7-12-2011; The Need to Complete Illinois’ 120-Day Rehabilitation Plans—thoughts from Roberta Bandes at Encore Unlimited

Workers’ compensation rehabilitation counselors in Illinois need to bring a high level of communication and creativity whenever assisting individuals in the vocational process. The complexities of the Illinois workers compensation law and economic climate make vocational planning challenging. The counselors at Encore Unlimited work with individuals and employers with real issues and real needs. A well-trained vocational counselor (Certified Rehabilitation Counselor) will be able to analyze an injured workers’ situation in order to develop and implement a vocational action plan for file resolution.

A fundamental aspect in the training of Certified Rehabilitation Counselors (CRC) is development of Individualized Written Rehabilitation Plans. It is essential these plans are customized to each unique individual and return to work situation. Many rehabilitation companies provide “cookie cutter” approaches to vocational services versus an individualized approach.

The Illinois Rehabilitation Plan is required to be completed when injured workers are off of work for 120 days and are not reasonably expected to return to full duty work. This is the employers’ responsibility.

Unfortunately, most rehabilitation plans are not written until the injured worker obtains maximum medical resolution, the employer cannot accommodate the work restrictions and a settlement was not achieved. The injured worker is then referred for vocational rehabilitation. The injured worker at that time is often

·         Focused on their poor recovery,

·         Angry with their employer for not returning them to work and

·         Thinking about filing for Social Security Disability; instead of making plans to return to work.

By not having a defined rehabilitation plan early in the process, it can result in no return to work, an increased risk of an ADA suit or retaliatory discharge suit and may result in a larger future settlement.

At Encore Unlimited, vocational counselors will work with the employer and injured worker to complete the plan and maintain it throughout the medical recovery process. The primary goal of the rehabilitation plan is to maintain the focus on return to work and insure all parties share this singular focus. In most cases this should be a return to work with the date of injury employer to their regular duty, a position with reasonable accommodations, or another position based upon their skills and training. If this is not possible then the counselor will assist the injured worker in obtaining a medically appropriate new position.

To establish the plan, the following should be completed:

·         Interview of the injured worker.

·         Thorough assessment of their past skills and education.

·         Assessment of current interest and aptitudes.

·         Determine need for completion of GED or ESL study.

·         Clarification of computer skills

In order to maximize your return to work outcomes, improve the return to work focus early on in the process and reduce future settlements by utilizing the Illinois 120-day rule for a rehabilitation plan.

This article was written by Roberta Bandes who is a CRC and knows the IL WC system very well. We thank her for her thoughts. You can reach her directly at rbandes@encoreunlimited.com.

7-12-2015; More reasons to consider WC PPO’s in IL--wide disparity in costs for common medical procedures

We were advised by leading state officials:

1.     The IWCC should promulgate the required form for WC PPO’s very soon—we were told it may be posted on their website as soon as today or tomorrow. Once we have it, we will send it to all of our readers.

2.     There is almost certainly going to be more guidelines or an approval process for WC PPO’s from the Illinois Department of Insurance. We understand they may be reaching out to the PPO industry to let them know what they are going to have to do.

Either way, we expect them to push hard to make the 2011 Amendments to the Illinois Workers’ Compensation Act a reality. As the WC PPO is a major cost-saving change, we are confident they are working hard and won’t want the Governor to be calling about putting the details into place.

Another major issue pushing the WC PPO into place in this state is the almost impossible disparity in the cost of medical protocols. If you had a choice of paying $300 or $1800 for an abdominal CT scan just by going to a clinic or a doctor in a nearby town, would you? It seems like a trick question but Illinois businesses are paying the higher cost every day basically because transparency in health care costs just isn't there. This lack of transparency gives rise to a situation where businesses can pay as much as 500-600% and more for the exact same medical procedure in the same town.

In a WC PPO, the folks setting up the PPO are seeking the best possible cost for each procedure in a fully “transparent” setting. We are certain Illinois and all U.S. businesses have a direct stake in the cost of healthcare. The unit cost of services and procedures has largely been a matter between the patient and the provider—we feel this is going to stop in the WC PPO setting.

Second, medical care is a highly complex service with little in the way of tools available for comparison shopping. It's complex enough even treating physicians themselves are often in the dark about costs about specific procedures, tests, or medications.

We are confident the WC PPO, once fully implemented by our government and the insurance industry is going to provide strong cost controls at every step of the workers’ compensation medical process. We are told the top PPO’s provide contract pricing below the already-cut Illinois WC medical fee schedule.

