This Series consists of three (3) separate articles and is worth tem (10) Credit Hours.  Each article has corresponding questions that can be found be clicking on the "Questions" link.

Article 1: Fixing the Broken Paradigm
Article 2: The Function of Testing in the VE Process
Article 3: Disability Management Components

During introductory remarks to the 16th Annual National Symposium on Workers’ Compensation, National Council on Compensation Insurance (NCCI) President William Hager said, “Unless we get unneeded services and providers out of the workers’ compensa­tion system, that house will come down.”¹   On the same track, Dr. Rochelle Habeck, a rehabilita­tion counselor, educator, and disability management consultant, reminds us that “many providers continue to function from a broken paradigm that can offer limited solutions to work disability and may actually contribute to escalating costs.”² 

And, indeed, the experience of the professional case managers at CEC Associates, Inc., is that workers’ compensation and other disability costs esca­late as a result of dysfunctional disability manage­ment approaches taken by employers.

There are several critical causes:

These are just some of the reasons why workplace disability costs increase when case management is involved.  However, the improper use of case manage­ment should not cause anyone to conclude that case management alone drives costs.  On the contrary, numerous reasons exist for escalating costs in the “broken paradigm” which Habeck invokes.

But we also know that timely, high-quali­ty case management yields results.  Re­covery from workplace injury or illness costs employers substantial sums of money.  A 1994 survey released by Northwestern National Life Insurance, Minneapolis, sug­gested that employers could save as much as $35 for every $1 spent on rehabilitation ser­vices to get injured workers back to work.  Savings come from reduced reserves which companies and their insurers set aside for extended disability payments.  Employer savings increase dramatically, to $96 for every $1 spent if workers could be brought back to their original positions, $46 if brought back to a different position within the same company, and $38 if a new position can be found with a different employer.³

As Habeck also predicts, if case managers are to continue providing the workplace with value-added services rather than additional costs, we must consider a number of work­place issues and dynamics that factor into nearly every rehabilitation case.  To move from that broken paradigm into a new, more effective generation of corporate service, case management professionals must reevaluate some basic industrial rehabilitation concepts.

Proactive Approach

We know that occupational disability is defined as a limitation resulting from physical or mental impairment that affects the amount or type of work an individual is capable of performing.  However, few employers realize that workplace disability is so expensive.  Studies have shown that companies spend an average of 8% of their annual payrolls on all facets of disability.  Researchers have shown that there are direct, indirect, and hidden costs in the equation.  For an organization with a modest $5 million payroll, the average loss attribut­able to disability means a cost of $400,000 per year.

Moreover, most employers do not realize workplace disability can be pre­vented and managed.  As with any organiza­tional problems resulting in substantial costs, members of the organization must take responsibility to manage the problem directly.  Few employers approach disability manage­ment proactively.

Disability management is a planned effort by a well-managed work organization to proactively prevent and manage injuries, illnesses, and other events in the lives of its employees that cause them to lose work time or productivity.  Disability management within organizations requires that the man­agement structure deal with the specific antecedents and consequences of changes in employee health and well being.  Dis­ability management programs (DMPs) must have strong case management and return-to-work components if they are to save companies the substantial direct and indirect costs associated with lost time, injury, and illness.

Analyzing and describing jobs are useful procedures in the rehabilitation of injured workers, and case managers must find a way to install these valuable procedures into the disability management system.  
 

Return to Work versus Light Duty

Of all the important paradigm shifts that have occurred in the processes of injury management and return to work over the past few years, the reformulation of what constitutes viable return to work is one of the most important.  In well-managed com­panies, when employees are injured or ren­dered ill, management representatives accompany the employee to the hospital, make frequent visits to the employee in recuperation both at the hospital and home, and accompany the employee to crit­ical-stage physician appointments.  This, of course, is effective case management.

Moreover, return-to-work assimilation is no longer described as “light duty,” but as transitional duty.  Transition is defined as including phased-in length of workdays, work hardening, job restructuring, and, if needed, retraining for another important job in the company.  To demonstrate the company’s concern for the welfare of injured employees and their families, a com­prehensive support system is delivered throughout the case.  The case managers, for example, are engaged in post-injury or illness, coordination of the health care sys­tem, and facilitation of not only maximum medical improvement but return to gainful activity, which is good for both employ­ee and employer.  Light duty has become an archaic concept and practice in proactive disability management protocols.  
 

Telephone Case Management

Not unlike the obsolescent light duty, telephonic case management has inherent limitations.  Penny-wise and pound-foolish, many insurance carriers, third-party admin­istrators, and self-insured employers have opted for the use of telephonic case man­agement over dispatching a case manager into the field.  However, nobody but direct supervisors and Human Resources personnel should be simply telephoning an injured or ill employee.  Case managers are best used in the field because these professionals are a critically important extension of the employer or organization into the healthcare system.  Case managers communicate, assess, observe, and facilitate the changing status of the injured employee’s functionality.  None of these critical processes can be accomplished by telephone.

It has been shown empirically that case management representatives gathering information over the phone too frequently collect different data than case managers who assess the same problem by direct per­sonal contact and observation.  The effec­tiveness of professional case managers should not be watered down with telephone case management.

Mediation

As a result of their claims for workers’ compensation benefits, injured employees naturally oppose their employers.  And, too often, the reverse is also true.  Even when a claim is “undisputed,” as they say, legal and insurance documents still read, “employee X versus employer Y.”  If suspicion does not hover over a workers’ compensation claim immediately, resistance will exacerbate the torn employer-employee relationship eventually.

Lost time has a way of accruing rather rapidly, particularly in the absence of proac­tive disability management.  Workers’ com­pensation claims breed conflict that too often spills over into games of blackmail and extortion.  Financial settlements become the mech­anism of getting rid of claimants, but not without hidden costs.  A layperson can only imagine what some companies pay to replace trained employees, but the Government Accounting Office reports the average cost as $26,200 per displaced worker.

DMPs should incorporate conflict resolu­tion strategies to decrease tension between employee and employer and to resolve lost-time issues between injured workers and their employers.  Case management pro­fessionals can assist their corporate clients by learning managerial mediation skills and encouraging companies to train managers in conflict resolution strategies.

Team Approach

Disability management teams will get the best results by including representa­tives from various departments of the orga­nization.  Total quality management and team problem solving are as essential to successful disability management program­ming as evolving business practices.  The ideal disability management team may include the case manager, the employee, the physician, the union steward, the claims representative, the safety director or desig­nated disability manager, and the legal rep­resentative.

All these participants are potentially in a critical relationship with the injured worker.  Team members share responsibility for problem identification, brainstorming solu­tions, and team communication, all geared to preventing co-malingering and proactive­ly managing disability.  The case manager may serve as the team leader or as a critical team member.  The message to the work organization and specifically to team mem­bers, however, must be that we will strive to limit any one individual’s continuing lost time.  A team approach is best.  

Upgrade Case Management Skills

Indications are that work organizations are increasing their use of case manage­ment professionals to coordinate and inte­grate a range of social, health, and rehabili­tation services to enhance the functioning and quality of life of employees.  As corpora­tions become increasingly aware of the costs of workplace disabilities and respond with proactive disability management pro­grams, case managers must go beyond the traditional role of advocate and learn the necessary skills to facilitate and maintain corporate DMPs.  These skills involve:

The single most important aspect of disability management is a total commitment to return employees to work.  Otherwise, costs are sel­dom reduced.  

Return to Productivity

Return to real productivity is the goal of disability management and, of course, the resolution of all lost-time situations.  Case management is the keystone of an effective DMP.  Case management has been defined in various ways as long as social work and systematic health care have existed, and new models for case management are evolv­ing.  Karen Kaplan, Director of The National Center for Social Policy and Practice, defines the basic premise of case manage­ment as: “The delivery of the right services at the right time.  Done correctly, case man­agement works because it helps ensure top quality care delivered in a timely fashion.  It allows the use of appropriate specialized services that maximize recovery.”

Case management remains the critical tool linking employer programs and policies with the health care delivery system.  Although managed care has captured the attention of employers and their insurance carriers, it is still case management that serves as the nexus between quality health care (whether “managed” or not) and voca­tional productivity.

Housed in a comprehensive DMP, case management can reduce health care costs and facilitate return-to-work strategies.  A comprehensive DMP includes:

Planning and monitoring these features of a DMP are the responsibility of a select team of employees (and perhaps one or more external resource people,  such as a case manager) who are empowered to design and operate a program to prevent and manage disability costs.  Generally, case managers are key members of the team.

What do case managers need to know in order to serve as members of the disability management team? How do case managers gain access to internal committees oversee­ing disability management?  And how do case managers ensure their continuing service to the workplace?  Case management profession­als must understand aspects of the corporate environment in order to successfully and effectively apply their skills and expertise.  
 

Organizations Are Political Landscapes

Broken paradigms are maintained in large organizations by individuals with vest­ed interests in keeping the status quo.  Insurance carriers or third-party administra­tors, insurance brokers, risk managers, union representatives, human resources managers, health and safety personnel, and operations staff may have a stake in keeping work systems as they are, even if those systems are dysfunctional.

Chances are, however, that a well-man­aged company that properly utilizes case management services will be receptive to the concept of disability management.  Case managers can steer ad hoc disability man­agement committees toward the goal of establishing proactive policies and proce­dures for handling lost time.  Many organiza­tions may wish to establish permanent dis­ability management teams that meet regularly to staff all lost-time cases.  Case managers may indeed lead these teams.

Case managers functioning as external consultants must realize, nonetheless, that helping to develop working alliances within any organization will be their greatest chal­lenge.  A case manager must seek and secure top management support for work­place disability management.  In most cases, this commitment must come from no less than a CEO, a CFO, or a managing board of directors.  Otherwise, the interdepartmen­tal cooperation necessary to develop an effective disability management program will not be realized.
 

Co-Malingering

In an unpublished paper, Ken Mitchell, PhD, a nationally recognized disability management consultant, defines co-malingering as the invisi­ble bond between worker and employer or an agent of either party (e.g., the treating physician and an injured worker can co-malinger; likewise, an injured worker and an enabling case manager can co-malinger).  Mitchell has offered this invaluable con­cept to both work organizations and case managers.  He writes, “Co-malingering is cooperative manipulation.  This manipula­tion can be intentional or involuntary, pas­sive or active, worker-centered or employ­er-centered, limited to a single event or habitual.  Co-malingering is a deception that results in a subversion of a private or public disability compensation system that is designed to protect the employer, employee, and health care provider alike.”

Typically, co-malingering is initiated and maintained by a system of beliefs, learned behaviors, and/or intentions that are applied to specific situations in the work­place, but fail to create an effective, mutual­ly satisfying outcome for employer and employee.

Mitchell concludes, “Co-malingering, while not always the result of an intentional act on the part of either the worker or the employer, is quite often supported and encouraged by the very system it seeks to deceive.”

Any party within the compensation system working with the employee can con­sciously or unconsciously co-malinger.  Rehabilitation personnel, physicians, super­visors, family members, lawyers, and claims personnel are but a few of the individuals who can co-malinger with an injured worker to main­tain the compensation sys­tem.  Workplace policies can also perpetuate co­-malingering.  Perhaps not realizing it, management and labor all too frequently agree on contractual lan­guage that results in co-­malingering.  Requiring that employees be 100% healthy before they return to work is an example of a co-malingering employer policy.  Case managers must recognize that co-­malingering can be a sig­nificant issue in the work­place politics of lost time and disability.  
 

Disability Versus Impairment

“Impairment’ and “disability” are signifi­cant terms in any disability compensation system, and understanding the dissimilarity of meaning between them is critical to an employer’s understanding of disability compensation.

American employers pay far too much for disability in the workplace because key decision-makers either do not comprehend the difference or do not act on the distinc­tion between impairment and disability.  In reality, the same impairment can result in different degrees of disability depending on the specific work situation, the characteris­tics of the worker, and the politics sur­rounding the disability claim.  For example, the amputation of several fingers may leave a machinist totally disabled.  But the same amputation may have little or no effect on a bus driver’s work.  The impairment is the same; the work is different.  Therefore, the disability is different.

Understanding the critical difference between impairment and disability has been liberating for many human resource and risk management personnel.  Charged with the responsibility of returning permanently impaired employees to work, case man­agers and disability managers now facilitate return to work by addressing and ameliorating return-to-work barriers, thereby reducing or totally eliminating disability.  Impairment is a med­ical concept, but disability is an occupational issue.  The work organization can actually manage disability.

Case managers must make sense of this distinction and communicate it effectively to all members of the disability manage­ment team.  If organiza­tions are to reduce the cost of workplace disability and meet the federal requirements of the ADA, the dif­ference between disability and impairment must be operational in return-to-work programs.  
 

Job Descriptions Are Key Tools in Return to Work

The ADA introduced new concepts to employers in terms of realizing the employment potentials of individuals with disabilities.  Two of the most significant concepts are the “essential functions” of a job and “rea­sonable accommodation.”  The process of job analysis and the outcome of job description are two of the most important steps employers might take to develop and maintain effective return-to-work programs.  Case managers must become proficient in job analysis and job description formulation.

