Does your Company Need an Occupational Medical Surveillance Program?
The big questions in the minds of management are: "Do I need to have
a medical surveillance Program?" and "Which program, if any , do I need?"
"If I do need a program, should it reside within the company or be outsourced
to hospital-based practices or free-standing private practices?" In certain
industries and exposures, OSHA will mandate drug testing, safety and industrial
hygiene activities, pre-employment, pre-placement examinations and periodic
medical surveillance examinations. Periodic examinations are usually more
focused and include selected tests that evaluate the kind of exposure
that is occurring and the types of medical problems that might be expected
to occur. Additional services, such as wellness or preventive medicine
programs, ergonomic evaluations of high risk areas, acute care clinics,
as well as, a comprehensive on-site health care of employees.
The responsibility for an on-site Workers Compensation ( WC) program is
often assigned to occupational health or safety professionals. WC systems
are well-known nationally for their ambiguity and complexity. The importance
of educating upper management may go unrecognized until necessary program
recommendations are not approved due to a lack of knowledge regarding
the purpose and function of the proposed action. Legislative and administrative
policies have transformed WC into a "complex, frustrating and expensive
A central premise of WC has been that injured workers may still have a
residual permanent disability, even after recovering from the initial
injury, and perhaps even after return to employment. It is the compensation
for these residual permanent disabilities that is the major contributor
to rising cost and increasing legal action. Attorney fees are usually
calculated as a percentage of the final amount awarded to the worker above
the usual wage and medical benefits. Thus attorney and medical specialist
have an incentive establish high disability ratings. The final award decision
is made by the WC Appeals Board based on he applicant and defendant medical
reports. Insurance companies also profit from the WC system by setting
standard insurance plan rates and using premium and reserve money as interest
free loans for investment since claims take so long to settle. Most insurance
companies have no incentive to pay claims quickly or to keep awards small.
The employer, can apply management controls to reduce costs due to poor
claims management, lack of communication, too many doctors and too much
litigation. It has been estimated that WC costs can be decreased by more
than 30% by implementing a program which will, first decrease injuries
and, second, minimize losses on actual injuries.
This program has two crucial components: 1) selection of employees and
2) on-site management of Workers' compensations claims. Careful planning,
written documentation, bargaining group approval and consistent hiring
procedures can avoid violation of handicap regulations. Employers can
refuse to hire/re-hire if the application is unable to perform the required
duties in a safe manner. This requires that written job descriptions,
uniformly applied, that specify in functional terms to establish the physical
requirements of the actual job. The written job-related requirements are
also an essential part of a system to safely return employees to work
after an injury or illness. In his manner, employees are better suited
for their job duties and are less likely to be injured. Cumulative injuries
are also reduced by carefully qualifying returning employees for their
particular job functions.
Communication and medical-legal review is also critical to effective management
of Workers' Compensations claims. 40% or more of the litigated claims
are initiate at a time when there are no litigable issues and due to confusion
resulting from lack of information and poor communication. Prompt communication
demonstrates employer interest and concern in addition to giving essential
benefit information and answering any questions. In addition, the best
possible care to bring a out a quick recovery should be immediately provided.
This will help eliminate the need for unnecessary and redundant medical
opinions. The American College of Occupational and Environmental Medicine
(ACOEM) have guidelines to standardize the evaluation and management of
occupational health problems and to reduce the variances in practices.
The occupational medicine physician is well aware of the psychological
and economic importance of an expedient return to work, the possibilities
of modified duty, and the importance of separating and documenting non-work-related
health factors. The review of medical charges for reasonableness, utilizing
medical second opinions before a procedure can significantly reduce medical
costs. If attorneys are task to report directly to the occupational medicine
specialist, their accountability and responsibility to the employer is
increased. Finally, monitoring the monthly and annual Workers' compensation
loss reports for loss trends and reserve/disbursement errors is essential
for the employer to evaluate carrier performance and on-site safety issues.