Injury Management: Making a Difference One Life at a Time

Injuries occur in the workplace as evidenced by the number of injuries reported to Bureau of Labor Statistics (BLS) each year. In 2012, BLS reported 4,628 fatal occupational injuries. OSH professionals must seriously aim to make a difference in the work environment one injury at a time, potentially saving one life at a time.

A work site can impact the course of an injury and the recovery of the employee when a nonfatal injury involving days away from work occurs. In 2012, BLS reported 443,560 sprains, strains and tears; 97,540 bruises and contusions; and 130,900 injuries resulting in soreness and pain to unspecified parts. An employer can be proactive in making a difference in how these injuries affect the employee and the company.

It is not that injuries are inevitable, rather, injuries are preventable. Yet, in the absence of prevention, workplace injuries will occur. An employer's, manager's or supervisor's response to that injury influences the recovery time for the injured employee, lost wages and the employee's self-worth/self-esteem. As a by-product of all of these, it affects the workers' compensation claim costs. It is all about taking each injury at a time, as if it were one life.

Appropriate Care at the Appropriate Time

The first response to an initial injury is usually the pivoting action that directs the rest of the claim. Many times, the leader at the work location is the first one to react to an injury. The successful treatment of an injury includes steps that are most effective when all occur in the appropriate order.

First, the person in charge must determine if it is a life-threatening emergency. The words life threatening are key. If it is life threatening, the emergency medical services (EMS) system should be activated immediately. All reports and high-level management notifications should wait until after EMS is activated. Once EMS is activated and the employee is being tended to by the appropriate medical professionals, all other company notifications can be made.

Should the injury or illness not be life threatening, other actions can take place that may drastically affect the outcome of the injury. First, the person in charge should remain calm and realize that it is not life threatening.

Overtreated Cases

In today's society, patience is a lost virtue. We are not patient for the grocery store checkout line, not for the commute that is hindered by a crash, and we certainly are not patient when it comes to medical care. We need to see a physician for every scrape and bump, and if we see a physician, we assume we will be given a prescription.

As reported in the media, overtreatment of simple viruses with unnecessary prescriptions has been known to create a superbug resistant to many antibiotics, causing resistance to medications and creating new strains of viruses that do not respond to antibiotics. The right treatment at the right time is critical.

Once Lost Time Starts, It Is Difficult to Stop

Imagine that you have just injured your back at work and the treating physician orders time away from work. As a result, you think your boss may be mad at you and that your peers will have to pick up the slack. You have nothing but time to think about how everyone could be mad at you. You get a sick feeling when you think about returning to work because your coworkers may resent you for getting injured. Your back pain becomes worse, and now the pain includes your left hip. You are anxious and depressed. After 3 months, you are not even sure who is still employed at the work site.

Once an employee is off work, the cycle is hard to break. The longer the time away, the harder it is to get the employee back to work. If an employee is off for more than 6 months, s/he is unlikely to return. The psyche of an injured employee is difficult to overcome. The psychosocial factors that affect the employee's ability to return to work are plagued with depression, frustration, thoughts of discrimination and perceived delays in workers' compensation care.

The best way to break the cycle is to not let it start. These strategies can help halt the potential of lost work days:

*Upon hire/orientation, inform employees that a quick return to work for occupational injuries is the organization's goal.

*Educate the treating clinic before an injury, and inform it of the company's willingness to make reasonable accommodations.

*Ensure that the treating physician knows returning to work is an option.

*Train managers who are responsible for interacting with an injured employee on what the first response steps are when an injury occurs.

*If the employee is given any restrictions, accommodate those restrictions.

*If the employee is off work, designate someone from the site, preferably someone who is compassionate, to call the employee at home at least weekly.

Compassionate Care

Treat others with dignity and respect. This may be challenging in the workplace when you feel someone may not be telling the truth about an injury. Take an employee at face value with regard to his/her pain and injury. Use an internal investigation to confirm compensability.

Lack of Compassion May Lead to Legal Representation

When an employee feels that s/he is not taken seriously concerning an injury, s/he may turn to the legal community for assistance.

When an injured employee is at home recovering, s/he might be exposed to TV commercials that advertise employees being mistreated by their companies. They also see how much money the attorneys claim to get for their clients.

When an employee retains an attorney, the claim proceeds slowly. Everything has to be communicated from his/her attorney to the insurance carrier's attorney. Don't let a lack of compassion be the deciding factor for an employee seeking legal representation. It is a lose-lose situation.

Suppose an employee claims a workrelated injury. However, you suspect the injury occured away from the job. You want to say something, but you know better. How do you show this person compassion? How can you act like you want to accommodate any restrictions the doctor may give? This employee is ruining the safety record that everyone else has worked so hard to gain. How do you keep your emotions in check?

Keep personal suspicions to yourself when talking to the employee about the injury. Show compassion because regardless of how the incident really occurred, this is an injured person. Let the investigation prove any discrepancies, and communicate to the insurance adjuster, not the employee, any concerns about a claim.

When a manager verbalizes to the employee or others such frustrations or doubts concerning an injury, this adds to the employee's frustration and may accelerate his/her path to an attorney.

The Journey of Injury Management

Prepare Before an Injury Occurs

It is important to prepare for injuries. This involves choosing the right occupational clinic, preferrably one that has board-certified occupational health physicians, as they understand the importance of a quick return to work as well as the use of conservative care. In addition, every employee should know the company's injury management process and what steps they are to follow, starting with immediately reporting an injury.

First Aid vs. 9-1-1

When initiating an injury management program, you will likely ask, How do you determine when you should call 9-1-1 versus when to use first aid? This can be answered by considering what you would do if the injury occurred at your home. If it were a less-severe injury, such as a sore ankle, what would you do? Would you take your loved one immediately to the physician or would you wait and see if the ankle was still sore in the morning? Remember, use the right treatment at the right time.