Job analysis is the examination of what a worker does, why it is done, how it is done, and the skills and abilities required to per­form the job.  Job analysis produces a systematic and detailed map of how a job is performed, and that map is the essential functions job description.  Once a job analysis is completed, gathered information can be arranged in essential function form.  A complete “essential functions” job description can do the following:

In the early years of private sector insurance rehabilitation, some case man­agers representing for-profit organizations were undoubtedly caught walking with dirty feet in client companies.  Rehab­ilitation counselors and case managers working from broken paradigms co-malin­gered, but rehabilitation case managers also functioned without a vision, and sel­dom with a model better than the reactive one bequeathed by insurance carriers on behalf of insured employers.

Case management is coming of age, however, and with the right tools and prop­er approaches, some case managers can make significant contributions within cor­porate DMPs.  The notion that disability can be proactively managed and prevented by the work organization itself is empowering.  The DMP concept makes it imperative that the case manager play a vital role in injury management and return to work, and func­tion within a framework of common goal-sharing, collaboration, and teamwork.  Notwithstanding Habeck’s alarm over increasing costs in the compensation sys­tem, case managers can encourage and lead client organizations to improve reac­tive and seldom useful injury management methods of the past and move beyond the broken paradigm.  

References:

1. A Summary of Issues Influencing Workers’ Compensation.  Boca Raton, FL: The National Council on Compensation Insurance; 1992.

2. Habeck R.V. “Achieving quality and value in service to the workplace.”  Work Injury Management; 1993; 2:1, 3-4.

3. Back To Work.  Minneapolis, MN: Northwestern National Life Insurance Com­pany; April 1994.

4. Calvin DE, Habeck RV, Kirchner KA.  A Report from the Leadership Forum on Disability Management.  East Lansing, MI: Institute for Rehabilitation and Disability Management of Washington Business Group on Health and Rehabilitation; October 1992.

5. Kaplan K.U. “Recent Trends In Case Management.”  In Encyclopedia of Social Work, 18^th ed. Silver Spring, MD.  
   

The Function of Testing in the Vocational Evaluation Process

By Beth McLaughlin and Jasen Walker, Ed.D.

The primary function of a vocational evaluation professional is to identify an individual’s vocational potential through the utilization of a systematic assessment process.  Through that process, the vocational professional is able to measure, observe, document, and determine an individual’s potential to successfully perform particular forms of work.

In many instances, vocational assessments are used to determine whether an injured (or ill) employer is able to return to work, and if so, to what kind of work.  If return to work is indicated, the outcome of the evaluation will address the critical issues of returning to employment.

The intended outcome of the assessment is to explore vocational options that will be the basis for a viable work re-entry plan.  A return to work is the optimal outcome; however, in a few cases, the outcome may indicate that work at any level may not be practical.  In these instances, treatments or other interventions need to be considered.  In all other cases, the objective is a return to work, with or without an accommodation.

Much, if not most, of the work done in vocational evaluation is based on documentation.  In addition, vocational rehabilitation professionals must rely on the recommendations of physicians in respect to an individual’s physical (or mental) capacities for work.  However, a frequent issue affecting the vocational evaluation process is the basic difference between the concept of “impairment” and “disability.”  Defining an impairment is, of course, within the scope of the physician’s expertise, whereas, defining disability is not.  In terms of a work disability, the person making the decision needs to understand the physical and mental requirements of the specific work task to decide whether the impairment will, with or without a work accommodation, impact the injured worker’s ability to carry out that work.  This expertise on occupational capacity belongs to the qualified vocational professional.

The process used by vocational rehabilitation professionals to accomplish this task is to assess or evaluate the injured worker, with a focus of determining occupational fit.  Good vocational assessment can be accomplished by utilizing the following methods:

However, despite the importance of testing in accurately assessing an individual’s characteristics and abilities, one of the most frequently asked questions are regarding vocational evaluations is, “What is the purpose of vocational testing?”  Many times, persons requesting a vocational assessment question the efficacy of administering a battery of tests.  In general, it is assumed that a person’s ability to perform a job can be determined solely by examining what type of work that individual had performed in the past, and therefore, any documentation beyond that is considered superfluous.  In fact, to the well-trained vocational evaluation professional, work experience plays only a part in assessing a person’s ability to function effectively in a particular job.  Most people fail to understand that occupational success is less dependent on an individual’s work history than is generally believed. 

Because of the wide variations in job descriptions and job demands, the work history alone does not ensure that the individual being evaluated has acquired specific skills.  Moreover, it has been the experience of well-trained vocational evaluators that individuals with particular work histories can possess dramatically different skill sets and worker characteristics.  One could simply perform a "transferability of skills" analysis on the basis of a person's work history.  However, not all longshoremen are simply longshoremen.  Some longshoremen, by virtue of their work experience, need not read or write, and to assume from their work experience alone that they cannot process information requiring reading and writing could potentially be a major assessment error.  To assume that the longshoreman is simply interested in objects and things because he has manually and mechanically unloaded ships and done nothing more in his employment, could also be fraught with miscalculation.  In the 1960s and early '70s, a Seattle, Washington Longshoreman, Harvey Jackins, wrote approximately 10 books and made a seminal contribution to a new form of counseling and psychotherapy called Re-evaluation Counseling.

Because effectively performing a specific job is dependent on several identifiable factors and not necessarily representative of individual’s potentials, vocational testing is an essential part of the evaluation process. Said differently, an individual's having performed a specific job does not yield all information about the person’s vocational capacities, and testing is an essential part of expanding our knowledge of that person’s potentials and alternative job compatibility characteristics.  Testing is designed to determine an individual’s appropriateness for select forms of work by assessing actual abilities, preferences, and suitability for various occupations.  As such, it can be used for a variety of purposes that would include assisting young adults in choosing a career path, helping individuals looking for alternative work, and, as is the case with vocational rehabilitation professionals, aiding persons returning to work after a disabling injury.  The vocational rehabilitation professional is able to accurately carry out test administration by applying knowledge acquired through formal and on-the-job training.

Through thoughtfully structured testing, a complete picture of an individual’s actual abilities and work potentials can be obtained.  More importantly, without comprehensive test data, determining an appropriate occupational match for an individual would be somewhat speculative.  That is, relying on previously acquired skills and/or employment history alone would not allow for a vocational rehabilitation professional to accurately prognosticate an individual’s potential to achieve success in a particular job, because such information would lack critical components to worker success, such as whether the individual possessed the language skills and/or interest to perform that work.

So, what is a test?  A test is a standardized procedure for sampling behavior and describing it with categories or scores.  Standardization is achieved if the procedures for administering the test are uniform from one examiner and setting to another.  Testing yields quantitative data, allowing the examiner to compare the test takers performance with the measured behaviors of others in a normative sample, or larger number of individuals with similar characteristics (i.e. age, education, gender, etc.)  Testing has the potential to provide qualitative data, which is the information about how individuals behave when confronted with particular, generally novel tasks.  Do they become nervous?  Are they able to sustain a particular effort?  Do they ask appropriate or inappropriate questions regarding the nature of the test administered, i.e., Will this identify my arithmetic potential, or Will this test help me get a job as a rocket scientist?  Does the test-taker seem interested or indifferent to the process?  Does the test-taker make a genuine effort, or do they sabotage the testing process?  

There are several factors that should be considered when developing criteria for vocational testing.  Those components would include academic achievement levels, aptitudes, personality characteristics, and occupational interests.  Through gathering data in each of these areas, along with understanding the history of the injured worker, one would be better equipped to successfully match a person to a particular job than relying upon work history alone. 

Academic testing measures an individual's abilities to read, spell, and arithmetically calculate.  In general, these abilities are acquired through the course of formalized schooling.  However, reliance on educational attainment without supplemental academic testing is not recommended because rarely does educational level equate perfectly with actual ability.  Therefore, achievement testing is essential in determining decisively the injured workers basic linguistic and mathematical abilities.    

Aptitudes are an individual’s natural capacity for learning, and aptitude testing is designed to predict an individual’s ability to learn certain skills.  Such skills can include, solving problems visually, understanding mechanical principles, perceiving differences in tabulated data rapidly and accurately, and comprehending written information.  The work that a person is most likely to be successful in is work that involves aptitudinal strengths.  

Personality testing is designed to determine an individual’s specific charaterological traits and can be used to decide what an individual’s temperament might be for a particular type of work.  That is, although a person’s ability to perform a particular type of work is important in job placement, for that individual to have the right temperament to effectively carry out the work on a daily basis is also critical to job success. 

Interest measures will delineate preferences for types of work for a particular individual.  By determining likes and dislikes, work for which a person would most likely find enjoyment can be more specifically described.  Obviously, individuals who enjoy what they do each day will have greater motivation to continue their work and will have a better chance to be successful in performing that work. 

Along with the actual assessment of an individual’s academic achievement, aptitudes, personality, and interests, vocational evaluation also requires making certain that the data obtained are an accurate reflection of the individual being tested.  In determining the validity of test data, one must examine three components that include standard performance level, consistency of performance, and response rate.  Additionally, motivation to perform can be assessed through observation of test-taking behavior.  These three factors, along with perceived level of motivation can be used to assess whether test results gathered are a valid representation of tests-taker’s actual potentials.  

The concept of standard performance level would suggest that examinees should perform at a level fairly consistent with their educational background or same age peers and should perform better on tasks that are more closely aligned with their academic and employment histories.  That is, one would expect that an architect would demonstrate good mathematical and visual problem solving abilities, while an author should possess good language skills.  Standard performance level would also suggest that there should be a correlation between an individual’s intellectual ability and acquired skills. 

Performance consistency suggests that examinees should demonstrate a similar ability level on tests measuring similar skills (e.g., vocabulary, reading comprehension).  That is, individuals should perform in a like manner on measures assessing like skills.  In addition, test data gathered should not show significant variance during the course of test administration occurring at one particular time.  Examinees should demonstrate minimal fluctuation within or between tests assessing similar skills that are administered at one sitting. 

Response rate assumes that examinees should be able to respond to questions on timed (speed) tests at a rate that would place them within a performance range equal to their general ability as long as direct physical limitations are not a factor.  Additionally, examinees should be able to complete untimed measures within the time frame identified in the test manual.   

Along with these three factors, trained vocational evaluators can assess motivational levels through observational information gathered during testing.  Although motivation is generally considered an internal dynamic, how examinees behave while taking tests can provide a significant amount of information about how invested the individual is in performing at an maximal level.   

Obviously, motivation to perform optimally should also be questioned when individuals make statements about their disinterest in the test-taking process or in their performance while working.  Additionally, injured workers invested in their performance should be observed taking time available to check their responses for accuracy.  For example, on a test of spelling ability, an examinee should not comment about believing a response is incorrect without making any effort to change the response.  Moreover, motivation should be questioned in individuals that engage in superficial conversation while working or succumb to possible distractions in the environment, skip or ignore test instructions or example problems, or work in an overly rapid and non-thoughtful manner.  To identify manipulation of test results, some tests, particularly personality measures, are equipped with their own validity scales.   

Vocational rehabilitation evaluations culminate in a comprehensive report (to the employer or referral source) detailing a viable course of action for the employee and/or providing information regarding an individual’s potential to perform particular forms of work.  These reports can be critical in use as the basis for decision making by the employer or as the prima facie evidence in litigation.  

In conclusion, vocational testing is an integral and critical aspect of the vocational evaluation process.  As described above, comprehensive understanding regarding an individual’s occupational potentials involves a careful examination of variables beyond simple physical capacities to work.  Therefore, in order to be effective, vocational assessment must include collection and interpretation of information in the realm of abilities, interests, and personality characteristics.  With the availability of such data, used in combination with an appropriate understanding of essential job functions, work ability decisions can be made with greater reliability and validity.   

For the vocational rehabilitation professional, it is essential that a vocational assessment be carried out in a manner that utilizes direct observation, review of documentation, physician input, client interview data, and standardized testing.  Again, to assume that occupational potential can be accurately ascertained without gathering data that includes academic achievement levels, vocational aptitudes, personality characteristics, and occupational interests, could result in a less than accurate assessment of an individual’s actual capacities to work.  In addition, by relying on limited information, the vocational rehabilitation professional would be increasing the risk of returning an injured worker to an unsuitable position, thus resulting in additional lost time from work as the individual is more likely to fail in adhering to the demands of a particular job.  

Only by completing a thorough assessment of an individual that includes administration of vocational testing can appropriate occupational potentials be determined.  In doing so, the vocational rehabilitation professional can make more accurate decisions regarding an individual’s ability to perform certain types of work and can better prognosticate that individual’s chance of being successful in doing so.  By understanding what an injured worker can do physically, intellectually, and temperamentally, a vocational rehabilitation professional can promote a successful return to work.   

Since the primary function of a vocational rehabilitation professional is to identify an individual’s vocational possibilities, it is essential that a thorough and comprehensive assessment occur.  Only through such as assessment can accurate and complete information regarding an injured worker’s capacity for work be obtained.  Anything less can only make a difficult situation more problematic.    

Understanding Vocational Testing (in the Forensic Vocational/Disability Evaluation Process)

Vocational/disability evaluation in personal injury matters is an effort to explain how medical impairment following personal injury interferes with work functions.  In order to understand how personal injury potentially affects a plaintiff’s capacity to work, one must first appreciate the difference between impairment and disability.  According to the American Medical Association’s Guides to the Evaluation of Permanent Impairment (Third Edition-Revised), impairment means “an alteration of an individual’s health status that is assessed by medical means,” and disability, “an alteration of an individual’s capacity to meet personal, social or occupational demands,” is assessed by non-medical means.

