A. The current disability management programs evolved from the workers’ compensation (WC) practice, laws, and programs.

B. In the 1970s and 1980s, many states reformed their workers’ compensation laws because of rising costs. Employers and insurance carriers began to develop cost-effective ways to respond to workers with occupational illnesses and injuries; hence, disability management and occupational health (OH) programs became more common.

C. From the perspective of reducing costs came the implementation of disability management programs, to not only address the needs of those employees, both ill or injured, but also in response to reducing costs and duration of absences from the workplace.

D. By facilitating earlier return-to-work (RTW) activities, the overall cost of disability was not only reduced but there was an increase in productivity as well. Gradually, the disability management programs expanded to include integrated approaches to care delivery and services.

E. The primary mission of disability management programs is to reduce the financial costs associated with all disabilities in a nonadversarial environment of claims administration. This is accomplished through the
development of a coordinated case management program with the focus on the individual’s ability rather than disability.

F. Disability management programs include coordinated access to employer-provided benefit plans and services that impact the employee with a disability (Box 25-1).

G. Internal departments that typically have responsibility for the design, administration, and implementation of one or more programs are human resources, risk management, OH, safety, finance, legal, and bargaining units.

H. External sources or departments that may be involved in the disability management program are the WC insurance carriers, health care providers, third-party administrators, life insurance carriers, reinsurers, disability carriers, and managed care providers.

I. The expanding recognition that both nonoccupational and occupational disabilities could be managed effectively and efficiently with the support of employers, supervisors, and caregivers gave rise to the managed integrated disability approach.

J. According to the American Association of Occupational Health Nurses (AAOHN), poor employee health costs about $1 trillion annually, so business executives look to OH nurses and case managers to maximize employee productivity and reduce costs through lowered disability claims, fewer on-the-job injuries, and improved absentee rates.

K. Through their recognized value to business, OH professionals commonly take a seat at the management table, providing input about staffing issues, budgetary considerations, and corporate policies and procedures that positively impact worker health and safety, and thus contribute to a healthier bottom line.

L. The practice of occupational and environmental health focuses on the promotion and restoration of health, prevention of illness and injury, and protection from work-related and environmental hazards.

A. Assistive device—Any tool that is designed, made, or adapted to assist a person in performing a particular task.

B. Assistive technology—Any item, piece of equipment, or product system, whether acquired commercially or off the shelf, modified or customized,
that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.

C. Capacity—A construct that indicates the highest probable level of functioning a person may reach. Capacity is measured in a uniform or standard environment and thus reflects the environmentally adjusted ability of the individual.

D. Clinical practice guidelines—Guidelines that summarize based on available evidence and national acceptance recommendations for care of clients with specific conditions. These guidelines are voluntary in nature and may be specific to an institution; some are mandated by state WC laws (e.g., Massachusetts), or they may be voluntary (e.g., New York). There are no nationally promulgated clinical guidelines dictating medical care.

E. Disability—Can be defined in different ways, all referring to a lack of or inability to function in a certain aspect of daily living (Box 25-2).

F. Disability case management—The process of managing occupational and nonoccupational diseases with the aim of returning the employee with a disability to a productive work schedule and employment. It is also known as limiting a disabling event, providing immediate intervention once an injury or illness occurs, and returning the individual to work in a timely manner.

G. Ergonomics—The scientific discipline concerned with the understanding of interactions among humans and other elements of a system. It is the profession that applies theory, principles, data, and methods to environmental design (including work environments) in order to optimize human well-being and overall system performance.

H. Ergonomist—An individual who has (1) a mastery of ergonomics knowledge; (2) a command of the methodologies used by ergonomists in applying that knowledge to the design of a product, process, or environment; and (3) applied his or her knowledge to the analysis, design, test, and evaluation of products, processes, and environments.

I. Functional capacity evaluation (FCE)—A systematic process of assessing an individual’s physical capacities and functional abilities. The FCE matches human performance levels to the demands of a specific job or work activity or occupation. It establishes the physical level of
work an individual can perform. The FCE is useful in determining job placement, job accommodation, or RTW after injury or illness. FCEs can provide objective information regarding functional work ability in the determination of occupational disability status.

J. Handicapped—Refers to the disadvantage of an individual with a physical or mental impairment resulting in a handicap.

K. Handicap—The functional disadvantage and limitation of potentials based on a physical or mental impairment or disability that substantially limits or prevents the fulfillment of one or more major life activities otherwise considered normal for that individual based on age, sex, and social and cultural factors, such as caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, working, etc.

L. Impairment—A general term indicating injury, deficiency, or lessening of function. Impairment is a condition that is medically determined and relates to the loss or irregularity of psychological, physiological, or anatomical structure or function. Impairments are disturbances at the level of the organ and include deficiency or loss of limb, organ, or other body structure or mental function, for example, amputation, paralysis, intellectual disability, and psychiatric disturbances as assessed by a physical examination.

