form occupational disablement form occupational disease.disease.

Return to work hierarchyReturn to work hierarchy

•• Same employer, same jobSame employer, same job•• Same employer, different jobSame employer, different job•• Different employer, same jobDifferent employer, same job•• Different employer, different jobDifferent employer, different job•• On the job trainingOn the job training•• Retraining for new careerRetraining for new career•• Self employmentSelf employment•• Independent livingIndependent living

RTW Same Employer/JobRTW Same Employer/Job

!! Can the client return to preCan the client return to pre--injury level of function?injury level of function?

!! Can the client return to work in Can the client return to work in an alternate capacity?an alternate capacity?

!! Will some combination be Will some combination be feasible?feasible?"" Light DutyLight Duty"" Modified DutyModified Duty"" Transitional Return to WorkTransitional Return to Work

RTW New Employer/JobRTW New Employer/Job

!! It is essential that the initial career goal It is essential that the initial career goal selected by the injured worker be selected by the injured worker be researched in the local market to determine researched in the local market to determine its feasibility. its feasibility. "" Is the job available? Is the job available? "" Would the injured worker be physically and Would the injured worker be physically and

mentally capable of performing the demands of mentally capable of performing the demands of the job as defined by employers? the job as defined by employers?

"" Would the injured worker need further Would the injured worker need further qualifications (such as formal training to obtain qualifications (such as formal training to obtain entry into the chosen occupation? entry into the chosen occupation?

"" Is it possible to obtain onIs it possible to obtain on--thethe--job training in this job training in this occupation? occupation?

"" Would a combination of formal training and job Would a combination of formal training and job placement be more effective?placement be more effective?

ResolutionResolution

Once the injured worker is returned to Once the injured worker is returned to function/work, the rehabilitation function/work, the rehabilitation professional must followprofessional must follow--up to make up to make sure that no problems, such as:sure that no problems, such as:"" changes in the job duties or work changes in the job duties or work

environmentenvironment"" nonnon--cooperation of the employee, his cooperation of the employee, his

coco--workers, or the supervisor workers, or the supervisor The rehabilitation professional should The rehabilitation professional should

also verify that the new employee's also verify that the new employee's performance is acceptable to the performance is acceptable to the supervisor/employer.supervisor/employer.

PT/OT Case Management PT/OT Case Management

## Licensed health care Licensed health care professionalprofessional

## Registered with theRegistered with theWorkersWorkers’’ Compensation Compensation CommissionCommission

PT/OT ActivitiesPT/OT ActivitiesContraindications for participating in Contraindications for participating in

Industrial RehabilitationIndustrial Rehabilitation•• The client is not medically stableThe client is not medically stable•• The client has other medical problems that would The client has other medical problems that would

adversely be affected by the testing, such as adversely be affected by the testing, such as cardiac difficultiescardiac difficulties

Guidelines for the paperworkGuidelines for the paperwork•• PhysicianPhysician’’s order not requireds order not required•• Informed consent to evaluate and/or to treatInformed consent to evaluate and/or to treat•• Medical Release of RecordsMedical Release of Records•• Medical RecordsMedical Records•• Job DescriptionJob Description•• Functional Job Description Functional Job Description

•• Information for PT/OT primarily from Julie HowarInformation for PT/OT primarily from Julie Howar’’s s Maryland WorkersMaryland Workers’’ Compensation Training for Compensation Training for Physical and Occupational Therapists 2005Physical and Occupational Therapists 2005

What are the basic services?What are the basic services?

!! Functional Capacity EvaluationFunctional Capacity Evaluation!! Work Hardening ProgramWork Hardening Program!! Work Conditioning ProgramWork Conditioning Program!! Job AnalysisJob Analysis

Functional Capacity Functional Capacity EvaluationEvaluation

An objective determination of the level of function.Components could include:Medical HistoryMusculoskeletal Assessment including

range of motion, strengthneurological functioning

Worker Behaviors Functional Abilities including present physical demand levelAbility to perform essential functionsImpressions and Recommendations

Definition of Work HardeningDefinition of Work Hardening

“A highly structured, goal oriented, individualized treatment program

designed to return the person to work.”Work hardening programs use real or simulated work activities designed to

restore physical, behavioral, and vocational function.