Medical experts are retained to describe how injury and/or illness alter an individual’s health status.  Vocational experts are assigned with responsibility of determining how the “alteration” of an individual’s health status impacts his/her employment and occupational potentials.  Economic experts assess the long-term financial impact of an individual’s disability.  Vocational disability evaluation is the keystone in the tripartite (medical-vocational-economic) analysis of loss associated with personal injury.  Vocational/disability evaluation is enhanced through the utilization of available methods for measuring an individual’s capacities to learn and work following a change in health status.  

Vocational/disability evaluation is best carried out by certified and/or licensed evaluators who possess training and experience in career assessment, evaluation of individuals with medical impairment, job placement of individuals with occupationally significant medical histories, job analysis, and vocational rehabilitation.  Vocational experts are uniquely qualified to assess the occupational significance of medical impairment and resultant functional limitations.  Few, if any, medical experts are trained in these disciplines, and the physician should not be placed in a position to determine industrial loss of use, economic loss, or any other type of loss arising from vocational disability (American Medical Association).   

Evaluation of occupational loss in personal injury cases is generally conducted by individuals who are Certified Rehabilitation Counselors, Certified Vocational Evaluators, Disability Management Specialists, and/or Clinical Associates or Diplomates of the American Board of Vocational Experts.  In Pennsylvania (as well as in other jurisdictions), competent vocational evaluators generally are licensed as Professional Counselors and/or serve as Vocational Experts for the Office of Hearings and Appeals of the Social Security Administration.

Vocational evaluation in matters of occupational disability is an evolving discipline.  As in any profession, not all vocational experts pursue their discipline with equal rigor or intensity.  Vocational evaluation to determine the impact of medical impairment upon an individual’s employability and wage potentials is an endeavor that requires not only training, experience, and proper credentialing, but a genuine effort to investigate (with a variety of tools) the examinee’s capacities to learn, work, and earn money through gainful activity.  

Vocational/disability evaluation ideally involves a careful review of any and all relevant medical information regarding the person to be evaluated.  The evaluee should participate in a clinical interview – a structured question-answer session – with the evaluator, who would ideally make inquiry and observation regarding the person’s medical background, social history, educational experiences, occupational endeavors, and interview behaviors (i.e. speech articulation, appearance, and ability to comprehend questions).  Generally speaking, this type of interview can last between one and two hours. 

Vocational/disability evaluation, however, also ideally includes administration of a standardized battery of tests, preferably designed to generate information regarding an examinee’s abilities to read, calculate arithmetically, reason in a number of ways, solve novel problems, use language properly, and employ cognitive abilities that could be utilized in work settings.  The test investigation could likely involve administration of occupational interest inventories, work personality questionnaires, and, at times, measures of upper extremity capabilities, both gross motor and fine fingertip.  The vast majority of individuals who have been injured musculoskeletally will be medically limited in terms of their exertional capabilities, and the effort in these types of cases is frequently to determine how well the individual can function in relation to data, people, and inanimate objects.  Moreover, one becomes invested in understanding how well the examinee can process information.  Such an effort requires far more than history taking (vocational interviewing) and so-called “transferability of skills” analysis.  Standardized vocational testing can be, and generally speaking is, an essential component of disability evaluation and residual employability assessment.   

Vocational Testing

Vocational testing is the administration of standardized tests that provide information regarding particular worker characteristics and behaviors.  A test is a standardized procedure for sampling behavior and describing it with categories or scores.  Vocational testing facilitates decision-making in occupational selection and classification of personnel and assists professionals and those being tested in making a career choice.  

Vocational testing with standardized measures has its roots in psychological and mental assessment of “feeble minded” citizenry, including early 20th-century immigrants and World War I army recruits.  Without question, vocational testing has evolved substantially and, of course, not without controversy.  Questions regarding test reliability, cultural and racial bias, the effect of other individual differences, test norms, predictive validity, and proper utilization of test results have challenged psychologists, test manufacturers, and test administrators for decades.  These pressures have continued to shape the field of testing.  Professional, moral, ethical, and social issues have influenced and will continue to influence the development and use of standardized testing.

One of the single most prolific vocational test administrators remains the Department of Defense with its employment of the Armed Services Vocational Aptitude Battery (ASVAB).  The ASVAB is the most widely used paper-and-pencil test in existence and is used by the Armed Services to screen potential recruits and to assign personnel to different jobs and training programs.  More than two million examinees take the ASVAB each year. 

Simply stated, one can more effectively and accurately predict the proper vocational placement of an individual when that individual’s personal history is supplemented by standardized test data.  An effective battery of vocational tests generally includes measurements of interests, abilities, and personality.  This tripartite appraisal allows one to predict if the person will potentially be satisfied with work, possess the abilities or aptitudes to learn and/or perform the work, and manifest personal characteristics to properly “fit” with the job functions required.  Vocational test batteries often investigate other worker characteristics as well.  Nonetheless, investigation of these three areas—interests, abilities, and personality (temperament)—is generally critical.
 

Vocational Testing in Matters of Personal Injury

Vocational testing in personal injury lawsuits provides the forensic examiner with additional data sets that detailed review of documentation and careful history taking cannot provide.  Vocational testing provides information regarding an examinee’s worker characteristics compared to others with whom she/he might compete for a job or particular type of job.  Careful and tactful questioning and a clearly identified work history cannot provide comparable information to that type of investigation that is also supplemented by standardized testing.  Occupational “match” or “fitness” can be enhanced substantially by employing vocational testing as an adjunct to detailed interviewing and observation.

Vocational testing permits the test administrator to formulate a more certain projection of an individual’s capacity to meet the demands of a job description.  Critical requirements of jobs can be matched with an examinee’s performances and results in standardized tests of abilities, interests, and personality.  Moreover, vocational testing can provide predictive information regarding an individual’s capacities to learn and develop new occupational capabilities through on-the-job training or classroom retraining.  

Customary Tests Utilized

Ability, achievement, intelligence, and aptitude testing employed in vocational/disability evaluation are generally designed to measure various behaviors that have application to an individual’s capacities to work effectively with data primarily, objects and things secondarily, and people to some extent.  A measured ability is a determination that the worker characteristic measured and possessed is sufficient to learn and perform a particular task.  According to Webster, an ability is the quality or state of being able; competence in doing; and natural talent or acquired proficiency.  Achievement may be thought of as the present level of an individual’s learning and her/his ability to apply what has been learned.  Intelligence is one’s potential to profit from experience and the capacity to understand or comprehend.  An aptitude is the capacity for learning a given discipline or subject matter.  The value of vocational testing in these areas is self-evident when there is a chance that an individual displaced from an occupation can return to the labor force in a similar or different job.  

Occupational interest testing allows the vocational test administrator to determine what type of work tasks will engage the individual, not necessarily what the individual is able to learn or do.  Discovering what type of jobs this individual will find satisfying is the goal of interest testing.  Without some degree of vocational interest or potential job satisfaction, the examinee will probably not be motivated to maintain a particular type of work or necessarily manifest sufficient effort, particularly in a job that she/he actively dislikes.  

Personality testing in vocational assessment is designed to measure that all-important aspect of occupational fitness, namely, personal characteristics that signal behavioral, social, emotional, and intellectual tendencies distinguishing one individual from another.  Vocational evaluation has long relied upon personality types to create an occupational match based on temperament—a person’s constitution, complexion, or makeup.  Personality traits of special occupational groups have been studied by vocational developmental theorists since the late 1930s.  Every individual inherits a tendency to expend her/his energies in some particular way, and that innate predisposition toward the manner of expending psychic energy, combined with various childhood experiences, molds the general style of an individual, which directly influences the individual’s pursuit and maintenance of a particular form of work.  It is clear that most Tractor Trailer Truck Drivers’ temperaments have common characteristics and School Teachers have different temperaments, but ones in common with other teachers.  Indeed, there are certain personality traits that are more conducive to elementary school teaching than secondary school teaching.  
 

Basic Statistical (and Practical) Considerations for Standardized Testing

The employment of standardized testing involves three basic considerations: Validity, Reliability, and Usability.  Validity is the most important consideration.  Validity of the test concerns what the test measures and how well it does so.  No test can be said to have “high” or “low” validity in the abstract.  Its validity must be determined with reference to the particular use for which the test is being considered.  Content validity involves essentially the systematic examination of the test content to determine whether it covers a representative sample of the behavior domain to be measured.  Content validity is most obviously important in achievement and aptitude tests.  Construct validity is probably the most important type of psychological theory.  With construct validity, there is a prediction of the results that should be obtained if the test is truly valid.  Criterion-related (or predictive) validity indicates the effectiveness of the test in predicting an individual’s behavior in a specified situation.  Based on the predictive validity of the test, one can make inferences from test scores to specific situations (e.g., a high score in Mechanical Reasoning will predict the potential to learn mechanical work).  

Attempting to define the validity of the test, however, will be a futile effort if the test is not reliable.  Reliability of standardized tests refers to the consistency of scores obtained by the same individuals when re-examined with the same test on different occasions, or with different sets of equivalent items, or under other variable examining conditions.  The concept of reliability underlies the computation of the error of measurement (error variance) of a single score, whereby one can predict the range of fluctuation likely to occur in any single individual’s score as a result of irrelevant, chance factors.  Stated simply, by test reliability, one refers to the reproducibility of a set of test results.  A test with high reliability is one that will yield very much the same relative magnitude of scores for a group of people under differing conditions or situations.  Reliability estimates are presented in a numerical coefficient.  A perfect reliability (correlation) coefficient of +1.00 is statistically impossible to obtain with any test, but essentially means that there is a one-to-one (absolute) correlation between scores obtained today with those that would be expected with the same instrument (or different sets of equivalent items) tomorrow.  

Classical test-score theory assumes that each person has a true score that would be obtained if there were no errors in measurement.  However, because measuring instruments are imperfect, the score observed for each person may differ from the person’s ability or characteristic.  The difference between the true score and the observed score results from measurement error.  Measurement error can be a function of various dynamics and sources and is not always a function of test reliability.  Anything that affects scores differently increases the amount of error variance and lowers the reliability and (indirectly) the validity of an instrument.  Examinee motivation, time influence, situation-induced factors (e.g., secondary gain), distortion (cheating or faking), and cultural differences are among the numerous sources of error variance.  

An experienced test interpreter will be able to account for the numerous factors that potentially cause measurement error.  One method of accounting for measurement error is to administer more than one instrument measuring the same behavior, such as arithmetic ability.  Another method is, of course, to review test data gathered by different sources, perhaps at different times, to make comparisons with information from a current assessment.  

Validity is the extent to which a test does the job desired of it; the evidence may be either empirical or logical.  Validity is established to a statistical comparison of scores with values on some outside variable.  Reliability is the reproducibility of a set of scores under differing conditions (i.e., consistency or stability of a measuring instrument necessary for, but not sufficient for, validity). 

Usability is consideration of the many practical factors that are going into the decision to use a particular test.  A longer test may be more reliable, even more valid; however, if there is only a limited time for testing, one may have to compromise with that particular ideal.  Whether the preferred test is too expensive or unavailable can determine the selection of one test over another.  

Vocational Evaluation Test Selection

Vocational evaluation should endeavor to integrate standardized test data from measures of ability, personality, and interest.  The most frequently employed ability measured in occupational assessment is the Vocational Aptitude Battery.  There are several vocational aptitude batteries on the market as well as some that are not readily available to the private practitioner but are nonetheless frequently referenced in military, educational, and employment records.  

Bennett Mechanical Comprehension Test – Designed to measure the ability to understand and perceive the relationship of physical forces and mechanical elements in practical situations, The Bennett Mechanical is considered a valid instrument for what it purports to measure and rates relatively high in terms of simplicity of instructions and responses required.  In many trades and occupations, the understanding of mechanical principles is a prerequisite to successful performance.  Automotive mechanics, plumbers, mechanical engineers, trade school applicants, and persons in many other “hands-on” vocations need to comprehend the basic mechanical principles in order to succeed in their fields.  This test consists of pictures about which the examinee must answer straightforward questions.  The situations depicted emphasize basic mechanical principles that might be encountered in everyday life.  In spite of its psychometric excellence, the Bennett Mechanical is in need of modernization.  

Career Ability Placement Survey – Designed to predict an individual’s potential to learn and/or perform occupations in 14 vocational fields, the Career Ability Placement Survey (CAPS) provides information regarding the test-taker’s Mechanical Reasoning, Spatial Relations, Verbal Reasoning, Numerical Ability, Language Usage, Word Knowledge, Perceptual (clerical) Speed and Accuracy, and dominant-hand Manual Speed and Dexterity.  Highly formulated on the Employee Aptitude Survey and the General Aptitude Test Battery, the CAPS can be administered individually or in a group.  It is easily and rapidly scored.  It has a very high predictive value with a predictive validity coefficient of .97 percent, according to the test makers.  The CAPS also has the advantage of being constructed with the COPSystem Interest Inventory, providing compatibility between aptitude and interest testing.  

