Workers' compensation -- Vocational rehabilitation

A work injury usually does not interrupt employment, but when it does, the employer and employee, working together, can usually bring about a return to work. However, if a work injury prevents an employee from returning to the job, vocational rehabilitation services may be requested.

Rehabilitation services are provided by experienced rehabilitation counselors approved by the department as qualified rehabilitation consultants or QRCs. A QRC conducts the rehabilitation consultation, writes the rehabilitation plan, provides rehabilitation services and guides the delivery of rehabilitation services by others.

A rehabilitation consultation to determine eligibility for rehabilitation services is the first step. The employer/insurer can request this consultation by referring the case directly to a QRC. The employee may also request a consultation; this should be done in writing to the employer/insurer -- employees may use a Rehabilitation Request form.

If liability for the claim is disputed, the employee may receive a consultation through the department's Vocational Rehabilitation unit.

When an employee requests a rehabilitation consultation, the employer or insurer responds to the request within 14 days by filing a Disability Status Report form.

If the employer or insurer believes a rehabilitation consultation would be helpful, the employer or insurer refers the case to a QRC. If the employer or insurer believes the employee will return to work with the employer without vocational rehabilitation services, the employer may request a waiver of the consultation and of rehabilitation services, using the Disability Status Report form.

If the department grants the waiver, the waiver is effective until 180 days after the injury. If the employee disputes there should be a waiver of a rehabilitation consultation, the employee may file a Rehabilitation Request form with the department.

The insurer may refer the employee to a QRC for a rehabilitation consultation; however, the employee has the right to choose the QRC for the rehabilitation consultation up to two months after a rehabilitation plan is filed with the department. After this period, the employee and the insurer must agree to any change, or have the matter settled by the department.

The rehabilitation consultation is a meeting between the QRC and the employee to determine whether the employee is eligible for rehabilitation services. The QRC will also talk with the employer and the health care provider to assess the likelihood that the employee will return to work with the employer. Eligibility for vocational rehabilitation is based on whether:

• the worker is unable to do his or her usual and customary job because of the injury;

• the employer is unable to provide other suitable employment, and;

• rehabilitation services will benefit the worker.

A dispute about eligibility can be settled by filing a Rehabilitation Request form with the department.

If the employee is eligible for rehabilitation services, a written rehabilitation plan is developed by the QRC. The QRC will talk with the worker, the employer, the insurer and the health care provider to develop the plan. The rehabilitation plan lists the vocational goal and the services needed to reach the goal. Only those services listed on the written plan or on later plan amendments can be provided. Rehabilitation services may include direct job-placement based on the worker's available skills, on-the-job training or retraining for a new job.

A written rehabilitation plan must be prepared within 30 days of the rehabilitation consultation; the employer/insurer then has 15 days to review the plan. The QRC must file the plan with the department within 45 days of the consultation.

The employee is responsible for following the rehabilitation plan and actively seeking work. Temporary total disability benefits may be stopped if the employee refuses a job offer consistent with their rehabilitation plan. The QRC provides the services of the plan or arranges for other service providers to do so. If there is no progress toward a return to work, the rehabilitation plan should be changed or closed. Rehabilitation services usually stop 30 days after a return to work. If there is a dispute about the vocational goal or services, the employee or the employer/insurer may file a Rehabilitation Request form with the department.

• A clear purpose:  The QRC's purpose is to help the employee return to work.

• A specific goal, with a specific plan:  The injured employee should know the goal for the outcome of the plan.

• A cooperative approach to service:  The QRC will ensure the injured worker is an important part of rehabilitation planning and implementation.

• Promptness:  The QRC should generate reports at least monthly; questions should be addressed immediately.

• Clear communication:  The injured worker should never be unsure about what is going on.

• Problem-solving:  The QRC is there to remove obstacles to the employee's return to work.