WC PPOs can be ranked by:

·         Provider Management: This is an understanding of the support in handling problematic providers, related to inappropriate billing, including unbundling, upcoding, undocumented charges and unreasonable “mark-ups”.

·         Geographic Access: This concept reviews the volume and location of different providers used most frequently by covered participants and those which if not contracted could result in extensive out-of-network cost for the plan.

·         Provider Disruption: This concept reviews the contracting strategy related to lesser discounts for a broader network versus deeper discounts for a more limited network.

·         Contract Quality: This concept reviews the contract structure of the most utilized and highest potential cost providers to determine if the arrangement places the provider at risk to deliver services cost effectively.

·         Actual Contract Savings: This concept reviews the reported savings between billed charges and amounts allowed by the contract. Significant effort is placed on gaining accurate reporting of savings minus disallowed charges and coding adjustments.

We are certain a WC PPO is going to be in your future. The more you learn about them, the better and more competitive your organization may become in the Illinois WC system.

7-12-2011; The “Perfect Storm” in Illinois Workers’ Compensation—normal work can’t be an “accident,” folks

The Belleville News-Democrat may force IL workers’ comp “causation reform” all by itself. The amazing work of reporters Beth Hundsdorfer and George Pawlaczyk keep finding more kookie claims from southern Illinois and lighting up the national press with how silly things are in that part of our state. Yesterday, they reported Illinois taxpayers may have to pay medical bills of more than $128,000 because a state employee didn't get the telephone headset she asked for, according to a published report Sunday. The Associated Press picked the story up and folks across the globe are again shaking their heads about what we are doing in Illinois. Please assume lawmakers in Springfield are among those grimacing.

The News-Democrat, citing state workers' compensation records, reported a prison finance clerk complained not having what she felt was an ergonomically sound work station or a telephone headset made her strain her neck, causing pain and worsening her pre-existing spine problems.

The newspaper reported Angela Grott, a clerk at the Menard Correctional Center, testified in a hearing in December 2010 not having a headset was the primary reason for her cervical pain. She said supervisors repeatedly denied her requests for a headset or altered work station.

The surgeon who operated on Grott said she had "a pre-existing disc degeneration that was aggravated" by holding the phone in an awkward manner, according to a summary of the claim provided by the Illinois Attorney General's Office. We are not aware of any state requirement on how to hold a phone while working. Now, the clerk's worker's compensation claim in medical bills is already $128,424. Veteran workers’ comp observers are certain she may also cost the State of Illinois hundreds of thousands in lost time and permanency, when the claim finally resolves.

Illinois Department of Corrections officials said they are waiting for telephone headsets to arrive, which will then be given to any employee who wants them. We are waiting for the first claim from a prison clerk who says he or she injured her neck due to the added weight of the headset causing strain on the cervical spine and similarly “aggravating” the problem. Please don’t be naïve--anyone with a state job and a medical problem can somehow relate it to their work—if you don’t change the job, the failure to change is the reason. If you change the job, the changes can also be the “accident” or the reason for the aggravation.

The problem our entire state is struggling with is the lasting trend in the workers’ compensation system in this state of work being an “accident” without need for the slightest trauma or unforeseen event. The concept of “repetitive trauma” has been expanded to just about any problem which requires any medical care.

We have heard from numerous claimant attorneys who all plead the age-old legal concept of the “eggshell plaintiff” makes such claims compensable—we point out the concept of an “eggshell plaintiff” means someone made a mistake causing an accident—once you set an accident in motion, you can’t claim the person injured should have been healthier or stronger.

The problem with using this “scrambled eggshell” concept for prison clerks asking for headphones is the “accident” is the claimant. We can’t imagine this clerk reported anything the slightest bit like what our fathers and mothers thought might be an accident occurred at her work.

We had a claim settle this week for an electrician who worked for our client for ninety days without any incident. Six weeks after leaving, he reported “pain” while working without describing it. About a year later, he had shoulder surgery and “related” it to his normal and ordinary work for our client. His doctor says some of his work put some strain on some parts of his body. All of it led to very unhappy settlement due solely to exposure. Please assume lots of construction workers are now reporting “pain” while working to satisfy the requirement of statutory notice of an “injury.”

As we have advised our readers and hearing officers and state-wide officials, these articles and complaints aren’t going to end unless and until someone makes sense of it. We don’t feel work can be an “accident” and have a sustainable system. We urge the entire industry to try to find a standard that makes sense because we are concerned massive changes may come someday if we don’t take simpler action ourselves.

Read more: http://www.bnd.com/2011/07/10/1781544/report-no-headset-for-prison-clerk.html#ixzz1Rr0hFLD3