Differential Aptitude Test – The Differential Aptitude Test (DAT) was first issued in 1947 to provide a basis for educational and vocational guidance of students in grades 7 through 12.  Subsequently, examiners have found the DAT useful in vocational counseling of young adults out of school and the selection of employees.  The DAT consists of eight independent tests: Verbal Reasoning, Numerical Reasoning, Abstract Reasoning, Perceptual Speed and Accuracy, Mechanical Reasoning, Space Relations, Spelling, and Language Usage.  The reliability of the DAT is generally quite high.  The test manual presents extensive data demonstrating that the validity data predict the DAT to be a good indicator of school grades and performances on other aptitude tests.  

General Aptitude Test Battery – In the late 1930s, the U.S. Department of Labor developed aptitude tests to predict job performance in 100 specific occupations.  In the 1940s, the department hired a panel of experts in measurement and industrial-organizational psychology to create a multiple aptitude test battery to assess the 100 occupations previously studied and many more.  The outcome of this herculean effort was the General Aptitude Test Battery (GATB), widely acknowledged as the premier test battery for predicting job performance.  Unfortunately, the U.S. Department of Labor limits distribution of the GATB to state agencies of Vocational Rehabilitation, Offices of Employment Security, and some public school districts and nonprofit organizations.  

Armed Services Vocational Aptitude Battery – Designed for the Department of Defense, the Armed Services Vocational Aptitude Battery (ASVAB) is administered to more than 1.3 million students each year.  A multiple aptitude battery, the ASVAB was designed for students in grades 11 and 12 and in post secondary schools.  The scores yielded are used in both educational and military settings.  The psychometric characteristics of the ASVAB are excellent, and the test manual and supporting documentation reveal that the ASVAB is a valid predictor of performance during training for a variety of military and civilian occupations.  Like the GATB, the ASVAB is not available to private practitioners, but the data these tests yield should be familiar to vocational experts who will frequently encounter them in educational and military records.   

The Wonderlic Personnel Test – Even though it is described as a personnel test, the Wonderlic is really a group test of general mental ability.  What makes this instrument somewhat of an institution in personnel testing is its format (50 multiple-choice items), its brevity (a 12-minute time limit), and its numerous parallel forms (16 at last count).  The reliability of the Wonderlic is quite impressive, especially considering the brevity of the instrument.  Internal consistency reliabilities typically reach .90, while alternative-form reliabilities usually exceed .90.  Regarding validity, if the Wonderlic is considered a brief test of general mental ability, the findings are also quite positive.  For example, one investigator reports a correlation of .91 between scores on the Wonderlic and scores on the Wechsler Adult Intelligence Scale, generally considered the gold standard in assessing adult mental ability.  

The Minnesota Clerical Test – The Minnesota Clerical Test (MCT) purports to measure perceptual speed and accuracy relevant to clerical work.  The MCT is divided into two subtests: Number Comparison and Name Comparison.  Each subtest consists of 100 identical and 100 dissimilar pairs of digit or letter combinations.  The examinee is required to check only the identical pairs, which are randomly intermixed with dissimilar pairs.  The score depends predominantly upon speed, although the examinee is penalized for incorrect items.  The reliability of the MCT is acceptable, with reported stability coefficients in the range of .81 to .87.  The MCT manual reports studies that are correlated with measures of job performance, measures of training outcome, and scores from related tests.  The job performance of directory assistants, clerks, clerk-typists, and bank tellers was correlated significantly but not robustly with scores on the MCT.  The MCT is also highly correlated with other tests of clerical ability.  
 

Achievement and Intelligence Testing

In particular situations, the vocational/disability evaluator will use measures of achievement and intelligence.  These types of instruments are used to investigate an individual’s capacities to learn and profit from additional education.  Achievement testing, particularly reading achievement, can also provide a preliminary determination as to whether the examinee can indeed read well enough to qualify for additional paper-and-pencil testing.  Intelligence testing can provide information on not only learning potential, but learning style as well.  Not every vocational evaluator is trained or qualified to administer particular intelligence tests.  For example, the Wechsler Adult Intelligence Scale, now in its third edition, is beyond the training and qualifications of most master’s level evaluators.  

Wide Range Achievement Test-Revision3 – The Wide Range Achievement Test-Revision3 (WRAT-R3) is an individually administered achievement test that was designed as an adjunct to tests of behavioral adjustment, intelligence, and aptitude.  Basically, this instrument is used to measure the achievement level or presence of a sensory-motor skills level in learning to read, spell, write, and arithmetically calculate.  

Peabody Picture Vocabulary Test-III – The Peabody Picture Vocabulary Test-III (PPVT-III) measures hearing or perceptive vocabulary, presumably providing a rough estimate of verbal intelligence, and one can use it as a screening instrument or as a supplement to other measures in evaluating learning problems and potentials.  The advantage of the PPVT-III is that it can be administered to a wide range of individuals, ranging from 2.5 years to adult.  

Peabody Individual Achievement Test-Revised – The Peabody Individual Achievement Test-Revised (PIAT-R) is designed to measure school achievement in the areas of mathematics, reading, spelling, general information, and written expression.  The PIAT-R covers a wide range of achievement levels from preschool to post-high school.   

Kaufman Brief Intelligence Test – The Kaufman Brief Intelligence Test (K-BIT) is a “screening” instrument measuring verbal and nonverbal intelligence, consisting of two subtests.  The Vocabulary subtest measures verbal, school-related skills (“crystallized thinking”) by assessing an individual’s word knowledge and verbal concept formation.  The Matrices subtest measures nonverbal and problem-solving skills (“fluid thinking”) by assessing an individual’s ability to perceive relationships and complete analogies.  The K-BIT’s standard scores are normed to permit direct comparisons with global scores earned by an individual on the Wechsler (1974, 1981, 1989) series of scales, the Kaufman intelligence scales, and on achievement batteries (such as the WRAT-R).  The K-BIT is normed for subjects ages 4 to 90, and one of its advantages is that it can be administered in 15 to 30 minutes.  Reliability findings for the K-BIT are exceptionally strong.  The K-BIT manual reports highly supportive validity data from 20 correlational studies.  Although the K-BIT yields standard scores having the same mean and standard deviation as the Wechsler and Kaufman scales, the K-BIT should not be used as a substitute for a comprehensive measure of the intelligence of a child or adult.  

General Ability Measure for Adults – The General Ability Measure for Adults (GAMA) provides an estimate of an individual’s nonverbal intelligence using abstract designs.  Nonverbal abstract figures (rather than verbal content) are used to minimize the effects of knowledge, verbal expression, and verbal comprehension on test scores.  This approach offers the advantage of providing an instrument that is accessible to a wide variety of people with different communication skills and diverse linguistic, cultural, and educational backgrounds.   

Beta III – This instrument is the third edition of the Beta Examination, a rough measure of general intelligence of persons who have difficulty reading or speaking English.  It is designed for use with individuals in the general population ages 16 to 89 years, or with individuals who are non-English speakers, are relatively illiterate, or have language difficulties.  The Beta III consists of five subtests: Coding, Picture Completion, Clerical Checking, Picture Absurdities, and Matrix Reasoning.  The final score is displayed as a nonverbal IQ.  Validity studies report that the Beta III is highly correlated with the WAIS-III.  

Slosson Intelligence Test-Revised - Designed as a screening instrument of intelligence, the Slosson is orally administered to eliminate reading by the test-taker.  Although the Slosson can be administered to illiterate or other clients who may be disadvantaged because of cultural or social status, it should be considered a screening instrument only.

Wechsler Adult Intelligence Scale-III - David Wechsler defined intelligence as the capacity to act purposefully and to adapt to the environment.  Intelligence is, he stated, “the aggregate or global capacity of the individual to act purposefully, to think rationally and to deal effectively with his environment.”.  The Wechsler Adult Intelligence Scale-III (WAIS-III) contains verbal and performance subtests and yields three IQs (Verbal Scale IQ, Performance Scale IQ, and Full Scale IQ).  The WAIS-III also provides index scores for Verbal Comprehension, Perceptual Organization, Working Memory, and Processing Speed.  The WAIS-III is considered the premier standardized test of adult intellectual capacity.  Administration requires considerable training and experience, preferably in earlier versions of the Wechsler tests.   

Structured Personality Tests

An examinee might have the aptitude, intelligence, and abilities to execute a particular type of work, but if she/he does not possess the temperament or “normal” personality variables (e.g., achievement, motivation, dominance, introversion/extroversion) suitable to the work expected, the occupational match will be inadequate, and the prospective worker will cause herself/himself or others problems in the workplace.  As a result, personality assessment is a key component to vocational/disability evaluation.  Objective personality measures are those that are structured in questionnaire form so the test administrator is not part of the psychometric process and the “structure” of the test is designed to eliminate ambiguity.  The clear and definite stimulus is provided, and the requirements of the subject are evident and specific.  An example of a structured personality test item is, “Respond ‘yes’ or ‘no’ to the statement: ‘I am happy.’” In contrast, a subjective (or projective) test item may provide a picture or inkblot and ask, “What might this be?”  In a projective personality test, the stimulus is ambiguous and the subject has few guidelines about what type of response is required.  

The foremost structured personality test in the world is the Minnesota Multiphasic Personality Inventory-2.  However, other personality questionnaires, including the California Psychological Inventory and the 16 Personality Factor Questionnaire, have been used frequently in career-oriented assessments and vocational/disability evaluations.  

Minnesota Multiphasic Personality Inventory-2 – In 1940, a number of articles detailing the development of a new paper-and-pencil personality test, the Minnesota Multiphasic Personality Inventory (MMPI), were published.  Since that time, the MMPI-2 has become the most widely researched and validated structured personality instrument in the world.  The MMPI is a true-false self-report questionnaire designed to assist in distinguishing normal personalities from abnormal groups.  Specifically, the test was designed to aid in the diagnosis or assessment of major psychiatric or psychological disorders.  Beginning in 1992, a major effort was made to date and re-standarize the original MMPI, and the result was the MMPI-2, which is used primarily to determine disabling psychological abnormalities, and its utility as a vocational assessment tool is limited.  

California Psychological Inventory – The California Psychological Inventory (CPI) is a personality inventory that develops descriptive concepts having relevance to personal, social, and vocational situations.  The CPI was developed, in part, from the MMPI by taking 178 items directly from the MMPI and adding 35 slightly revised items from the MMPI.  Eighteen CPI scores are yielded in such areas as dominance, sociability, socialization, responsibility, self-control, and flexibility.  The CPI is appropriate for both females and males possessing at least a seventh-grade reading level.  Although it covers several of the same areas as the MMPI, the CPI is considered to be much less threatening to the examinee and, as such, elicits less hostility and resistance on the part of the test-taker.  

Edwards Personal Preference Schedule – Designed to assess 15 basically normal personality variables, the Edwards Personal Preference Schedule (EPPS) was originally developed for college students and adults to be employed primarily in counseling settings.  The personality instrument was designed for normal clients with a fairly high reading level.  Some test sophistication is necessary for completion, and it may not be appropriate for assessing the personality of severely disturbed clients.  Although widely accepted in the rehabilitation field, the EPPS requires a relatively high reading level, which limits its usability with some clients.

The 16 Personality Factor Questionnaire – Now in its fifth edition, the 16 Personality Factor (16PF) Questionnaire assesses 16 of the most important dimensions of personality.  Not only is a personality profile developed from the 16 factors, but observations are also available regarding clinical aspects of behavior, vocational implications, further vocational patterns, and occupational fitness projections.  Data regarding an examinee’s occupational fitness for 24 different occupational groups are yielded by 16PF items.  It is considered less threatening than the MMPI-2.  The test is developed with a factor-analytic strategy that identifies only those traits about which questions are asked.  Short-term test-retest correlation coefficients for the 16 source traits are impressive; however, long-term test-retest coefficients are not so impressive.  The 16 source traits gleaned by testing result in five second-order factors, for which one can obtain scores and further predict vocational compatibility.  

The Myers-Briggs Type Indicator – The Myers-Briggs Type Indicator is a theoretically constructed test based on Carl Jung’s theory of psychological types.  Jung theorized that there are four main ways in which we experience or come to know the world: sensing, knowing via the sensory systems of sight, hearing, touch, and so on; intuition, guessing what underlies sensory inputs; feeling, focusing on the emotional aspect of experience; and thinking, reasoning or thinking abstractly.  The purpose of the Myers-Briggs test is to determine what four modes the examinee relies upon and where the examinee falls on an introversion-extroversion dimension.  The Myers-Briggs, like other personality measures, helps in predicting vocational preference when used in conjunction with ability and interest tests.  

Occupational Interest Measures

An implicit theme in vocational/disability evaluation is that people with medical impairments are more apt to be satisfied, to remain in their jobs, and to be productive employees if they possess an interest in what they are doing occupationally.  In addition to having the ability and possessing the necessary temperament for occupational fit, one would hopefully also possess sufficient interest in the task at hand.  There are a number of vocational interest tests utilized by the vocational evaluator.  

Career Assessment Inventory – To assess an individual’s likes and dislikes, the Career Assessment Inventory (CAI) was patterned after the Strong Vocational Interest Blank and the Strong Vocational Interest Inventory.  But in contrast, the CAI is used for individuals seeking immediate career entry and for clients wanting jobs requiring some post-secondary education, such as technical training.  The CAI has both Vocational and Enhanced versions, dispelling some early criticism regarding the original measure not always being appropriate for college-bound or eligible clients.  

