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Proactive claims management saves time, money

Although many employers attempt to help workers return to work, a number of factors may prevent them from being able to do so. A common problem for many employers in dealing with complex claims is gathering updated functional abilities information in order to deal effectively with return to work. This difficulty may be caused in part by uncooperative doctors, difficulties in contacting the compensation board for updates, uncooperative workers or incomplete or conflicting information received on the workers’ progress.

There are a number of things that employers can do to be more effective in gathering information. 

First, it is important to gather as much information as possible about the injury at the outset of the claim. Determine what the area of injury is and the mechanism that caused it. This information will indicate what activities the worker should avoid during the acute phase of their recovery, and will help narrow down what type of accommodation is required.

It is also important to maintain communication with the injured worker throughout their recovery in order to progress with return to work. Employers should ask workers about the type of treatment they are receiving and how often. Employers are not precluded from assisting workers in finding appropriate treatment, such as physiotherapy, in order to assist the worker in entering treatment as soon as possible. Although many workers are hesitant to receive treatment from a practitioner that has a relationship with the employer, most are pleased to have any assistance they can get to navigate through the health care system.

Employers should explore all options for gathering functional abilities information. While many employers rely on the workers’ family doctor for information, physiotherapists or chiropractors can be an excellent source of functional abilities information since they see the worker more often than the treating physician.  As such, they may also be more helpful with the return to work process. 

While a worker may visit their doctor once per month, they often see their physiotherapist several times per week. Consider contacting the physiotherapist or chiropractor for updated information. Ensure such a treating practitioner is aware that modified work is available and what type of work is being offered. 

Again, it is important to follow up with the worker to determine how they are progressing with any treatment. Find out whether they are attending the treatment and if it is helping them. If not, recommend that they follow up with their doctor to determine if any other treatment may be in order.

In the more complex cases, employers may consider sending the worker for an independent medical examination that is paid for by the employer. As these examinations can be costly, they should only be used if there is incomplete, inconsistent or contradictory medical information.

Often, these examinations can be helpful in clarifying functional abilities. They may also be very focused. Functional abilities evaluations, for example, helps to determine whether the worker is capable of performing specific duties relevant to either their pre-accident or other duties. 

Each compensation boards may have different policies surrounding independent medical examinations. Therefore, consult with your case manager if you are considering arranging for one.

Finally, the workers’ compensation board may be helpful in clarifying functional abilities or suitability of work that is being offered. An employer’s duty is to offer work that is suitable for the worker. The compensation board should have access to the most current functional abilities information, and may be able to assist in recommending or arranging examinations for the worker.

Difficulty in gathering information about a worker’s functional abilities is a common hurdle faced by many employers. However, rather than letting a claim run its course, while concurrently running up the costs, it is important to be proactive in managing the claim, both for the benefit of the worker, and for the financial benefit of the employer.

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David Marchione is an OHS consultant and paralegal with Toronto-based law firm Gowlings. You can contact him at david.marchione@gowlings.com or visit www.gowlings.com/ohslaw.

Mari-Len De Guzman

Mari-Len De Guzman is the former editor of Canadian Occupational Safety magazine and www.cos-mag.com.
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