Ongoing Follow-Up

An injury continues until the person reaches his/her preinjury state or until maximum medical improvement is achieved. In the sore ankle example, check up on the employee in the morning or have him/her report to the office before going to the assigned workstation. Continue this until the employee no longer has any pain, discomfort or concern. Of course, the employee will need to be using conservative treatment to help facilitate the recovery (e.g., over-the-counter anti-inflammatories). Ongoing follow-up also means that if the employee has a clinic visit and the physician orders restrictions, s/he must follow up with the physician until s/he has no restrictions.

Until the physician is satisfied that the employee is at a full-duty release and no further medical follow-up is needed, s/he is to be under medical treatment. As the employer, continue to ensure that the employee attends all follow-ups, even if feeling better.

Contact During Lost Time

Maintaining weekly contact with the employee while s/he is away from work for an occupational injury keeps that employee engaged. The contact need not be a lengthy conversation, rather a simple, genuine inquiry as to how the employee is feeling. The work site representative should also note that s/he looks forward to the injured employee returning to work. S/he may end the conversation by asking if the injured employee needs help with anything regarding the workers' compensation claim. If so, follow up with the insurance carrier or workers' compensation manager. Then, relay the information back to the employee in a timely manner.

Medical Treatment Approval: Employee Advocate

Sometimes the injured employee must wait for approval on surgery or physical therapy. If this is relayed to the site, the company representative handling the workers' compensation claims must be notified. The employee must be informed about actions being taken to ensure proper care. The company will need to be the advocate for the employee to ensure that s/he receives medical care in a timely manner.

Closing a Claim (Case)

From the initial reporting of the injury to the closure of the workers' compensation claim, "the right treatment at the right time" is the motto. If the employee suffers a strain/sprain, the right treatment at the right time might be conservative over-the-counter first-aid treatment. Site representatives must be knowledgeable about first aid and over-the-counter medications or have a medical resource available to discuss this option with the employee. If the employee needs more significant medical care (e.g., MRI, surgery, physical therapy) then the site must ensure that these items are approved quickly so the employee can begin the treatment and recovery process.

Immediate Investigation

The site should perform an investigation as soon as possible. First, use OSHA's recordability determination tree to determine whether it is an OSHA-recordable incident. The investigation should include a handwritten, signed statement from the employee. Other pertinent data such as whether the employee was scheduled to perform the work being done at the time of injury must be included. Were the proper PPE being used? Was the employee following the correct procedures while performing the task?

Witness statements from coworkers and supervisors must also be included. A reenactment of the event(s) can be revealing for those involved, including the injured employee. Then, the person responsible for the investigation should collate all data into a summary with a determination of corrective actions to be implemented.

Escort to Clinic

To ensure that the injured employee receives the appropriate treatment at the appropriate time, it is often common practice to escort him/her to the clinic for an initial evaluation. This is also an opportunity to provide the clinic with the billing information for the workers' compensation carrier so that the employee does not receive any medical billing.

Escorting the employee will also allow the company to verify any restrictions the employee may receive or if it is off-work notice, to remind the physician that the company will make accommodations for any modified duty the physician feels is appropriate.

Employee Follow-Up

The injured employee must communicate with the work site after every doctor visit. This is usually communicated on a document from the doctor's office that states when the employee can return to work, any restrictions on the employee and the date of the next follow-up visit. Even if the employee is off work, si he is responsible for ensuring that the company receives the documentation indicating his/her work status after each doctor visit. The injury is the employee's injury, and s/he must take responsibility for his/her medical care.

Advocating for the Employee With the Insurance Carrier

Workers' compensation carriers can delay approving treatment for employees. Thus, the safety manager must be the employee's advocate. The employee must let his/her employer know if a referral to a specialist or physical therapy is being requested. Follow up immediately with the insurance carrier to let its staff know to expect the referral. This also lets the carrier know that you are aware and on top of the case. Follow up with the insurance carrier every 2 to 3 days until the treatment is authorized or denied.

Keep Employee Informed

This is a lot of information for the employee to deal with along with the injury itself. As information is gathered from the insurance carrier regarding approvals or a request is submitted to the adjuster for approval, communicate this to the employee. Once the employee knows that you are his/her advocate, s/he will readily communicate with you. Getting the employee the right care at the right time is a win-win situation for everyone.

Conclusion

Injuries are avoidable with a strong plan for prevention. This takes time to develop, overcoming obstacles and changing longstanding workplace cultures. As you strive to prevent all injuries, endeavor to implement a comprehensive injury management program. Provide employees with the appropriate care at the appropriate time, and ensure compassionate care and aggressive injury management. Ensuring a closure of the case can make all the difference, one life at a time.

References

Bureau of Labor Statistics (BLS). (2013). Injuries, illnesses and fatalities. Retrieved from www.bls.gov/iif/data.htm

CDC. (2013). Making healthcare safer: Stop infections from lethal CRE germs now. CDC Vital Signs.

OSHA. (2001). Recording criteria. (29 CFR 1904.4). Retrieved from www.osha.gov/ pls/oshaweb/owadisp.show_document?p_ table=STANDARD S &p_id=9635

Shaw, W.S., Robertson, M.M., Pranksy, G., et al. (2003). Employee perspectives on the role of supervisors to prevent workplace disability after injuries. Journal of Occupational Rehabilitation, 23(3), 129-142.

B.J. (Bonnie) Heinrich, RN, C0HN-S/CM, STS, is a workers' compenstation managerfor URS. She is a professional member of ASSE's Central Texas Chapter and a member of the Healthcare Practice Specialty.