Career Occupational Preference System Inventory – The Career Occupational Preference System (COPS) Inventory was designed to determine an individual’s likes and dislikes for 168 vocational activities and as an interest measure compatible with the CAPS.  The COPS is published in two versions, the vocational measure and one more appropriate for professional occupations.  In addition to an examinee’s responses to individual vocational activities, the data are available for the client’s work preferences in relation to 14 vocational families, the same categories surveyed by the CAPS.  

The Strong-Campbell Interest Inventory – In 1974, David Campbell published a new version of the Strong Vocational Interest Blank, which he called the Strong-Campbell Interest Inventory (SCII).  The SCII incorporates J.L. Holland’s theory of vocational choice.  After many years of study, Holland postulated that interests express personality and that people can be classified into one or more of six categories according to their interests: Realistic, Investigative, Artistic, Social, Enterprising, and Conventional.  The SCII in its current form is divided into seven parts and has 325 items to which a test-taker responds “like,” “dislike,” or “indifferent.”  Some criticize the SCII because it emphasizes professions that require college and professional training.  

The Minnesota Vocational Interest Inventory – The Minnesota Vocational Interest Inventory (MVII) is designed for men who are not oriented toward college and emphasizes skilled and semi-skilled trades.  The MVII assesses nine basic interest areas, including mechanical interests, electronics, and food service, as well as 21 specific occupational scales, including those for plumber, carpenter, and truck driver.  The MVII has been used extensively by the military and by guidance programs for individuals not going to college.  

The Reading Free Interest Inventory-2 – Most interest questionnaires are normed on a particular reading level, generally from five grades of education and higher, but the Reading Free Interest Inventory-2 (RFII-2) can be administered to adults who are illiterate or non-English speaking.  The RFII-2 provides an examinee’s expressed interests in 11 vocational groups.  The RFII-2 interest patterns furnish information for individuals engaged in a wide range of occupations and job tasks at unskilled, semi-skilled, and skilled levels, and is not limited to entry-level positions.  The non-reading feature of the inventory requires no verbal symbols or written statements for interpretation by examinees.  The pictorial illustrations with occupational significance are presented in a “forced-choice” technique.  Presenting pictorial activities of individuals engaged in clearly illustrated, artist-drawn job tasks circumvents the decoding and reading comprehension barrier for those individuals with limited verbal or reading ability.  

These represent but a few of the many standardized instruments that are available to the vocational/disability evaluator who is charged with the responsibility of answering questions regarding an individual’s capacities to work and earn money following the onset of a potentially occupationally significant medical impairment.  Tests are imperfect.  Clinical impressions are limited.  When test results do not make sense in the context of clinical impressions, they may be wrong, or our “impressions” may be faulty.  Neither is comprehensive in its illumination.  The important issue it is that the forensic expert attempt to employ as complete a set of investigative tools as possible.  In the realm of vocational testing, coverage of the examinee’s interests, abilities (and/or aptitudes), and personality is probably essential.  Ideally, post-injury test data in these areas can be compared to information contained in documentation regarding the test-taker’s capacities and traits in these areas.  In this regard, nothing is more informative than school and employment records regarding the plaintiff’s achievement and pattern of performance before the accident in question.    

Pre-morbid Test Data and Pre-accident Achievement

Most injured people have undergone standardized testing earlier in their lives, sometimes at work, frequently if they have had military experience, and almost always during their formal educational years.  School records of relatively young individuals (i.e., children and youth to middle-aged adults) can be helpful to the forensic examiner in assessing the plaintiff’s pre-morbid learning potentials and achievement motivation.  Beginning in second grade, public-school students are generally tested every two years with a battery of achievement tests.  Private schools have generally followed suit with this testing policy.  Complete school records, and not simply report cards or academic transcripts, can include substantial information, including screening for school readiness and assessment of learning disabilities and related disorders.  Individual achievement tests, including tests that might be repeated during forensic assessment, may be used for direct comparison.  One should keep in mind that direct comparisons must be made carefully with, frequently, numerous intervening variables in mind.  However, pre-morbid patterns of learning and achievement can be highly valuable to the forensic examiner charged with the responsibility of assessing educational, vocational, and behavioral change that might otherwise be attributed to accident and injury.  School records, military documentation, and employment information, when discovered, can be valuable sources of data regarding the plaintiff’s pre-accident achievement and potential.  
 

Other Important Issues

Psychology and the legal system have had a long and uneasy alliance characterized by mistrust on both sides.  Within the legal system, lawyers and judges maintain antipathy toward the testimony of non-medical experts because of concern that their opinions are based on “junk science” or perhaps no science at all.  Also, expert witnesses are somehow perceived as individuals hired to profess almost any viewpoint that serves the interests of the party paying them.  Vocational experts generally find the adversarial system and courtroom proceedings offensive, particularly when the expectation of yes-no answers to cross-examination questions is maintained.  Psychological and vocational experts have been trained to see the gray areas of psychological and vocational development and genuinely consider those areas when assessing an individual’s psycho-vocational development.   

To be imposed upon with black-and-white constructs from individuals who do not fully understand the discipline is too often disconcerting to the expert.  Expert witnesses of all types generally endeavor to make their profession “a life’s work,” and most experts take seriously their obligations to the justice system, including the role of assisting a judge or jury in determining the truth of the matter being litigated.  For better or worse, non-medical experts, including vocational evaluators, do testify in court cases, and the focus of the testimony often assists decision-makers in understanding vocational capacity, loss, and how medical impairment might cause disability and diminution of earning power.  

The legal system’s ignorance of non-medical evaluations, however, is exemplified in the Pennsylvania Rules of Civil Procedure (which were reformulated in 1998).  The pertinent rule added:  

…when the earning capacity of a party, or of a person in the custody and control of a party, is in controversy, the court in which the action is pending may order the party to submit to an evaluation by a suitably licensed or certified evaluator. 

This reformulated rule is significant because it authorizes courts to permit vocational examinations and further specifies that the examinations are to be conducted by a “suitably licensed or certified evaluator.”  This rule (4010.1) is significant because it recognizes the importance of vocational examination.  This is not to say that the rule establishes an absolute right to a vocational examination.  While courts, especially Pennsylvania courts, arguably have the discretion to deny such an examination, no criteria were established indicating when, if ever, it would be permissible to compel a vocational examination.  At a minimum, it should be considered an abuse of discretion for a court to refuse to hear a vocational examination when an injured plaintiff has retained his/her own vocational expert who has, in fact, performed a vocational examination.  

The discretionary component of the reformulated rule is troubling and may prevent the creation of a uniform approach to vocational examinations in Pennsylvania’s courts.  It is disturbing because it creates several restrictions on vocational examinations that may adversely affect the vocational expert’s capacity to perform his/her job.  The critical restrictions are:  

These allowances have the potential to create a deposition-like atmosphere during the vocational examination and can promote an adversarial relationship that inhibits the plaintiff from participating in the examination with candor.  Vocational testing is standardized and normed on populations without the use or presence of a representative and/or tape recorder.  Such changed testing conditions can have a negative effect on the test-taker’s performance and compromise the normative data comparison(s) required in test interpretation.   
 

Expert Testimony in Light of the Daubert and Kumho Cases

While there are other cases that impact the issue of “expert testimony,” two seminal cases are Daubert and Kumho.  In federal cases, Daubert (Daubert v. Merrell Dow Pharmaceuticals, Inc.) places the responsibility on the trial judge to determine whether expert testimony is scientifically valid and properly can be applied to the facts of a case.  There are five primary issues:  

1. Whether the theory or technique in question can be (and has been) tested;

2. Whether it has been subjected to peer review and publication;

3. Its known or potential error rate;

4. The existence and maintenance of standards controlling its operation; and

5. Whether it has attracted widespread acceptance within a relevant scientific community.

Kumho (Kumho Tire Company, Ltd. v. Carmichael) further refined Daubert to include any expert testimony, whether “scientific” or “non-scientific.”  Kumho decided that the Court had defined Daubert in terms of “scientific testimony” because the testimony relevant to the Daubert case was in fact of a scientific nature, but that Daubert applies not only to scientific expert testimony, but to all expert testimony offered in federal courts.  The reliability test for whether the expert testimony is admissible is the word knowledge, i.e., the expert’s knowledge, and not any word that modifies that knowledge, like scientific.  

Pressure on the legal system to both understand and consider the ramifications of Daubert, Kumho, and other cases dealing with expert testimony remain unfinished business and a continuing controversy for both the expert and the legal professional retaining an expert for testimony.  The issue of expert testimony in the federal courts is extremely complex and should not serve here to detract from the primary concern for testing as a critical aspect of vocational evaluation.  Bad jokes and mistrust regarding both legal professionals and experts from various disciplines will undoubtedly continue indefinitely.   

Certainly not without its faults, our legal system, however, is considered the best in the world by many, and those who hold themselves out as experts and expert witnesses generally endeavor to maintain the integrity of that system.  When the expert witness does not honor the importance of the legal system with professional behavior, the system itself generally takes care of the problem.  Forensic experts, nonetheless, should endeavor to better appreciate the system that they serve, and, of course, lawyers hiring experts will continue to learn more about the sciences that those experts represent.  
 

Summary

Vocational/disability evaluation in legal matters of personal injury is a critical component of arguing economic damages following the onset of vocational disability.  The concomitant evolution of personal injury law and disability evaluation have brought the lawyer and vocational expert together with greater appreciation of the difference between medical impairment and occupational disability.  Vocational/disability evaluation involves more than reviewing the plaintiff’s records or conducting a question-answer interview after a record review.  Thorough assessment of an injured person’s employability and capacity to earn money, both before and after the accident in question, requires an analysis of all potentially available data affecting work options.  Standardized testing can clearly augment an analysis of the plaintiff’s potentials and how those potentials may have changed as a result of personal injury and associated medical impairment.   

Various standardized tests have been refined over the years to provide valid and reliable data regarding worker characteristics and behaviors that affect and predict occupational outcomes.  Following a medical determination that an individual’s health circumstances have potentially compromised physical and/or mental functioning, there may very well be a legal argument that a change in a person’s functioning has compromised earning power.  Vocational/disability evaluation is the keystone in the tripartite analysis of how personal injury might alter an individual’s vocational and economic potentials.  Vocational testing is an important tool among the vocational expert’s methodologies of assessing occupational disability and residual employability.  

Other issues related to vocational testing in personal injury cases include the long and uneasy alliance between psychology and the legal system.  Vocational experts, like other psychologically trained professionals, have had difficulty accepting the black-and-white constructs typified by the “yes and no” expectations of courtroom proceedings.  Rule 4010.1 of the Pennsylvania Rules of Civil Procedure recognizes the importance of vocational examination but provides the plaintiff with allowances that potentially interfere with the examination process.  Concomitantly, federal cases, such as Daubert and Kumho, place greater demands on the vocational expert to offer “scientific” testimony.  By fully appreciating both the value and shortcomings of standardized testing, vocational experts and legal professionals alike can assist the personal injury adjudicator to make wise decisions concerning losses associated with occupationally significant medical impairment.  

Why Vocational Assessments are Essential to the Rehabilitation Process and Why the Qualifications of the Evaluator are Critical to the Outcome

Background:

A primary function of qualified Vocational Rehabilitation professionals is to assist employers (or their insurance carriers) to return employees who were injured (or ill) to work. 

The process used by Vocational Rehabilitation professionals to accomplish this charge is to assess or evaluate the employee.  This evaluation aspect of the comprehensive process is accomplished by:  

The evaluator (tester) carries out this activity by applying the knowledge he has acquired through formal (and certified) education in an accredited program.  The Vocational professional works in collaboration with physicians, psychologists, social workers, therapists, health care providers, and other vocational professionals.  

The intended outcome of the assessment is to explore vocational options that will support a viable work re-entry plan.  A return to work is the optimal outcome; in rare (cata-strophic) cases, the outcome may indicate that work at any level may not be practical.  In these rare instances, treatments or other interventions need to be considered.  In all other cases, the objective is a return to work, with or without an accommodation (as proscribed by the Americans with Disabilities Act).  

Basically, vocational evaluations are designed to determine preferences (individual interests) and suitability (individual aptitudes and achievement levels).   These factors can be determined through the application of formal psychometric methods/materials, such as occupational interest inventories, and with vocational aptitude tests.  

Vocational assessments are used to determine whether an injured (or ill) employee is able to return to work, and if so, to what kind of work.  If return to work is indicated, the outcome of the evaluation will address the critical issues of competitive employment.  Diagnostic vocational testing or functional evaluations may include an: 

Comprehensively, all vocational evaluations focus on cognitive, educational, and emotional issues. 

Testing is done to develop baseline data on which an employment plan may be structured.  There are numerous test instruments available (see attached), depending on the test administrator’s qualifications.  A sampling of frequently used instruments could include:  

Vocational rehabilitation evaluations culminate in a comprehensive report (to the employer or insurance carrier) detailing a viable course of action for the employee.  These reports are critical as the basis for decision making by the employer.  In addition, the evaluation reports can be, and frequently is) the prima facie evidence in litigation.    

Why the Qualifications of the Evaluator are Critical

Much, if not most, of the work done in vocational rehabilitation is based on documentation.  That is, when the records indicate that the client has a high school diploma (or even a GED diploma), for example, that fact is assumed to equate to a certain level of achievement.  In reality, an assumption of achievement level and that level as determined by objective testing, are purely coincidental. 