M. Injury—Harm a worker encounters while on the job that is subject to treatment and/or compensation under the workers’ compensation insurance or laws and regulations. Injury also refers to any wrong or damages done to another, done to his or her person, rights, reputation, or property.

N. Job modification—Altering the work environment to accommodate a person’s physical or mental limitations by making changes in equipment, in the methods of completing tasks, or in job duties.

O. LTD income insurance—Insurance issued to an employee, group, or individual to provide a reasonable replacement of a portion of an employee’s earned income lost through a serious prolonged illness during the normal work career.

P. Mobility—The ability to move about safely and efficiently within one’s environment.

Q. Nondisabling injury—An injury that may require medical care but does not result in loss of working time or income.

R. Nonoccupational disease—Any disease that is not common to or does not occur as a result of a particular occupation of specific work environment.

S. Occupational disease—Any disease that is common to, or occurs as a result of, a particular occupation of specific work environment.

T. Occupational health case management—The process of coordinating the individual employee’s health care services to achieve optimal quality care delivered in a cost-effective manner. It may focus on large-loss cases—that is, high-cost, prolonged recovery—or those with multiple providers and fragmented care.

U. Paid time off (PTO) arrangements—A benefit that provides employee with the right to scheduled and unscheduled time off with pay. Fulland part-time regular employees accrue PTO based on years of service. PTO days may be used for vacation, personal time, illness, or time off to
care for dependents. It usually does not include jury duty, military duty, bereavement time for an immediate family member, or sabbatical leave.

V. Partial disability—The result of an illness or injury that prevents an insured or injured person from performing one or more of the functions of his or her regular job.

W. Physical disability—A bodily deficiency that interferes with education, development, adjustment, or rehabilitation and generally refers to chronic health problems but usually does not include single sensory impairments such as blindness or deafness.

X. Social Security Disability Income (SSDI)—Federal benefit program sponsored by the Social Security Administration. Primary factor is disability and/or benefits received from deceased or disabled parent; benefit depends on money contributed to the Social Security program by either the individual involved or the parent involved.

Y. STD income insurance—The provision to pay benefits to a covered person/employee with a disability as long as he or she remains disabled up to a specific period not exceeding 2 years.

Z. Time loss management—A proactive process used for the management of employee absenteeism due to sickness and medical leaves. Usually, a time loss management program focuses on ensuring employee’s health, productivity, safety, and welfare. It does not aim to prohibit sickness absence; rather, it facilitates a timely return to work.

AA. Vocational assessment—Identifies the individual’s strengths, skills, interests, abilities, and rehabilitation needs. Accomplished through on-site situational assessments at local businesses and in community settings.

BB. Vocational evaluation—The comprehensive assessment of vocational aptitudes and potential, using information about a person’s past history, medical and psychological status, and information from appropriate vocational testing, which may use paper and pencil instruments, work samples, simulated workstations, or assessments in a real work environment.

CC. Vocational rehabilitation—Cost-effective case management by a skilled professional who understands the implications of the medical and vocational services necessary to facilitate an injured worker’s expedient return to suitable gainful employment with a minimal degree of disability.

DD. Vocational rehabilitation counselor—A professional who assists individuals with physical, mental, developmental, cognitive, and emotional disabilities to achieve personal, career, and independent living goals in the most integrated setting possible. Rehabilitation counselors utilize many different techniques and modalities, including assessment, diagnosis and treatment planning, counseling, case management, and advocacy to modify environmental and attitudinal barriers, placement-related services, and utilization of rehabilitation technology.

EE. Vocational rehabilitation counseling process—A process that includes communication, goal setting, and beneficial growth or change through self-advocacy, psychological, vocational, social, and behavioral interventions.

FF. Vocational testing—The measurement of vocational interests, aptitudes, and ability using standardized, professionally accepted psychomotor procedures.

GG. Work adjustment—The use of real or simulated work activity under close supervision at a rehabilitation facility or other work setting to develop appropriate work behaviors, attitudes, or personal characteristics.

HH. Work adjustment training—A program for persons whose disabilities limit them from obtaining competitive employment. It typically includes a system of goal-directed services focusing on improving problem areas such as attendance, work stamina, punctuality, dress and hygiene, and interpersonal relationships with coworkers and supervisors. Services can continue until objectives are met or until there has been noted progress. It may include practical work experience or extended employment.

