Develop a Return to Work Plan
When creating a return to work program the patient’s history, relevant clinical information, and the occupational history should be considered. Additional information may be required on a case-by-case basis in order to create an informed and appropriate return to work plan. Things to consider when formulating a return to work program:
- Information about the nature of the job, fitness requirements and risks
- Potential provocative occupational exposures
- Task limitations
- Availability and/or feasibility of part-time work and/or schedule modifications
- Feasibility of graded return to work duties
- Possibility of task modification and environmental restrictions
- Providing appropriate aids
- Relocation to another job after appropriate retraining
Once the clinician has gathered all of the relevant data, he/she must make several decisions based on clinical judgment, including
In physiological terms, is the patient able to fulfill the demands of the job?
Ex. A dental hygienist requires excellent manual dexterity and good exercise tolerance to maintain non-neutral positions for extended periods.
Is the combination of work and health status likely to pose an increased risk to the employee?
Ex. If the worker has significant loss of sensation in his/her thumb, index, and middle fingers, there may be increased risk for pinch or burn injuries.
Could the worker’s health pose an increased risk to others?
Ex. If the worker has significantly decreased grip strength, he/she may place co-workers at risk during team lifts.
Good judgment must be used when recommending restrictions since inappropriate restrictions can delay healing and could cause permanent damage. Conversely, recommendations that are too restrictive can also impede recovery. To balance these considerations, it may be helpful to keep a small set of weights in the office to help objectively gauge the patient's capabilities.
Engage the patient in a dialogue to help determine which tasks are particularly inflammatory as well as the possibility of time off work or modified work. This is also an opportunity to consider appropriate referrals and consultations to facilitate the return to work process.
NB: Assessment of fitness for work is not absolute, i.e. fit or unfit. Indeed, clinicians should recommend reasonable modifications to the workplace or job tasks so as to permit the worker to return to work as soon as possible with as little risk to themselves and to others, in order to ensure a smooth recovery process.
Monitor the recovery process
Communicate
It is important to keep an open line of communication with your patient to ensure recovery. Furthermore, coordination of activities between the physician and other health care professionals can expedite the recovery process. Depending on where your practice is located federal or provincial laws may obligate you to report work-related injuries to the relevant authorities. In Ontario physicians are required to communicate with WSIB initially and at periodic intervals during treatment and rehabilitation, especially if the patient is eligible for some form of income replacement or compensation.
If the physician recommends time off work or modified duties then the patient's employer should be duly informed. When communicating with the employer the physician should focus on ability to work. The emphasis should be on a worker’s capabilities not just limitations, as capability information is much more helpful to the empolyer when trying to accomodate temporary work-reassignment. Physicians must also be mindful of the Personal Health Information Protection Act and must not disclose the worker's medical condition(s) to employers. When communicating to an employer a phsyician can use the following formula:
“patient seen, can return to work on _______(date), with following restrictions/capabilities ______”.
Obligations in a work-related injury
Physicians First Report, Form 0008A (Previously Form 8)
This is the initial medical report and is crucial to the patient and the WSIB when opening up a claims file.
Physician’s Progress Report, Form 0896A (Previously Form 26)
Treating physicians are required to provide on-going up-to date medical information to the WSIB by completing and forwarding the form.
Functional Abilities Form for Timely Return to Work, Form 2647A
The WSIB requires employers and workers to cooperate in return to work efforts and this form assists workers and employers in identifying suitable and available functional abilities or limitations, with emphasis on abilities. The employer or employee must initiate the completion of this form.
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