The recommendation of physicians in respect to a specific patient’s physical capacities to work is also frequently unreliable I went on regarding actual employment potential.  At issue here is the basic difference between “impairment” and “disability.”  Defining an impairments is, of course, within the scope of the physician’s expertise, whereas, providing statements of vocational disabilities are not the physician’s purview.  In terms of a work disability, the designated decision maker needs to understand the physical and mental requirements of the specific work task to decide whether the impairment will, with or without a job accommodation, become a disability for the employee.  This expertise on occupational capacity is the qualified Vocational professional.  In addition to the issue of the Americans with Disability Act’s (ADA) definition of accommodation, “with or without” a job modification, for example, physician’s are generally not in a positions to know what the specific physical (standing time, pounds to be lifted or whatever) or mental requirements of a job are.  Qualified Vocational Evaluators are educated and experienced in the issues of job analysis, disability assessment, and evaluation of an employee’s ability to perform at a specific level of accomplishment.  

Still another important issue in terms of qualified evaluators as opposed to unqualified but practicing vocational professionals, is the important issue of the qualifications to testify in litigations.  This issue was addressed by the 9^th Circuit Court in 1993 in a case named Daubert et al v. Merrell Dow Pharmaceuticals, Inc.  “Daubert”, as it is commonly referred to, says:  

            “ Expert opinion based on scientific technique is inadmissible unless the technique is generally accepted as reliable in the relevant scientific community.”

The ruling requires that trial judges must make a preliminary assessment of whether the testimony’s underlying reasoning and methodology is scientifically valid and properly can be applied to the facts at issue.  Considerations include whether:  

Meeting the threshold requirements of “Daubert” in litigation is daunting even for qualified, certified, and richly experience Vocational Experts.  Engaging vocational evaluators without the minimum qualifications to do professional evaluation, including testing is likely to be unproductive.

The Components of a Disability Management Program

by Jasen M. Walker, Ed.D.,  C.R.C., C.C.M., and Fred Heffner, Ed.D.

Well-managed companies develop and maintain Disability Management Programs.  They do this to control costs and to earn the dedication and loyalty of their employees.  Following is a description of the basic components of a Disability Management Program

Disability Management is a cost-containment function.  Employers who are interested in cost containment are, by the same token, interested in creating and operating an effective Disability Management Program (DMP).

Exemplary DMPs, as defined by well-managed organizations, all have specific components.  These components are stated in terms of the actions taken to create an effective program:

Selling Management on the Benefits of a Disability Management Program

For a Disability Management Program (DMP) to succeed, it will require the unreserved support of top management. 

While it may be possible to develop a DMP without the expressed, documented support of the organization’s CEO, the program is certain to be more successful if top management understands the benefits that derive from such a program.  This issue goes to the very heart of the organization’s “culture.”  If top management understands and overtly supports programming that values each employee, the organization is positioning itself among the best-managed organizations in the country.  

The issue is not just that top management gives its approval to the development and implementation of a DMP.  Rather, the issue is that by doing so the organization is demonstrating that it recognizes it cannot succeed in the long term if it does not care for, and advocate for, the welfare of its employees.  This commitment becomes as important to the organization as the Vision Statement the organization has developed to guide and nurture its corporate growth.  

Top managers who resist providing documented support of a DMP are, at the same time, resisting a willingness to honor and protect their employees.  A full commitment encourages a good life for each employee --one that encompasses both an individual’s home life and work life. 

Should top management resist uncompromising support on the basis of the best interest of their employees, they certainly cannot resist the development of an effective DMP on the basis of cost containment.  There are a number of longitudinal studies on cost factors relating to DMP, including the several studies done over the years by the UNUM insurance company.  Briefly, the findings of another cost analysis --the Watson Wyatt/Washington Business Group on Health-- found that two-thirds of the companies that do not integrate their disability programs reported incurring annual direct disability costs of 5.4 percent of payroll, while those that did integrate reported direct costs of only 2.7 percent of payroll.  In every case where studies have been conducted, cost containment is dramatically enhanced when an effective and comprehensive DMP is in place.  

In organizations that do not have comprehensive DMPs, the Human Resources professionals of these organizations must organize a strategy to get top management support.  Once the support is documented, the new direction needs to be promoted and publicized both within the organization and without, as appropriate. 

Creating and Empowering a Disability Management Team

The single most effective way of planning and operating a Disability Management Program is through the formation of a Team.  Planning and implementing a DMP within a work organization is different from the creative process in other endeavors where “too many cooks spoil the broth.”  

There are several reasons why a team approach is appropriate.  First, the decision-making process needs to represent a number of special interests.  For example, the employees covered by the DMP need an opportunity to be represented in the policy-making and decision-making components of the program.  Similarly, Supervisors who will be directly impacted by the operation of the DMP must also be given a voice in the policy shaping and operation of the program.  A “Team” without representation of these two constituencies is bound to fail. 

Other considerations for team membership are a bargaining unit representative, a representative from the organization’s medical professions, if any, and, of course, representatives from the Human Resources department who will be charged with the operation of the program.  Frequently, return to work decisions following occupational injury not only involve medical considerations and supervisory concerns, but ADA and FMLA issues with which HR professionals are most familiar. Further, any other individual who may be in a position to be an obstruction to the planning and operating components should be considered for membership as a way of channeling this person’s potentially negative influence. 

Consideration might also be given to including an individual from the community who has experience in a disability advocacy role in the community, for example, the Executive Director of the County Association for the Hearing Impaired.  The inclusion of such experienced advocates, regardless of their specialties, can provide valuable insights into the needs and desires of individuals with disabilities, as well as knowledge of effective programming used in other organizations. 

If feasible, the teams should be appointed, and thus empowered, by the CEO.  After the team has been created, its first responsibility will be to organize the team to achieve objective-driven outcomes.  Objectives, including milestone completion dates, are the first order of business.  Evaluations need also to be developed and scheduled to assess the team’s effectiveness. 

Creating and Operating a Transition-to-Work Program

To succeed at returning an employee to work, a planned, specific, and documented strategy is needed.  The "plan" is created through the composite input of all of the principals in a situation, and the "Transition-to-Work Plan" is developed as a joint effort.  Essential members of a Disability Management Team include the following: 

It is not essential that all team members physically meet to develop the plan.  A draft plan (strategy) can be given to the treating physician, for example, for input or, at least, consent in the form of an approval signature.  A communications protocol for getting treating physician input is a critical feature of the procedures that need to be developed. Essential function job descriptions will be key to that communication between work organization and treating physician. 

Employers may also want to consider individuals with specific expertise as consultants to the construction of a given Transition-to-Work Plan.  For example, individuals with experience in ergonomics, a specific disability (e.g., hearing impairment), and/or job redesign could represent cost-effective additions to the team in appropriate cases. 

Caveat:

It will be absolutely essential that the rehabilitating/transitioning employee understands the Transition-to-Work Plan that is being designed for him/her, that he/she has had an opportunity to help to shape the plan, and that he/she accedes to the plan's objectives.  Involving the employee returning to work helps prevent "injured worker helplessness" and reduces the likelihood that the employee will find legal representation leading to adversarial interaction.  However, if the injured employee is legally represented, the Disability Management Team should consider inviting the employee’s legal representative to a return-to-work planning session. 

Click here for a PDF format of Sample DM Components

Quantitative and Qualitative Outcome Measures: 

All newly implemented management concepts need to be evaluated for effectiveness.  The Transition-to-Work program is no exception. 

To measure the process quantitatively, the base standards need to be documented. Until Workers' Compensation costs began to skyrocket, many companies did not return many (most?) injured/ill workers to the company.  Outsourcing was the typical approach.  In those cases, Return-to-Work (RTW) programs were rare or nonexistent, and there were no baseline data to measure how effective the program was or how much it saved. 

What a company does in terms of its disability programming is financially significant, and if there is no extant database of information, a data gathering procedure should be designed and activated simultaneously with the Transition program. 

Questions that should be answered as a result of the data gathered include such things as: 

Flexible Return-to-Work Options Bridge the Gap Between Injury and Full Duty 

The April 5, 1997, issue of the Pennsylvania Bulletin was given over to a "Statement of Policy" on Act 57 of the Workers' Compensation Act.  This statement was created by the Pennsylvania Department of Labor to "explain and enforce the provisions of the WC Act."  That is, these statements indicate what standards employers will be held to in terms of Act 57 compliance. 

Section 306(B)(2) of Act 57, the Pennsylvania Workers' Compensation Act, states: 

If the employer has a specific job vacancy the employee is capable of performing, the employer shall offer such job to the employee. 

The language in Pennsylvania's Workers' Compensation law challenges employers to have pro-active Return-to-Work (RTW) programs, and there are compelling reasons every employer should want to do so to: 

1. save significantly on Workers' Compensation costs, and

2. reduce exposure to disability discrimination lawsuits under the Americans with Disabilities Act of 1990.

Over the past several years, employers have frequently resolved their injured worker situations by asking Vocational Rehabilitation specialists to find new jobs for these workers.  Now, studies of this approach to workplace injuries have shown that a Return-to-Work program is by far more effective for employers than traditional outsourcing.  In fact, a Return-to-Work program in a medium-sized company reduces lost-time indemnities by 20-40%.  In addition to these significant cost-of-doing-business savings, RTW programs: 

To assist employers who are not presently sponsoring RTW programs in their work organizations, CEC Associates in Valley Forge, PA, offers comprehensive services of to:

1. create a Return-to-Work program and

2. train professional staff to implement it.
   

Understanding the Principles of Learned Helplessness/Learned Laziness and Learned Optimism as they relate to Disability Management

Learned Helplessness and Learned Optimism are constructs of human behavior developed, researched, and reported by Martin E. P. Seligman, a professor at the University of Pennsylvania in the early 1970s and 1990s respectively.  Learned Laziness is a concept researched at the University of Minnesota while Seligman was investigating Learned Helplessness initially in animal studies and eventually in a full range of human subjects.  Seligman moved beyond the Learned Helplessness model to configuring an anecdote of sorts, that of Learned Optimism. 

Briefly stated, Learned Helplessness is the theory that when individuals perceive no relationship between their behaviors and social outcomes, they learn helplessness.  When individuals are rewarded non-contingently, that is, they are paid regardless of their behaviors, they learn laziness. Seligman refined the learned helplessness model with a theory of attribution.  He suggested that depending on attributional style, a particular individual was more or less susceptible to learning helplessness.  Seligman does not comment on learned laziness, a theory that has sometimes been called the "welfare pigeon" syndrome.  Not incidentally, the notion of learned laziness has been at the core of the "welfare to work," movement. 

In 1992, Jasen Walker, an educational psychologist and vocational/disability evaluator in private practice, applied the theories of Learned Helplessness and Learned Laziness to the fields of disability management, work injury management and vocational rehabilitation.  Walker concluded that the lost time system in general and the workers’ compensation programs in most states can induce both laziness and helplessness in those injured employees that the systems are purportedly designed to help.  Walker coined the term "injured worker helplessness," and described how different players in the workers’ compensation lost time system set the stage for an injured individual to adopt the belief that behavioral outcomes are beyond his or her control.  At the same time, the system provides wage replacement and non-contingent rewards to the claimant who learns laziness as a result.  Walker has shown that the lost-time injury compensation systems provide the necessary conditions for learning both helplessness and laziness. 

Learned helplessness and learned laziness are important concepts to understand when designing Disability Management Programs.  By understanding the ramifications of these behavioral/motivational theories, employers are more likely to succeed at planning and implementing programs that will benefit the long-term interests of both the employer and the employees. 

In short, work organizations need to design procedures to assist injured workers to return to productivity as soon as possible, injury management programs that keep injured employees out of the workers’ compensation system and in the workforce.  The procedures and programs would include, for example, that require supervisors to interact with injured workers immediately following lost time injury.  Transition-to-Work programs that facilitate job accommodation and modified employment as soon as medically possible are also critical in preventing the antecedents to learning helplessness and laziness. 

Seligman further contributes to an understanding of injured worker helplessness by advancing his motivational theory with the notion that individuals are also capable of learned optimism.  Seligman offers the construct of "attribution theory" as a means of understanding that certain individuals can be prone to pessimism as opposed to optimism by virtue of their explanatory styles.  Walker again adopted Seligman's thinking along with the important work of Rodney Lowman (Work Dysfunctions, 1993) and introduced the concept of the "disability-prone" employee.  Some employees, under particular management and work conditions are, in fact, more susceptible to accident and injury than other workers.  Further, disability proneness can be predicted by trained human-resource professionals, and when this is done, preventative and early interventions (i.e. mediation intervention and/or employee assistance programming) can be taken to avoid lost time secondary to disability. 

Seligman also posits that individuals can be tested as being inherently, and largely, either pessimistic or optimistic.  Therefore, some companies, especially those that have high turnover rates (insurance sales, for example), have begun to test job applicants on their pessimism/ optimism quotients.  Those who test optimistic are more likely to persist and succeed.   

Understanding the Role of the Vocational Evaluation and the Functional Capacity Evaluation 

To make informed employment decisions about employees who have been ill or injured, employers need specific, relevant data.  These data must cover two separate aspects of an employee’s present circumstance: physical condition and vocational suitability.  The evaluations that produce the information employers need to make these decisions are performed by certified and skilled professionals. 