CARF

Definition of Work ConditioningDefinition of Work Conditioning“a work related, intensive, and goal-

oriented treatment program specifically designed to restore an individual’s

systemic, neuro-muscular (strength, endurance, flexibility, etc.) and

cardiopulmonary function.” The objective of the work conditioning program is to

restore the client’s physical capacity and function so the client can “return to

work”.APTA

Medical Case Management Medical Case Management

Today, case management strategies Today, case management strategies have been embraced in a managed have been embraced in a managed care environment within the workerscare environment within the workers’’compensation marketplace. the compensation marketplace. the nurse case manager role will nurse case manager role will continue to expand. Essential skills continue to expand. Essential skills include expert clinical abilities, highinclude expert clinical abilities, high--level communication techniques, and level communication techniques, and knowledge of planning and work knowledge of planning and work reentry and reintegration for reentry and reintegration for maximum effectiveness. maximum effectiveness. Excerpt from an Excerpt from an article in the article in the Nursing SpectrumNursing Spectrum

Medical Case Manager Medical Case Manager ActivitiesActivitiesData collection and assessment: The First Report of Injury is Data collection and assessment: The First Report of Injury is

frequently the first factual account of the accident that telephfrequently the first factual account of the accident that telephonic onic case managers receive. case managers receive.

The case manager needs to obtain, review, and analyze all pertinThe case manager needs to obtain, review, and analyze all pertinent ent medical information, including medical history, current status, medical information, including medical history, current status, diagnosis, prognosis, and current treatment plan.diagnosis, prognosis, and current treatment plan.

Data analysis, diagnosis, and establishment of goals: After the Data analysis, diagnosis, and establishment of goals: After the acute acute phase of the injury, the case manager will assess the patientphase of the injury, the case manager will assess the patient’’s s temporary or permanent alterations in function resulting from thtemporary or permanent alterations in function resulting from the e injury. injury.

Community and Work Reintegration: The final phase of the case Community and Work Reintegration: The final phase of the case management process is facilitating the Return to Work or management process is facilitating the Return to Work or permanent modified alternative duty. permanent modified alternative duty.

In collaboration with the medical provider, the insured worker In collaboration with the medical provider, the insured worker reaches medical stability and maximum improvement, and all reaches medical stability and maximum improvement, and all treatment ceases. treatment ceases.

If competitive employment is not an option for the client, the cIf competitive employment is not an option for the client, the case ase manager helps identify community resources and/or vocational manager helps identify community resources and/or vocational rehabilitation counseling. rehabilitation counseling.

Excerpt from an article in the Excerpt from an article in the Nursing SpectrumNursing Spectrum

Vocational Case ManagementVocational Case ManagementAssess the progress being made in reaching the Assess the progress being made in reaching the

vocational goal.vocational goal.Meetings determined on a case by case basis. Meetings determined on a case by case basis. Responsibilities for communicating the results of these Responsibilities for communicating the results of these

meetings and any necessary plan revisions should meetings and any necessary plan revisions should have been identified in the rehabilitation plan have been identified in the rehabilitation plan

All parties who agreed to the components of the All parties who agreed to the components of the rehabilitation plan must be kept apprised of its rehabilitation plan must be kept apprised of its progress.progress.

As return to work is the ultimate goal of the rehabilitation As return to work is the ultimate goal of the rehabilitation plan, the provision of job placement services is critical plan, the provision of job placement services is critical to the process. to the process.

Before an injured worker is actually placed in a job, the Before an injured worker is actually placed in a job, the rehabilitation professional must make sure that both the rehabilitation professional must make sure that both the employer and the injured worker understand the employer and the injured worker understand the conditions of employment, conditions of employment,

It is advisable that the position being offered is discussed It is advisable that the position being offered is discussed with the treating physician, possibly utilizing a job with the treating physician, possibly utilizing a job analysis.analysis.

Vocational Case Management Vocational Case Management ActivitiesActivitiesIf in job development, you should If in job development, you should

strive to provide 10 strive to provide 10 –– 15 job 15 job leads per week, obtain the same leads per week, obtain the same amount from the injured worker, amount from the injured worker, schedule at least one interview schedule at least one interview per week, and attend one or two per week, and attend one or two if feasible. Appropriate leads if feasible. Appropriate leads beyond those listed on the beyond those listed on the rehabilitation plan may also be rehabilitation plan may also be pursued pursued

PT/OT Time Based Injury Treatment AlgorithmPT/OT Time Based Injury Treatment Algorithm

Insurance Company / Case Manager Communication System

Acute Injury Phase 1Acute Injury Phase 1--3 weeks3 weeks SubSub--Acute Injury Phase 4Acute Injury Phase 4--12 weeks12 weeks Chronic Injury Phase 3 months & overChronic Injury Phase 3 months & over

75% of People Return To Work75% of People Return To Work 80% of People Have Returned To Work80% of People Have Returned To Work 90% of People Have Returned To Work90% of People Have Returned To Work

Injury Medical Exam

& TreatmentNLT-2 Days Acute PT

NTE - 6 Weeks

Medical Re-EvaluationNLT - 21 Days

Active PTNTE - 6 Weeks

Job TaskAnalysis

Functional Capacity Evaluation3 Months ADI

Medical Re-Evaluation

NLT - 12 WeeksWork HardeningNTE - 6 Weeks

Vocational Consultant

(Job Placement)

