Workers' Compensation Focus, WINTER 1998
(Focus is published by the Oregon Department of Consumer Business Services,
Workers' Compensation Division)
by Nancy Bieber
The Rehabilitation Review Unit (RRU) conducted a system survey during the late summer and fall of 1997 to assess the current process of delivering vocational assistance to injured workers. A pool of 355 claimants was randomly selected by the information Management Division from all workers with claims closed in 1996 who received permanent disability awards and who had not returned to work. RRU determined whether workers received eligibility evaluations, and for eligible workers, RRU determined whether services were provided in accordance with the current rules. Most of the files reviewed indicated the insurers were processing claims according to the statutes and rules. The only exception was in the area of eligibility determinations: 8 percent of claimants never had an evaluation, and another 18 percent were completed late.
In addition to the file reviews, RRU surveyed each worker, employer, insurer, and any attorney or vocational provider involved with the claim. Figure 1 shows the response rate for each group. Because of the number of respondents, the results of the survey need to be interpreted cautiously and should not be generalized to all workers, attorneys, employers, insurers, or PROs. There are suggestive trends, with strong consensus among groups in some areas, and considerable disagreement in others.
Of the 170 workers who were located and responded to the survey:
|
|
Total surveyed |
Surveys completed |
Percent of surveys |
|
Workers |
355 |
170 |
48% |
|
Employers |
261 |
110 |
42% |
|
Insurers |
150 |
65 |
43% |
|
Attorneys |
143 |
34 |
24% |
|
PROs |
60 |
38 |
63% |
79 percent returned to work after their claims closed
45 percent returned to kind of job they were doing at the time of injury
65 percent were making the same or higher weekly wage than at the time of injury
27 percent had used their Preferred Worker benefits to return to work
61 percent of those not working said that limitations resulting from the injury prevent their return to work.
In general, all groups surveyed felt positive about the system on most issues. Some findings are highlighted below:
Workers and employers were almost unanimous in agreeing there is value to providing vocational assistance. Most attorneys and vocational providers agreed. Insurers surveyed thought the costs of the current system are too high.
A majority of insurers, vocational providers, and employers agreed the current eligibility requirements for training are appropriate. Workers and attorneys thought training should be provided to all injured workers unable to return to regular work. Insurers favored decreasing training to 12 months; workers and employers thought the current 16-month limit was appropriate; and vocational providers and attorneys favored extending the time limits.
All groups generally agreed the current time frames
are appropriate for providing vocational assistance. However, vocational providers
did not agree that 60 days was sufficient to develop a training plan and favored
an increase in days.
All groups favored review of return-to-work plans by RRU.
All groups agreed administrative review is the appropriate
review of insurer decisions regarding vocational matters and that RRU is the
appropriate body to conduct the reviews. Nevertheless, the results indicate
concern about whether RRU staff review cases in an impartial and thorough manner.
Workers and employers responded positively. The majority of attorneys felt RRU
was usually impartial, but four of the attorneys answered that the reviews were
never fair and impartial. The majority of insurers and vocational providers
felt reviews were impartial and thorough sometimes or rarely.
Does RRU conduct the administrative review in an impartial and thorough manner?
After completion of the survey, all participants were invited to attend a day-long
conference to discuss the results and recommend changes to the current system.
About 40 people attended, including one injured worker, one insured employer,
and several self-insured employers, insurers, vocational providers, claimant
attorneys, and trainers. Issues were divided into five main topics, and each
participant was able to select up to three topics for small group discussion.
At the end of the day, each study group presented its findings. The topics included:
philosophical issues
eligibility criteria
nature and extent of services
the role of RRU
analysis of some suggestions for system changes
There was consensus among participants that Oregon should continue to provide vocational assistance to injured workers. There was general agreement that current eligibility criteria was appropriate for training, but those surveyed thought direct employment services should be extended to all injured workers who are unable to return to regular work, possibly with funding through the Preferred Worker Program. There was also general agreement that training limits should be extended to allow some workers to obtain associate degrees, but also concern that extending limits would create a sense of entitlement among workers. There was also further concern about RRU's objectivity in conducting administrative and plan reviews.
RRU is responding to concerns expressed in the survey and some pilot projects are underway. One such project will provide mediation before any investigation begins, with a different consultant conducting a review, if one is needed. Another project is to use vocational arbiters, independent vocational providers who will conduct some of the fact-finding if all parties to the dispute agree.
WCD thanks all who participated in the survey. Each survey was several pages long and took considerable time to complete. Nevertheless, most participants also added many thoughtful comments. The results of the survey will help the Management Labor Advisory Committee and other decision makers analyze and revise the current statutes, and will help RRU look at its processes and procedures.
If you have questions or comments about the survey, please call Teddy Forester, (503) 947-7738 or e-mail her, Teddy.R.FORESTER@state.or.us.
Nancy Bieber is the acting manager of the Dispute Resolution Section of WCD. She can be reached by e-mail, Nancy.H.BIEBER@state.or.us or by phone, (503) 947- 7731.