II. Work conditioning—An intensive, work-related, goal-oriented conditioning program designed specifically to restore systemic neuromusculoskeletal functions (e.g., joint integrity and mobility, muscle performance including strength, power, and endurance), motor function (motor control and motor learning), range of motion (including muscle length), and cardiovascular/pulmonary functions (e.g., aerobic capacity/endurance, circulation, and ventilation and respiration/gas exchange). The objective of the work conditioning program is to restore physical capacity and function to enable the patient/client to RTW.

JJ. Work hardening—A highly structured, goal-oriented, and individualized intervention program that provides clients with a transition between the acute injury stage and a safe, productive RTW. Treatment is designed to maximize each individual’s ability to RTW safely with less likelihood of repeat injury. Work hardening programs are multidisciplinary in nature and use real or simulated work activities designed to restore physical, behavioral, and vocational functions. They address the issues of productivity, safety, physical tolerances, and worker behaviors.

KK. Work modification—Altering the work environment to accommodate a person’s physical or mental limitations by making changes in equipment, in the methods of completing tasks, or in job duties.

LL. Workers’ compensation—An insurance program that provides medical benefits and replacement of lost wages for persons suffering from injury or illness that is caused by or occurs in the workplace. It is an insurance system for industrial and work injury, regulated primarily among the separate states, but regulated in certain specified occupations by the federal government.

A. The Case Management Society of America (CMSA) describes in its standards of practice for case management (CMSA, 2010) that case management practice extends across all health care settings and by providers of various professional disciplines and backgrounds. This without a doubt applies to the practice of disability and occupational health case management.

B. Disability and occupational health case managers may use the CMSA standards as a guide for the implementation of their roles and case
management programs. All of the standards are relevant to disability and occupational health case management practices including the case management process, roles and functions, advocacy for the client/support system, and legal and ethical expectations.

C. Case managers in the disability management and occupational health care settings must be knowledgeable about the CMSA standards of practice. They also must inform their employers and other health care professionals they collaborate with when dealing with a client with a work- or non-work-related disability and occupational illness about their existence, value, and need to adhere to them.

D. This chapter introduces case managers to the basic concepts and practices of disability management and occupational health, design of case management programs for this specialized patient population, and role of the case manager in such settings and explains how collaboration may occur between case managers in the medical and rehabilitation work settings and those in private/independent practice or those who work for employers in the occupational health area.

A. Disability has been defined in a variety of ways for the purposes of programs, policies, and the law.

B. In a report by the Cherry Engineering Support Services, Inc., Federal Statutory on Definitions of Disability prepared for the Interagency Committee on Disability Research (2003), it was noted there were 67 separate laws defining disability for federal purposes.

C. Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA) of 1990 have adopted a definition that takes into consideration the individual, the physical surroundings, and the social environment.

D. From a legal, benefit, and social program perspective, disability is often defined on the basis of specific activities of daily living (ADLs), work, and other functions essential to full participation in community-based living.

E. To be found disabled for the purposes of Social Security Disability income benefits, the individual must have a severe disability that has lasted, or is expected to last, at least 12 months and which prevents the individual from working at a “substantial, gainful activity” level.

F. Both Section 504 of the Rehabilitation Act of 1973 and the ADA of 1990 define a person with a disability as someone who:

A. The Certification of Disability Management Specialists Commission (CDMSC), the only nationally accredited organization that certifies disability management specialists, recently completed a role and function study tracking the changes in disability management. Four specific practice domains were identified:

B. Disability and Work Interruption Case Management programs, which consist of functions or activities such as those described in Box 25-3.

C. Workplace Intervention for Disability Prevention consists of activities or functions including those listed in Box 25-4.

D. Box 25-5 includes the essential activities that constitute successful development, management, and evaluation of disability management programs.

E. Employment Leaves and Benefits Administration is accountable for the following activities:

F. Disability case management not only is an important workplace productivity program but also addresses more advanced workplace productivity concepts. These include:

G. Disability managers are a part of an interdisciplinary team involved in integrated benefit practice, productivity enhancement, and health and wellness programs.

H. Increased emphasis on early intervention and job accommodation reduces disability-related costs.

A. It is important to recognize that from a disability case management perspective, the number of workers 55 years of age and older is expected to grow 38% by the year 2020. The incidence of disability increases with age; the number of employees with work-limiting disabilities is usually much higher in the 50- to 59-year age group.

B. The U.S. Census Bureau of Americans with Disabilities reported that in 2010, approximately one out of ten persons with disabilities has a severe disability. In the prime employable years of 21 to 64, over 30% of those individuals with severe disabilities are employed (US Census Bureau of Americans With Disabilities, 2012).

C. According to the U.S. Department of Labor’s Office of Disability Employment Policy, every seven seconds, a baby boomer turns 60.

D. The Society for Human Resource Management (SHRM) released the results of a recent survey related to employers’ incentives for hiring individuals with disabilities.