The guiding principle behind these evaluations is that the employer wants the employee to return to work as soon as possible, and the employee wants to return.  Employers and evaluators are, in exemplary programs, invested in the evaluation outcomes for the express purpose of returning the employee to productivity. 

Vocational evaluations are performed by certified vocational experts. Functional capacity evaluations are performed by physical therapists or other trained health care providers (e.g., chiropractors and psychiatrists).  

Functional capacity evaluations determine in great detail the capacity for work of an individual in terms of lifting strength, durability for certain tasks, length of time for standing or walking, etc. These detailed factors are then used by vocational experts to determine the kinds of jobs a worker can perform, and by extension, the jobs available in a given work organization for anyone with that capacity.  Vocational experts apply a battery of tests designed to determine an individual’s preference and suitability for work, and use their experience to guide the employer to the best return-to-work approach for an individual employee. 

It is important to recognize that employment decisions are always to be made by the employer, not by evaluators.  For example, a judgment by a physician that an individual cannot work is not acceptable.  The outcomes of both the vocational evaluation and the functional capacity evaluation are specific as to the kinds of tasks an individual can perform, and it is then the responsibility of the employer to decide whether there are jobs available that match the vocational and capacity data.    

Using Vocational Testing in Return-to-Work Decisions

Employers invested in implementing effective disability management programs will benefit from a greater appreciation for, and utilization of, vocational assessments.  These assessments employ standardized measures of ability, interest, personality, and work temperament.  

Normally, the choice of a career, which is often thought of as a once-and-forever decision, surpasses many other major life events in the potential impact on a person’s life and productivity.  Vocational decisions after an occupationally significant injury are equally difficult.  “Occupational fit” based on outcomes from a vocational assessment administered by a trained Vocational Specialist is the key to a successful transition-to-work.  For an individual who cannot return to the same position he/she held before the injury, modified employment is generally the solution for the employer wanting to show loyalty to the organization’s workers.  Modified employment is frequently in the best interest of the employee as well. 

Experience has shown that good vocational assessments must include the collection and interpretation of information in at least three separate domains: abilities, interests, and personality characteristics.  Comprehensive understanding, and therefore competent return-to-work decisions, rest on a careful examination of variables beyond simple physical capacity to work.  If a truck driver who has been injured is offered the opportunity to become dispatcher, the employer will first have to know how well he can read and whether he can adapt to indoor work.  On the other hand, the ability to read may not be an essential requirement to be productive as a radio dispatcher for the company but working inside will be.  Truck drivers, to stay with the example, can be intelligent enough and temperamentally suited to be excellent dispatchers and traffic managers if they are given the opportunity to learn through on-the-job training.  Vocational evaluations provide the specific information employers need to make appropriate decisions. 

At the point of hire, most employers do not know enough about the people they employ.  Surprisingly, an occupational injury actually provides an opportunity for the employer to reevaluate a worker’s capabilities and his/her potential to be productive in the workplace.  Using effectively written “essential function” job descriptions, understanding an individual’s post-injury functional capacities, and carefully assessing the returning employee’s abilities, interests, and work temperament hold the key to effecting a successful accommodation in a return-to-work plan.  

Vocational evaluators who have practical experience in career assessment and vocational testing can investigate an individual’s mental abilities, vocational interests, and occupationally relevant personality characteristics.  Occupational testing in general can be accomplished in less than three hours.  With the availability of these data to compare (match) with essential-function job descriptions, return-to-work decisions can be made with greater validity and reliability than relying simply upon “guesstimates” of what a person might do based on work experience alone.  

Determining what a person can do physically, intellectually, and temperamentally helps employers to match employees to available jobs.  This information will generally constitute the major difference between successful and unsuccessful return-to-work efforts.   

Creating a Medical Care Plan to Guide an Injured Worker through the Treatment Process 

A Medical Care Plan needs to be created by the designated Case manager or Health Care Coordinator to guide and monitor the Treatment Process.  The Guide sets forth the step-by-step procedures needed to monitor the Medical Care of the injured worker. 

The designated Case Manager is to be notified immediately when an accident occurs and he/she should become involved by accompanying the injured employee to the initial medical treatment and by visiting the injured employee at the treatment site as soon as possible after the accident.  From that early involvement, the Case Manager will monitor and record the treatment details.

Click here for copies of sample Case Management Reports

Implementing Medical Care Coordination for Cost Containment

Creating and operating a Medical Care Coordination process includes five stages: 

1. Gaining Top Management’s Commitment for the Process

2. Developing Procedures for the Process

3. Training Appropriate Staff Members in the Process

4. Implementing Medical Care Coordination

5. Evaluating the Implemented Process
   

Gaining Management’s Commitment for a Medical Care Coordination Program

Well-managed companies have comprehensive Disability Management Programs in place and working for the benefit of both the company and the individual employee.  Top managers need to take time from the day-to-day operational problems of a company to focus on the need for Disability Prevention and Management processes.  There are two significant reasons why this kind of process is essential to every company: 

1. The cost of not having a program in place is formidable and even threatening to the company’s long-term viability.

2. Management demonstrates a commitment to the welfare and job satisfaction of its valued workers through the endorsement of a disability support program.  

The responsibility for achieving a management commitment to the individual components of a Disability Prevention and Management program should fall to the company’s Human Resources Department administrators. It is their responsibility to gather and organize data that spell out the cost of disability in their company, as well as collecting literature that describes what well-managed companies (DuPont, L.L. Bean, United Parcel Service, etc., etc.) have done, and are doing, in terms of Disability Management and Return-to-Work programs. 

Of the various components of a comprehensive Disability Management Program that are critical to cost reductions, Medical Care Coordination is pivotal.  Activities leading to a management commitment for a Medical Care Coordination process are: 

This presentation should include: 

Once the commitment from management is in hand, the Human Resources department must develop and conduct planned dissemination and education sessions for all employees.  

Developing Procedures for the Medical Care Coordination Process

To coordinate the treatment program (the medical care program) for an injured employee, a qualified medical professional is needed.  Generally, this person is a Certified Case Management Professional. In the Medical Care Coordination process, a qualified professional tracks and monitors the treatment of an injured employee for the purpose of gaining the best possible treatment for the employee, and for ensuring that the medical fees and charges are fair, reasonable, and within the range of standard and acceptable charges for these services in the employment region. 

A planning team should be organized and convened for the purpose of writing procedures.  This team should include a/an: 

The objective of the team is to plan and document a process for coordinating the treatment of any injured  or ill employee.  The finished document can be considered a work in progress, as opposed to a non-alterable document, and should be revisited and updated/revised on a regular basis.   

Training Staff Members in Medical Care Coordination 

The primary Medical Care Coordinator should be responsible for devising an approach to train other employees in their roles in the process.  All employees should be oriented on the company’s Medical Care Coordination process, and appropriate staff members on their direct role in carrying out the process. 

All employees should receive introductory information on the process so that they will know how they are to be covered in the case of an accident, and so they will have an opportunity to appreciate the company’s concern for them.  Other individuals will need to be trained in specific roles.  For example, all Supervisors need to understand their responsibilities when an accident occurs, from the first steps of providing medical attention through the final return-to-work steps. 

The Medical Care Coordinator’s responsibility here is to plan and deliver the needed training.  This plan includes: 

Implementing Medical Care Coordination  

With the rationale and the documentation created and in place, the implementation phase should also be planned out in sequenced steps with a start date, milestone activities, and a projected (implementation) completion date.  The Coordinator should create a project management chart (called a Gantt Chart) either by employing project management software (TimeLine, MS Project, etc.) or simply plotting out with paper and pencil the specific steps in their logical, sequenced order.  The chart helps the Coordinator to think through the steps and to monitor the process to keep it on schedule after it has been undertaken. 

The Gantt Chart includes the following information: 

If the chart is organized to show events as lines that relate to a row of dates at the top, then the final graphic representation helps the reader at a glance to see where the project is at any given time, which events have been completed, and which events still needed to be accomplished.
 

Evaluating the Medical Care Coordination (MCC) Process  

As with all management processes, the MCC program will mature and improve as it is evaluated and fine-tuned.  To evaluate it, the Coordinator will need to develop surveys of the specific individuals who are affected by the process in one way or another.  The objective should be to get meaningful input, not merely glossed-over acceptance.  To get this, the survey instrument will have to be designed in a way that will evoke the kind of honest appraisal that will serve to strengthen the process. 

Surveys have become an indispensable management tool in well-managed companies.  Good managers conduct many surveys in a year’s time.  Surveys should not be thought of as always looking at a subject in global terms.  Mini-surveys on one or two specific issues can be designed and conducted to evaluate effectiveness and guide the redesign of a process element. 

In addition to conducting surveys to evaluate the process, the Coordinator should seek out and engage the assistance of local experts to look at a specific concept and advise on it.  These “experts” could be company employees (we continue to under-utilize the skills and knowledge that individual employees have) or community experts.  Individuals in the community, for example, who are advocates for individuals with certain kinds of disabilities could serve companies and generally will be happy to have been asked.   

Initiating the Case Management Process 

The objective is to undertake the management of a case internally so as to head off the management of the case by the injured employee him/herself and/or his/her surrogates (Attorneys, Medical Practitioners, Bargaining Unit Officials, Social Workers, Family Members, or whoever.) This aggressive, pro-active involvement is designed to work vigorously for the return of the employee to productivity and to control and reduce the costs attending the lost time process. It is also important to note that Case Management is an in-person, face-to-face activity; Case Management cannot be effectively accomplished telephonically. 

General observations of the claimant that the Case Manager should make would include such things as:

Case Management as a "3 Point Contact" Process

Contacts: 

1. The Case Manager and the Injured Employee 

The purpose here is to establish the baseline data: the extent of the injury, the symptoms, the medical history, and the medical background including immediate family.  This information is gathered into a report that informs the process as it moves forward.  This report is frequently called a history, and it serves as the basis for predicting how long specific treatments should take and how long the treatment totally will take before the return-to-work phase can begin.
 

2. The Case Manager and the Appropriate Medical Providers   

The purpose here is to ensure that the injured employee is treating with a physician (or other provider), and that this is the appropriate provider for this case.  Frequently, the company has "preferred providers," and in some states, the Workers' Compensation law requires that the employee treat with a company-designated provider for a specified period of time.

When the injured employee is not, in the opinion of the professionally trained Case Manager, connected with the appropriate physician, the Case Manager is responsible for making a correct connection. Generally, Case Managers make the decision to change providers on- he basis of second opinions. Case Management may also become involved with arranging for Utilization or Peer Reviews.

The Case Manager will be looking for a prognosis that will signal (project) the time when the employee can begin the return-to-work phase.

The information the Case Manager gets from the medical providers leads to decisions on the most cost-effective and timely way to get the employee back to work.  To what degree will the worker recover and what is a reasonable timeframe for a good outcome?  If the answers to these questions are not satisfactory, it is the responsibility of the Case Manager to redirect those aspects of the treatment that are not working to both the employee's and the employer's benefit.

3. The Case Manager and the Employment Representative

As a return-to-work outcome is established and dated, the Case Manager begins working with the employer to determine the availability of a suitable job and what, if any, accommodations need to be made for this return to productivity.

Job Descriptions based on the ADA-defined concept of "essential functions" are critical to the process here.  A job accommodation may be needed, and the Case Manager will need to understand the job re-design process to be effective in this task.  (Understanding the "ergonomics" of a given job is generally a preventive issue.)

When the employee does report for work, there should be a "Transition-to-Work" plan in existence to phase into full productivity.  This plan reintroduces the employee to the reality of work through sequenced, incremental planning and work-hardening exposures.  So-called "light-duty" should be avoided.  Instead, transition to meaningful, optimal work is preferred.  When that is deemed impossible after a reasonable effort at transition-to-work, the Case Manager should involve a competent vocational rehabilitation professional for purposes of alternative job placement.

In the gathering of background information, the Case Manager may focus on some or all of the following: 

Creating Job Descriptions Based On Essential Functions as Determined by Job Analysis

The American with Disabilities Act requires that Job Descriptions be based on the essential functions of a job.  That is, the unessential functions of a given job cannot be used to deny an employee from performing the job.  In addition, and significantly more important, is that Job Descriptions must be based on structured Job Analyses. 

Job Analysis is a process that requires rigid adherence to verifiable measures and a taxonomy of defined terms.  For example, if the job requires “standing,” the analysis must work from the established definition of that term and delineate the duration involved in the function (i.e., standing), the frequency and duration of rest periods, and the surface on which the standing is done, etc.  “Lifting” has to be described in terms of weight, frequency, height of the lifts, the motions other than lift required, etc.  In short, Job Descriptions must be based on careful observations of precise actions.  Describing a job in general terms is not productive and does not serve either the employer or the employee.  Vaguely defined jobs will not permit medical-decision-making for return to work.   

Developing Safety and Wellness Programs 

In many jurisdictions, Safety (and wellness) are highly valued.  In Pennsylvania, for example, safety programs are recognized as being so cost effective that its Workers’ Compensation Act requires insurance carriers to give employers who have such programs significant discounts on their premiums.   

In many states, the departments of labor have minimum standards for Safety programs.  These standards are used to measure compliance for a company wanting to receive the discount, but they also serve as guides for planning and operating such programs. 

The focus on wellness includes addressing all aspects of preventive health as well as controlling existing conditions that are recognized health risks.  Specific targets include all addictions (including smoking), obesity, the proper use of nutritional diets, exercise, and communicable disease avoidance. The methodology of wellness is education, and the emphasis is on the extended family as well as the individual employee.  