Medical Re-EvaluationNLT - 24 Weeks

Release To WorkFull Duty

Release To WorkModified Duty

Settlementand / or

Case ClosureReturn To Work

ADI = After Date ofADI = After Date ofInjuryInjury

NLT= No LongerNLT= No LongerThanThan

NTE = Not To NTE = Not To ExceedExceed

1-3 Weeks 4-12 Weeks 3 Months and over

Within 24 HoursWithin 24 Hours

!! Open File/Obtain recordsOpen File/Obtain records!! Contact all parties (plaintiff Contact all parties (plaintiff

attorney permission required for attorney permission required for client)client)

!! Acknowledgement LettersAcknowledgement Letters!! State Forms State Forms –– R33 and VRR33 and VR--7?7?

"" PT/OT PT/OT ––VR7 referral form.VR7 referral form.

General Time Frames General Time Frames for Case Managementfor Case Management

FollowFollow

Within two weeks if possible:Within two weeks if possible:

!! Send letter confirming date and Send letter confirming date and location of initial interviewlocation of initial interview

!! Meet with clientMeet with client!! Confirm all demographic/contact Confirm all demographic/contact

informationinformation!! Relate hierarchy and roleRelate hierarchy and role!! Obtain signed releaseObtain signed release

Prior to Initial ReportPrior to Initial Report

!! Obtain any additional necessary Obtain any additional necessary information, for example:information, for example:"" MedicalsMedicals"" Job DescriptionJob Description"" Transferable Skills Analysis*/TestingTransferable Skills Analysis*/Testing"" Employer contact re: employment statusEmployer contact re: employment status

!! Report recommendations to all Report recommendations to all partiesparties

ImmediatelyImmediately

!! Update claims representative Update claims representative and injured workerand injured worker’’s attorney:s attorney:"" Return to work (include details)Return to work (include details)"" No show/no callNo show/no call"" NonNon--attendance of interviewattendance of interview

!! Return calls from either claims Return calls from either claims representative or injured representative or injured workerworker’’s attorney. s attorney.

Begin case management, following your Begin case management, following your own recommendations and revise as own recommendations and revise as necessary.necessary.

!! For Vocational Staff:For Vocational Staff: You must complete You must complete a Maryland WCC Rehabilitation Plan that a Maryland WCC Rehabilitation Plan that will be signed by all parties. You may use will be signed by all parties. You may use simultaneous faxes to distribute, attach simultaneous faxes to distribute, attach individual signatures to the body of the plan individual signatures to the body of the plan and file with the WCC for stipulation. and file with the WCC for stipulation. Attached to the plan should be the initial Attached to the plan should be the initial report, Functional capacities report, Functional capacities documentation, and labor market documentation, and labor market documentation. Suitable gainful documentation. Suitable gainful employment definitions are a factor in employment definitions are a factor in deciding which job targets to include. deciding which job targets to include.

!! Complete WCCComplete WCC--R33 every 90 days, if R33 every 90 days, if assigned.assigned.

Initial ReportInitial Report

!! Demographic InformationDemographic Information!! Medical, vocational and educational historyMedical, vocational and educational history!! PsychoPsycho--social and financial information that social and financial information that

is pertinentis pertinent!! Current functioning levelCurrent functioning level!! Client interests/goalsClient interests/goals!! Recommendations with time framesRecommendations with time frames!! Complete WCCComplete WCC--R33 if assigned and VR7 R33 if assigned and VR7

referral formreferral form

Begin case management, following Begin case management, following your own recommendations and revise your own recommendations and revise as necessary Cont.as necessary Cont.

!! For Medical Staff: For Medical Staff: If an injured worker is If an injured worker is unable to return to work in his previous unable to return to work in his previous occupation, you may feel that training occupation, you may feel that training concurrent with medical case management concurrent with medical case management (for example, GED) would be beneficial. If (for example, GED) would be beneficial. If this is the case, a vocational counselor will this is the case, a vocational counselor will need to complete a rehabilitation plan, need to complete a rehabilitation plan, submit it to all parties for their signature, submit it to all parties for their signature, and file it with the WCC for stipulation. and file it with the WCC for stipulation.

!! Complete WCCComplete WCC--R33 every 90 daysR33 every 90 days

DocumentationDocumentation

!! Document your activities in your case Document your activities in your case notes.notes.

!! Include pertinent details without being Include pertinent details without being unnecessarily wordy. unnecessarily wordy.

!! ALWAYS INCLUDE insurance company ALWAYS INCLUDE insurance company file number in message or email. file number in message or email.

!! State your name (spell it if it is unusual and State your name (spell it if it is unusual and the claims representative is not familiar the claims representative is not familiar with you). with you).

