1. An Overview of Case Management 2013 East Central Iowa Safety & Health Conference Kirkwood College February 26 th, 2013 Karl Schewe BA, MBA

2. Purpose To ethically and legally: – Help participants prevent workplace aggravation of non-work-related medical conditions – Minimize OSHA Recordability and Lost Time for work-related medical conditions

3. Process Discuss the ethical & legal framework for non- work-related Return to Work Present a Job Requirements form that can be used to help facilitate medical clearance Discuss the ethical & legal framework for OSHA Recordability Present case-management strategies and tactics Keep in mind that your company policies have bearing on what you can and cannot do.

4. Expected Outcome That participants who need them will come away with some practical ideas and tools to help them with case management for both: – Employees returning to work from non-work- related medical care that could affect their job. – Work-related injuries and illnesses

5. Return to Work from a non-work- related medical absence Why do we need to manage this? If you significantly aggravate it, you own it. A significant aggravation simply means something aggravated it to the point that it triggered OSHA Recordability.

6. Return to Work from a non-work- related medical absence How do we approach this issue? – Ethical considerations: Treat others the way you would want to be treated. Be fair and consistent. – Legal considerations: Know your company’s HR policies. HIPPA – You are only interested in fitness for duty. ADA - Are the restrictions temporary or permanent?

7. Return to Work from a non-work- related medical absence Have a system: – What is “Fit for duty”? – Identify your job requirements ahead of time (see handout). – Help the personal physicians to have some “skin in the game”. – Communicate the expectations to employees. – Have supervisors give notice if someone appears to not be fit for duty.

8. Return to Work from a non-work- related medical absence Be consistent in how you apply your system: – If you differentiate between work groups, be consistent within each group (salaried vs. hourly). – Temporary vs. permanent restrictions

9. Return to Work from a non-work-related medical absence Questions???

10. Work-Related Injuries & Illnesses Why do we need to manage this? – Patient Care – Worker’s Compensation costs – Company metrics Recordable cases Lost Time cases

11. Work-Related Injuries & Illnesses Ethical Considerations: – Patient care is #1 It’s the right thing to do. Conditions can worsen. – Your company’s name is on the line. Legal Considerations: OSHA requires accurate recording. You must be able to demonstrate good faith and defend your decisions. OSHA Recordability normally tracks with Worker’s Compensation but not always.

12. Work-Related Injuries & Illnesses How do we approach this issue? – Know the regulations: 29 CFR 1904 (See handout for parts of it.) OSHA Record-Keeping Handbook Letters of interpretation Consider a phone call to OSHA. (Ann Jackson in Iowa) – Is it work-related? Watch out for special cases such as: – Parking Lots – Secondary injuries from personal events – Workplace violence – Does it trigger Recordability or Lost Time?

13. Work-Related Injuries & Illnesses Case management strategies: – Know your care providers: Do they know the regulations? Do they care? Do they know you? Beware of conflicts of interest (WC tends to pay on time and sometimes pay more). – Know your supervisors: Do they know the regulations? Do they know you? – Ensure that employees know that they must report incidents promptly.

14. Work-Related Injuries & Illnesses Specific steps that will help: – Work with Occupational Medicine providers & ER physicians. Assure them that patient care comes first. Verify that they know the regulations. Educate them on your workplace exposures, and also the exposures that you do not have. Discuss multiple visits vs. “what if” prescriptions. Clarify restricted duty opportunities.

15. Specific steps that will help (continued): – Educate your supervisors – Accompany the employee to the clinic or ER. – Educate your employees – Never forget that patient care comes first. Never compromise your credibility or integrity by being unrealistic or unethical. Do the best you can, and realize that sometimes a situation simply is what it is.

16. Work-Related Injuries & Illnesses Specific tactics - Patient care comes 1 st !: – Pain meds vs. ice & OTC ibuprofen – “What if” antibiotics vs. follow-up visits – Butterflies or Steri-Strips vs. stitches, staples, or glue. – Rescinding a prescription – “Use as tolerated” vs. specific restrictions, but DON’T CHEAT. – Rigid vs. non-rigid means of support – ER – Time off vs. follow-up with company doctor

17. Work-Related Injuries & Illnesses Questions???

18. Purpose To ethically and legally: – Help participants prevent workplace aggravation of non-work-related medical conditions – Minimize OSHA Recordability and Lost Time for work-related medical conditions

19. Process Discuss the ethical & legal framework for non- work-related Return to Work Present a Job Requirements form that can be used to help facilitate medical clearance Discuss the ethical & legal framework for OSHA Recordability Present case-management strategies and tactics Keep in mind that your company policies have bearing on what you can and cannot do.

20. Expected Outcome That participants who need them will come away with some practical ideas and tools to help them with case management for both: – Employees returning to work from non-work- related medical care that could affect their job. – Work-related injuries and illnesses