Interventions are also an aspect of wellness, generally in the form of an Employee Assistance Program (EAP) resource.  Psychological supports are included in the comprehensive mix and are addressed through appropriate counseling.  Family relationships may also factor into the well paradigm if they are, or can become, corrosive. 

Safety measures are, in terms of immediate and direct payback to the work organization, the most significant step an employer can take to protect and maintain employees and to contain disability costs.  Unlike wellness programs, safety programs are industry specific.  That is, all but basic safety procedures will vary from industry to industry.  Safety specialists/consultants are available to help establish Safety programs.  Once they are functioning, it is important that workers have immediate input into the process since they are in the best position to recognize unsafe procedures.  Safety programming is so cost effective that employers must provide at least some lease time (paid time) for the process. 

A Disability Management Program without a pro-active and robust Safety and Wellness program is an incomplete program.
 

Training Staff in Managerial Mediation 

All Disability Management programs must consider preventive as well as reactive measures.  Safety and Wellness programs fit this preventive requirement.  Another component of a comprehensive DMP that is preventive is Managerial Mediation.  

The world has learned over the past decade that conflict resolution is essential to smoothly working organizational systems.  Government programs (the EEOC, for example) require the application of conflict resolution before they will support litigation, and schools across the nation have implemented conflict resolution programs at every educational level.  Conflict resolution in the workplace was well entrenched long before either of the two entities cited above adopted the practice. 

In business, conflict resolution is generally know as Managerial Mediation, a concept developed by Dr. Daniel Dana.  The reality of most accidents and injuries in the workplace is that they are preceded by some sort of conflict, overt or covert, between two or more individuals.  The requirement is that managers understand the significance of unresolved conflicts, and that they have the training in the mediation process needed to resolve disputes, before workplace antagonism leads to accident and/or injury. 

The training in Managerial Mediation is so cost effective and the results so effective that no work organization can justify not having a trained cadre of Mediators.  The methods and materials for the training are available from appropriate sources (such as CEC Associates, Inc.), and the concepts are not difficult to learn or apply.  Once mediation skills are introduced to managers, the payoff for the company in terms of diffused conflict is dramatic.
 

Managing Workplace Absences

Introduction:  

The single most difficult challenge for employers is to gain control of employee productivity.  A recent survey of employers by the PA Chamber of Business and Industry found that “employee problems” outweighed even such concerns as the application of technology, the flow of raw material and supplies, and all other core operating problems. 

If this is true, what are the specific “employee problems” that concerned employers struggle to manage?  The problems with employee productivity can be identified as falling within a common set of issues that have been addressed successfully by some employers and in some model programs.  The purpose here is to outline the issues in a working framework, and then provide an answer to specific questions by companies concerning any of the components of the framework. 

Employers need to understand “employee problems” through two different filters: the legal ramifications and the practical applications.  The legal ramifications have to be addressed by lawyers in the field of labor law and workers’ compensation; the practical application issues need to be addressed by management.
 

Broad-Based Issues in Employee Productivity:

Frequently Asked Questions (FAQ)  

Q:   Why is it important for a company to design and implement an Absentee/Disability    Management Program? 

A:   There have been a number of longitudinal studies that demonstrate the value, in both dollars and employee productivity, for companies that develop programs that address absenteeism.  These programs return significant value for both disability and non-disability causes of absenteeism.  One of the measures of “well-managed” companies has been whether they have policies in place that demonstrate that they value their employees.  Disability Management programs are an important component of that concern.
 

Q:  What is a Transition-to-Work Program? 

A: Traditionally, employers used a “light duty” approach to returning injured employees to work.  That process proved to be largely ineffective.  A transition-to-work program is one that creates a scheduled and incremental re-entry to full productivity.  The process for Transition-to-Work has been developed and the materials to guide its implementation are available through CEC Associates, Inc. in Valley Forge, PA (1-800-246-9767).
 

Q:  What are Vocational and Functional Capacity Evaluations?  

A:  These evaluations, performed by certified and skilled professional, are used to return people to work.  Vocational Evaluations are preformed by vocational experts, and Functional Capacity Evaluations are performed by physical therapists or other trained health care providers (chiropractic and physiatric).  These evaluations are critical components of an employer’s effort to return employees to productivity as soon as possible.  Functional capacity evaluations determine in great detail the capacities for work of an individual in terms of lifting strength, durability for certain tasks, capacity for standing or walking, etc., etc.  These detailed factors are then used by vocational experts to determine the kind of jobs a worker can perform, and, by extension, the jobs available for an individual.  Both of these professionals are extremely valuable assets for an employer who is interested in dealing positively with employees who were ill or injured.
 

Q:  Why should Job Descriptions be based on a Job Analysis? 

A:  There are a number of important reasons why a job analysis is essential to the development of a Job Description.  The Americans with Disability Act (ADA) mandates that Job Descriptions are to be based on the “essential functions” of the job only.  In case of litigation, the Job Description becomes prima facie evidence, if created before an EEOC complaint.  Also, hiring decisions should be based on valid Job Descriptions so that the new hire has an opportunity to request a reasonable accommodation if necessary.  The only way to determine the physical, educational, and environmental aspects of a given job is to conduct a detailed analysis of the job.  This analysis includes determining specifics like the length of time required to stand (or sit), pounds to be lifted, motions to be made, repetitions, distances to extend the body, etc., etc.  Human resources professionals responsible for creating Job Descriptions should be trained to conduct a job analysis.  It is important to distinguish between the process, Job Analysis, and the outcome, the Job Description.
 

Q:  What is the value of a Safety and Wellness program to an employer? 

A:  There are two important reasons why every employer should have a Safety and Wellness program in place, and both reasons carry financial benefits.  First, employers who do have qualifying programs in place get legislatively mandated discounts in many states on their Workers’ Compensation premiums.  The second reason is that Safety and Wellness programs have always produced strong Return-on-Investments (ROI).
 

Q:  Why should companies be interested in Managerial Mediation and Alternative Dispute Resolution?  

A:  Alternative Dispute Resolutions (ADRs) are carried out in a legal framework.  Generally, the professional, who sits between the disputants, is an attorney, and the judgment rendered to resolve the dispute is, by pre-agreement, binding.  Managerial Mediation is a process whereby managers in a company are trained in mediation so that they can intercede when two or more employees are in conflict.  These conflicts are almost always destructive, and employers are well advised to train their managers in the mediation process.  Mediation is an incredibly effective tool that works wherever people come in regular contact with each other.  Most schools in the U.S. now have Mediation programs.  Where managers are trained to conduct mediations between disputants, the long-term results dwarf the small investment to train managers in the process.  Employers can arrange through CEC Associates in Valley Forge, PA to train staff in Managerial Mediation.
 

Q:  Why do some employers use Case Management?   

A:  Case Management is a process that employs a specialist, frequently a Registered Nurse or a Certified Case Manager, to monitor and guide the treatment and rehabilitation progress of an injured employee.  By using standard guides, the Case Manager can determine whether the treatment is the correct treatment, whether it is effective, whether it is proceeding on schedule, and whether the fees are within the standards for a specific geographical area.  Companies continue to hire and use Case Managers because they have experienced results from the process.  In addition to monitoring recovery time and costs, perhaps the most important value of the process is that, with it, employers can demonstrate their support and concern for valued employees.  Case Management by telephone has not proven to be very effective in other than minor, uncomplicated cases.  The ROI for direct Case Management is much higher than for telephonic management.
 

Q:   Why should employers be concerned with compliance in respect to the Americans with Disabilities (ADA) and Family Medical Leave Act (FMLA)?  

A:   The most compelling reason why employers should want to understand the ADA and the FMLA is that by doing so they are demonstrating a commitment to their employees.  To expect employees to be loyal to the company, well-managed companies have long work hard to create and implement policies that support their employees.  Both of these acts are the law of the land, and it is unlikely that that fact will change in the foreseeable future.  So compliance will be a concern to all clear thinking employers.  But more importantly, support of the acts will signal an equally important support of dedicated employees.  Employers must be aware of the critical interaction among Workers’ Compensation, the Americans with Disability Act, and the Family and Medical Leave Act.

Integrated Disability Management  

A number of companies have developed and implemented exemplary Disability Management plans.  The reason for having a Disability Management plan is as a guide to assist employers do what is required to assist valued employees in any way possible and to control the significant costs of workplace absences.  The state-of-the-art Disability Management program combines its disability management efforts with claims administration for all injuries and illnesses, whether they are occupational or non-occupational.  The integration also combines both short- or long-term disabilities.  This process further brings into the mix related issues such as safety and wellness programs, group medical coverage, and even comprehensive attendance management.  
 

Impairment and Disability 

The American Medical Association (AMA), in its document, Guides to the Evaluation of Permanent Impairment, distinguishes clearly between impairment and disability.  Impairment is a medical concept involving a change in one’s health status.  Impairment results from illness or disease.  Disability, on the other hand, is a non-medical phenomenon, essentially the difference between an impaired individual's capacities and the social or occupational demands of a particular situation.  Disability is most often a vocational concept. 

If we are to reduce the cost of workplace disability and achieve the goal of the ADA by putting qualified individuals with disabilities to work, employers and their insurance carriers must recognize the distinction between disability and impairment.  Indeed, employers and their disability claim’s representatives should cease asking physicians, “Can Mr. Smith work?” or “Is Mr. Smith totally disabled?”  The employer and Mr. Smith are in the best positions to answer these questions once medically determined capabilities (not disabilities) are defined.  Physicians are generally not trained to answer questions of disability.  Yet employers ask physicians these questions repeatedly, and they are disappointed by the response, “Mr. Smith cannot work; he is totally disabled.” 

In reality, the same impairment can result in different degrees of disability depending upon the specific work situation.  For example, a complete amputation of a finger can leave a concert pianist totally disabled.  But the same amputation may have little or no effect on an intra-city bus driver.  The impairment is the same; the work is different and, therefore, the disability is indeed different, obvious in one situation and absent in the other. 

Understanding the critical difference between impairment and disability has been liberating for many company human resource and risk management personnel.  Charged with the responsibility of returning permanently impaired employees to work, risk managers now modify work or work settings to accommodate a worker’s impairments and associated limitations, thereby reducing or totally eliminating disability.  Disability is, therefore, manageable.  When work changes or modifications are acceptable to both employee and employer, disability management can be a win-win human resource outcome. 

Workplace modifications have been researched and described for nearly two decades by the Job Accommodation Network (JAN).  JAN has found that most work accommodations are practical in nature and less expensive than most employers assume:  61 % of all job accommodations cost less than $500.  Moreover, rehabilitation counselors and the employee are critical, essential resources for further understanding of how an individual with a particular impairment might become, or might continue to remain, productive.  Most job incumbents know how their work tasks could be modified for efficiency's sake. 

With the groundbreaking work of national agencies such as JAN, it is now apparent that we can actually manage disability in the workplace.  It is like managing the objectives of a project or a program; taking charge of and managing workplace disability can be accomplished with imagination, clear objectives, and teamwork. 

Employers can anticipate relief from occupational disability costs when they realize that workplace reform supersedes any legislative reform, including the numerous proposals to overhaul dozens of state workers' compensation laws.  As with most changes, some companies show leadership, and their programs serve as bellwethers for realistic and achievable disability management.  Other companies, because they are less well-informed on the issues, continue to resist change.

Community Advocacy Resources

The most common reason cited by employers for not hiring a disabled worker is a lack of qualified workers.  (These results are as reported in a Louis Harris survey conducted for the International Center for the Disabled.)  Since in fact there are approximately 8.4 million Americans with disabilities who want jobs, the reason cited is not a valid reason.  If too many employers still labor under the misapprehension that there is a scarcity of qualified individuals with disabilities available for employment, then advocacy groups have not, and are not, doing enough to dispel the misconception. 

To assign responsibility in even more detail, advocacy groups at community-based levels probably have a greater chance to influence the situation than do national groups.  National groups need to continue to provide perspective, direction, and resources.  National agencies are responsible for the sensitizing of Congress and keeping the pressure on there.  National agencies are also more effective with large companies as opposed to small companies.  And it is important to have large companies support the cause.  Fifty-two percent of companies with 10,000 or more employees hire individuals with disabilities versus only 16% of companies with 10 to 49 employees. 

As the (only) fifty-two percent indicate, large companies also need to do more.  This is to be the continuing challenge for the national agencies.  But the effort to assist small companies to understand the value of employing individuals with disabilities falls almost exclusively to community-based advocacy groups. 

What should these community-based agencies be doing to help area employers hire and support qualified individuals with disabilities?  Consider the following: 

Planning Disability Management Programs  

The role of community-based advocacy groups is to reach all employers in the area to make certain they understand the cost of not including individuals with disabilities in the company.  The objectives are to identify the individuals with authority in a company and to get them committed to the process.  The commitment is manifested through direct action, and community-based agencies can play an important role in the action by providing planning expertise and development of resources. 

The question is, “Who in the company can obligate to the decision?  And, if the person who is authorized to do so does not, what responsibility do others have?”

1996 CEC Associates, Inc. All rights reserved.  

No part of these materials may be reproduced without permission from CEC Associates, Inc., P.O. Box 987, Valley Forge, PA 19482. (610) 935-7560.

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