Vocational rehabilitation can be a four letter word in the workers’ compensation arena, and trust in voc rehab counselors remains tenuous – especially when a claim ends up in litigation. Is there anything we can do to make this resource more effective?
Rhonda Coffee, Case Management Manager with CorVel Corporation’s office in Metairie, sat down with Louisiana Comp Blog to discuss how vocational rehabilitation could be improved upon to get more injured workers back to gainful employment, based on her 22 years of experience in the field. One major key to success: eliminating communication barriers.
This interview has been edited for brevity and clarity.
Comp Blog: Various stakeholders in the industry use difficulties with voc rehab as an example of workers’ comp’s adversarial nature. Have you found this to be the case? Is it hostile?
Coffee: I have experienced this, and I would say about 80 percent of the litigated cases that I see as a VRC [vocational rehabilitation counselor] to some extent, appear to be influenced by the claimant’s attorney. To get to the client initially, we have to go through their attorney, and most attorneys won’t allow direct contact with the injured worker, which delays my ability to effectively provide services and inhibits what I’m able to do as a VRC. I’m here as an advocate for my client, claimant, injured worker – whatever descriptor you want to use – it can be a significant hurdle when I have to go through the attorney’s office.
In my mind, I’m here to move my client’s case in a positive direction for their benefit, but I think that the relay of information to the client from their attorney can sometimes be misconstrued.
Comp Blog: So is it often already combative when you get to that first meeting with the injured worker to discuss their case?
Coffee: Some clients will fight me the whole way through the process – and it is a process. I’m here to assist in determining their ability to return to work, not to disrupt their benefits. In fact, I have to follow my clients’ treatment throughout my involvement to make sure I’m doing my best towards moving in the right direction. I need to be aware if they have any setbacks that could affect their return to work status, since I don’t want to keep researching any job options that may no longer be viable for my client.
Comp Blog: Is medical improvement and functionality something that you assess on an informal basis as you move through the process with a client?
Coffee: Absolutely. I have to be objective about that, it’s an ethical issue. Sometimes I do have to go to the adjuster and say, “Hey, I had to stop this meeting because he couldn’t sit still, or he reported he was in a lot of pain.” If there’s a work release on file but I see these kinds of problems, I may need to verify their medical status with their doctor.
Comp Blog: At what point in the life of a claim do you usually get involved?
Coffee: We sometimes aren’t referred to files for a while after the date of injury. I’ve gotten cases that were years old by the time I see them. Now sometimes, if the injury is really bad and they aren’t anticipated to reach maximum medical improvement by their physician for up to a year after surgery, it makes sense that voc won’t be involved until MMI is reached and we get the work release. Other times, it could be upwards of two to three years down the line.
Comp Blog: When claims take that long to surface on your desk, did someone just drop the ball?
Coffee: Sometimes that could be the case.
However, you also have to consider the individual involved. If, every time in the history of this claim it looks like they’re progressing and then suddenly there’s a setback, it could take a long time before it reaches me, depending on how involved the injured worker’s medical status is. There could have been prior voc on the file that was discontinued, which essentially means that I start the process over.
Comp Blog: How often do personal issues come up in your day-to-day work with a client?
Coffee: As a voc rehab counselor, I have to view the person as a whole. Much like when a doctor assesses co-morbid conditions, I can’t just take the case at face value and only focus on the work injury when I’m trying to determine their full return to work abilities. I have to consider medical going forward, educational attainment, occupational background, geographical location, etc.
Comp Blog: And on the psychological issues: seeing the whole person probably involves recognizing those barriers and figuring out how they can be surmounted.
Coffee: We have a case right now with a claimant whose job involves driving. This person was in a car accident and has subsequently developed a fear of driving. That’s a very real barrier towards assisting that person in returning to work, even if they are at MMI, because there could be limitations to accessing public transportation and other services. Even if we provide transportation, how long can that last? All of that has to be considered, not just the physical injury.
Comp Blog: What in your experience are big factors in the success or failure of vocational rehabilitation at the individual level?
Coffee: The attitude of the claimant is a huge factor, which can be influenced by family, co-workers, friends, and/or attorneys.
Claimants sometimes report that they chose to retain an attorney, because they felt like the employer was not receptive to them at the onset of their injury. To them, that could feel like a betrayal, after being a loyal employee for years. I can’t necessarily blame them for seeking out representation when they feel that way. It’s unfortunate, but voc rehab counselors can get lumped in with everyone that touched that claim, including the employer, who they may view in a negative light, so as I said, that negativity is present and from the beginning, it feels like you start running uphill.
Comp Blog: Regarding that suspicion or negativity, you have ethical standards to abide by, correct? So it behooves you to work in your client’s best interests?
Coffee: Yes, as mentioned, I’m here as an advocate for my client. While I’m there, I don’t have anything to do with their benefits or settling the claim or whatever. Let me do my job and see if in fact there is anything out there that this person can do that is within the confines of their release and full abilities as obtained. Sometimes there may be no viable job options identified that fully fall within the injured workers known abilities.
Comp Blog: Does the ever-increasing bureaucracy of a claim affect the efficacy of voc or trust in the voc rehab process or in the individual counselor?
Coffee: The general bureaucracy is an issue. I’ve yet to have a client who, when I become involved, doesn’t question why I’m there. There are so many people involved on any one file that I understand how frustrating that must be to answer the same questions over and over again. I have to make it clear to them that I am an independent referral source and there to provide a service to them. I’m not here to return you to work by any means necessary, I’m here to determine your capacity for work and move forward with that as dictated by the status of release, among other factors. My ability to do my job is highly dictated by their status of release and abilities as identified.
Comp Blog: Are there any suggestions/policy changes that you would recommend to improve the process?
Coffee: Aside from the barriers we encounter with some plaintiff attorneys, the main thing is timing. I think that when an individual is getting close to MMI, but maybe not quite at the point of the doctor’s release, that’s when we should start talking to all of the parties involved so that we’re ahead of it. And finding something available with the original employer, or providing other options before MMI can possibly give the injured worker a boost of confidence – they see the light at the end of the tunnel.
Image courtesy of Rhonda Coffee via LinkedIn