!! Provide contact numbers where you can be Provide contact numbers where you can be easily reached.easily reached.

!! Copy all correspondence to the WCC and Copy all correspondence to the WCC and claims representative and/or attorney claims representative and/or attorney (depending to whom you are writing).(depending to whom you are writing).

Monthly ReportingMonthly Reporting

!! Report at least monthly. Report at least monthly. !! Some insurance companies have guidelines in Some insurance companies have guidelines in

terms of report formats/time frames and billing terms of report formats/time frames and billing codes.codes.

!! Be mindful of your language. Always include an Be mindful of your language. Always include an overall summary.overall summary.

!! Always include recommendations with timeframes.Always include recommendations with timeframes.!! Your report should not come as a surprise to any Your report should not come as a surprise to any

party as you are maintaining constant verbal party as you are maintaining constant verbal communication throughout the life of the case.communication throughout the life of the case.

!! Reports are primarily reviewed by the Commission Reports are primarily reviewed by the Commission at the time of a hearing, so they should be objective. at the time of a hearing, so they should be objective.

ClosureClosure

!! For Medical Staff: For Medical Staff: This is normally done when an This is normally done when an injured worker reaches MMI, returns to work, or injured worker reaches MMI, returns to work, or case management can no longer have a benefit to case management can no longer have a benefit to the injured worker.the injured worker.

!! For Vocational Staff: For Vocational Staff: This is normally done when This is normally done when an injured worker returns to work, settles his case, an injured worker returns to work, settles his case, states he is not interested in vocational services and states he is not interested in vocational services and his attorney concurs, or proves nonhis attorney concurs, or proves non--cooperative.cooperative.

!! For PT/OT: For PT/OT: This is normally done when the injured This is normally done when the injured worker has reached a plateau, functionally and will worker has reached a plateau, functionally and will not benefit from further service.not benefit from further service.

!! Closure reports should summarize your work on the Closure reports should summarize your work on the entire file. entire file.

!! Complete WCCComplete WCC--R33 if assigned &/or VR2 closure R33 if assigned &/or VR2 closure formform

Task AssignmentsTask Assignments

Expectations on how you will handle task assignments Expectations on how you will handle task assignments often vary between insurance companies and, even, often vary between insurance companies and, even, claims representatives. Here a few tips to ensure claims representatives. Here a few tips to ensure your task assignment goes smoothly:your task assignment goes smoothly:

!! Clarify the scope of the current assignmentClarify the scope of the current assignment!! Update the referral source within 24 hours of Update the referral source within 24 hours of

completion (same day if possible)completion (same day if possible)!! Notify the referral source of any additional needs Notify the referral source of any additional needs

you identifyyou identify!! If asked to close the file ask if the referral source If asked to close the file ask if the referral source

would like you to call them at a future date to would like you to call them at a future date to determine if additional services are neededdetermine if additional services are needed

Rehab PlansRehab Plans!! Research your plan Research your plan –– the new WCC the new WCC

guidelines require objective support for your guidelines require objective support for your goals in working with injured workers. goals in working with injured workers. ACINET.ORG is a great site for obtaining ACINET.ORG is a great site for obtaining general labor market information. general labor market information.

!! Write your plan. It should be completed Write your plan. It should be completed immediately following initial assessment after immediately following initial assessment after verbally receiving authorization of your verbally receiving authorization of your recommendations.recommendations.

!! Forward the plan via fax or email to the Forward the plan via fax or email to the claims representative. claims representative.

!! Forward the claims representativeForward the claims representative--signed signed plan to the injured workerplan to the injured worker’’s attorney and the s attorney and the injured worker Review the plan with the injured worker Review the plan with the injured worker at the earliest possible time injured worker at the earliest possible time and attempt to get signature, donand attempt to get signature, don’’t forget to t forget to have the injured worker sign the rights and have the injured worker sign the rights and responsibilities statement.responsibilities statement.

Rehab Plans Cont. Rehab Plans Cont.

!! Once all signatures are obtained, forward Once all signatures are obtained, forward to the WCC with the stipulation as soon as to the WCC with the stipulation as soon as possible for a stipulation order. Stipulation possible for a stipulation order. Stipulation makes this agreement a legal, binding makes this agreement a legal, binding document. Until the rehab plan is document. Until the rehab plan is stipulated it is an informal contract.stipulated it is an informal contract.

!! When you receive the notice of stipulation When you receive the notice of stipulation copy all parties.copy all parties.

!! If you receive approval to extend a plan If you receive approval to extend a plan from an claims representative complete from an claims representative complete page one of the plan indicating an page one of the plan indicating an extension and send to the WCC. Copy all extension and send to the WCC. Copy all parties. parties.

!! All OJT, Training, and SelfAll OJT, Training, and Self--employment employment plans must also include labor market plans must also include labor market surveys.surveys.