Does your Company Need an Occupational Medical Surveillance Program?

The big questions in the minds of management are: "Do I need to have a medical surveillance Program?" and "Which program, if any , do I need?" "If I do need a program, should it reside within the company or be outsourced to hospital-based practices or free-standing private practices?" In certain industries and exposures, OSHA will mandate drug testing, safety and industrial hygiene activities, pre-employment, pre-placement examinations and periodic medical surveillance examinations. Periodic examinations are usually more focused and include selected tests that evaluate the kind of exposure that is occurring and the types of medical problems that might be expected to occur. Additional services, such as wellness or preventive medicine programs, ergonomic evaluations of high risk areas, acute care clinics, as well as, a comprehensive on-site health care of employees.

The responsibility for an on-site Workers Compensation ( WC) program is often assigned to occupational health or safety professionals. WC systems are well-known nationally for their ambiguity and complexity. The importance of educating upper management may go unrecognized until necessary program recommendations are not approved due to a lack of knowledge regarding the purpose and function of the proposed action. Legislative and administrative policies have transformed WC into a "complex, frustrating and expensive adversary process.

A central premise of WC has been that injured workers may still have a residual permanent disability, even after recovering from the initial injury, and perhaps even after return to employment. It is the compensation for these residual permanent disabilities that is the major contributor to rising cost and increasing legal action. Attorney fees are usually calculated as a percentage of the final amount awarded to the worker above the usual wage and medical benefits. Thus attorney and medical specialist have an incentive establish high disability ratings. The final award decision is made by the WC Appeals Board based on he applicant and defendant medical reports. Insurance companies also profit from the WC system by setting standard insurance plan rates and using premium and reserve money as interest free loans for investment since claims take so long to settle. Most insurance companies have no incentive to pay claims quickly or to keep awards small. The employer, can apply management controls to reduce costs due to poor claims management, lack of communication, too many doctors and too much litigation. It has been estimated that WC costs can be decreased by more than 30% by implementing a program which will, first decrease injuries and, second, minimize losses on actual injuries.

This program has two crucial components: 1) selection of employees and 2) on-site management of Workers' compensations claims. Careful planning, written documentation, bargaining group approval and consistent hiring procedures can avoid violation of handicap regulations. Employers can refuse to hire/re-hire if the application is unable to perform the required duties in a safe manner. This requires that written job descriptions, uniformly applied, that specify in functional terms to establish the physical requirements of the actual job. The written job-related requirements are also an essential part of a system to safely return employees to work after an injury or illness. In his manner, employees are better suited for their job duties and are less likely to be injured. Cumulative injuries are also reduced by carefully qualifying returning employees for their particular job functions.

Communication and medical-legal review is also critical to effective management of Workers' Compensations claims. 40% or more of the litigated claims are initiate at a time when there are no litigable issues and due to confusion resulting from lack of information and poor communication. Prompt communication demonstrates employer interest and concern in addition to giving essential benefit information and answering any questions. In addition, the best possible care to bring a out a quick recovery should be immediately provided. This will help eliminate the need for unnecessary and redundant medical opinions. The American College of Occupational and Environmental Medicine (ACOEM) have guidelines to standardize the evaluation and management of occupational health problems and to reduce the variances in practices. The occupational medicine physician is well aware of the psychological and economic importance of an expedient return to work, the possibilities of modified duty, and the importance of separating and documenting non-work-related health factors. The review of medical charges for reasonableness, utilizing medical second opinions before a procedure can significantly reduce medical costs. If attorneys are task to report directly to the occupational medicine specialist, their accountability and responsibility to the employer is increased. Finally, monitoring the monthly and annual Workers' compensation loss reports for loss trends and reserve/disbursement errors is essential for the employer to evaluate carrier performance and on-site safety issues.