By Goldgarb, Howard
Risk Management , Vol. 36, No. 2
An Insider's Guide To Choosing A Rehabilitation Provider
Ten years ago the problem was different: Rehabilitation was something that people vaguely associated with disabled war veterans and people who suffered what were euphemistically called "handicaps." The typical understanding of rehabilitation was that it was some kind of effort to teach amputees to walk or blind people to weave baskets. There was little understanding among laymen of either the possibilities or the problems. Rehabilitation rarely touched the average worker's life; when it did, it was handled by public agencies--with a low success rate that was virtually guaranteed by high per-counselor caseloads and generally adverse conditions.
Today, however, rehabilitation is very much a part of our lives. Insurers and employers (as well as local, state and federal governments) understand what rehabilitation does and the need for such services. Whether mandated by law (as it is in a number of states) or voluntarily included as part of the employer's/carrier's workers' compensation claims management program, rehabilitation has become an accepted part of the medical-care/recovery process. This acceptance has led to the appearance of many private rehabilitation providers that have largely supplanted the public agencies in dealing with injured workers. The companies have the same avowed purpose--to return the injured or ill worker to optimum function and thus to work. How they work toward that goal, and the methods they use, vary along with their rate of success. Given the premise that rehabilitation is not only accepted but necessary, the problem becomes which provider to choose.
What to Look For
How local is the provider's local office? Does the company operate from a distant corporate headquarters, using telephone and mail services only? Are there regional offices? Are there offices in most major cities?
Rehabilitation is not a long-distance service. Whether they are called case managers, rehabilitation specialists or counselors, skilled personnel must be available for personal contact. They must be able to meet with the client, physicians and therapists to assess the patient's condition and the suggested treatment program. They must know the community facilities and resources and be able to deal effectively with the local medical community. They must also be familiar with local business, industry and educational facilities.
The need for a physical presence is very strong. Without it, it is almost impossible to gauge an injured worker's fear of job interviews or returning to the place where he was nearly killed. The clammy hands and ashen face cannot be seen through telephone wires.
The company should provide a full range of services to the client and not just what is available. The most obvious example is medical case management. This service is essential in dealing with catastrophically injured workers or those suffering from severe job-related illnesses. Burn victims should be in well-equipped burn centers; patients with head trauma or spinal-cord injuries should be moved expeditiously to the appropriate regional centers. While most rehabilitation workers are aware of such facilities and can make appropriate recommendations, effective case management requires a great deal of attention and a high degree of specialized experience and expertise. In short, it requires a qualified case manager.
The assessment should be thorough. The case manager should evaluate the client's home situation and the amount--or lack--of support provided by the family and assess the client's motivation to return to work. The assessment should deal with vocational issues and address the possibility that not only disability but the client's age or outdated skills may severely restrict his or her return-to-work options.
Some services should be offered in-house. The company should perform its own testing, work evaluations and computerized transferable skills analyses. …