Bankoski, Joyce

Brown, Calvin

Fitzpatrick, James

Honberg, Ron

Mintz, Lee

Smolkin, Charles

Van Dyk, Karen

English

University of Baltimore School of Law

University of Baltimore Law ForumVolume 17Number 2 Winter, 1987 Article 161987Workers' Compensation Rehabilitation inMaryland: An Attitude SurveyCharles SmolkinSmolkin Vocational ServicesKaren Van DykVocational Counseling AssociatesRon HonbergJames FitzpatrickCalvin BrownSee next page for additional authorsFollow this and additional works at: http://scholarworks.law.ubalt.edu/lfPart of the Workers' Compensation Law CommonsThis Article is brought to you for free and open access by ScholarWorks@University of Baltimore School of Law. It has been accepted for inclusion inUniversity of Baltimore Law Forum by an authorized administrator of ScholarWorks@University of Baltimore School of Law. For more information,please contact snolan@ubalt.edu.Recommended CitationSmolkin, Charles; Van Dyk, Karen; Honberg, Ron; Fitzpatrick, James; Brown, Calvin; Mintz, Lee; and Bankoski, Joyce (1987)"Workers' Compensation Rehabilitation in Maryland: An Attitude Survey," University of Baltimore Law Forum: Vol. 17: No. 2, Article16.Available at: http://scholarworks.law.ubalt.edu/lf/vol17/iss2/16Workers' Compensation Rehabilitation in Maryland: An Attitude SurveyAuthorsCharles Smolkin, Karen Van Dyk, Ron Honberg, James Fitzpatrick, Calvin Brown, Lee Mintz, and JoyceBankoskiThis article is available in University of Baltimore Law Forum: http://scholarworks.law.ubalt.edu/lf/vol17/iss2/16Workers' Compensation Rehabilitation in Maryland: An Attitude Survey by Charles Smolkin, CRC,CIRS,CVE, Karen Van Dyk, CRC,CIRS Ron Honberg, CRC, James Fitzpatrick, Calvin Brown, Lee Mintz, Joyce Bankoski, R.N., CIRS. I n recent years, the focus of workers' 'compensation in Maryland has evolved from medical management and finan-cial compensation to a process which con-siders the claimants' psychological and fi-nancial need to return to the workforce. In the future, the role of attorneys involved in workers' compensation law may expand from helping injured workers to obtain benefits to ensuring that their clients are afforded maximum opportunities to return to the workforce. It is consequently impor-tant for attorneys to develop a working knowledge of rehabilitation concepts per-tinent to injured workers and also to be-come familiar with issues of concern to professionals providing assistance to these workers. The increasing concern with the broader needs of claimants has been a step forward in workers' compensation law. The entire process has become more complex with the involvement of a greater number of professional disciplines and personnel in assisting claimants to return to work. Dur-ing the process, an individual may become involved with physicians, attorneys, claims adjustors, rehabilitation nurses, and various other medical, rehabilitation and insurance personnel. Moreover, these professionals may present conflicting viewpoints to claimants depending upon which side of the issue they represent-claimant vs. em-ployer. The resulting confusion, bewilder-ment, and frustration felt by a claimant may impede an already cumbersome pro-cess and ironically may serve as a deterrent to the return to work of the disabled indi-vidual. Specifically within the field of rehabili-tation counseling, there has been a feeling that public and private counselors often 34-The Law Forum/Winter, 1987 work at cross-purposes to the detriment of the claimant. This is attributable to the perception of differences in orientation of the two rehabilitation sectors. State voca-tional rehabilitation counselors do not work directly for insurance carriers or solely within the workers' compensation system and may frequently feel constrained by the limits placed on their rehabilitation options by the worker's compensation law and insurance carriers. The federal/state vocational rehabilitation program has a history of maximizing potential, while on the other hand workers' compensation fo-cuses on vocational restoration. Because of their large caseloads, timeliness of evalua-tion and services has been a problem. Con-versely, private vocational rehabilitation counselors receive referrals directly from insurance carriers. They work with smaller caseloads and can consequently work faster in facilitating a claimant's return to work. However, private rehabilitation is fre-quently perceived as being bound by the insurers philosophy to return injured work-ers rapidly to work without fully consider-ing case complexities or client potential. Recognizing that the often adversarial relationship between public and private vocational rehabilitation, attorneys, and insurance carriers is detrimental to work-ers' compensation claimants, the Task Force on Injured Worker's Rehabilitation was established in 1985 to facilitate greater understanding and cooperation among pro-fessionals involved in the rehabilitation of injured workers. This group was originally established as an educational and informa-tional forum to include only rehabilitation counselors. However, the idea elicited en-thusiastic responses from other professions involved in the workers' compensation pro-cess. Consequently, the Task Force ex-panded into a truly multi-disciplinary group with core members including attorneys, claims adjustors, rehabilitation nurses and rehabilitation administrators. The goals of the Task Force are to pro-mote improved professional relationships between the public and private rehabilita-tion sectors through joint education, to highlight concern of the injured worker re-habilitation community, and to enhance professionalism through cooperative edu-cation. In order to accomplish these goals, the Task Force has developed and disseminated an attitude and needs questionnaire with distribution to a broad range of profes-sionals involved with the rehabilitation of injured workers. Annual training pro-grams on rehabilitating injured workers have been developed and conducted. Fi-nally, in recognition of the present lack of clear operational guidelines for use by involved professionals, the Task Force is developing a "Practices Manual" to be available for general use by professionals involved in the rehabilitation of injured workers. Procedure A Needs and Attitudes Assessment Ques-tionnaire draft was developed by a sub-committee of the Task Force. The draft was distributed to all members of the Task Force and subsequently revised. The revi-sion was distributed through the Task Force for input from the community of rehabili-tation counselors, attorneys, nurses, insur-ance personnel, vocational evaluators and other professionals. Comments were received by the sub-committee and a final questionnaire was de-vel oped and disseminated by the members of the committee, the Workers' Compen-sation Commission's rehabilitation office, and the Division of Vocational Rehabilita-tion through the Maryland ,Rehabilitation Center to over 1,000 professionals working or interested in the Maryland workers' compensation process. Analysis Two hundred and fIfty-six questionnaires were returned. The Maryland State De-partment of Education, Office of Manage-ment Information Systems staff, computer analyzed the questionnaire with the fol-lowing results: The respondents by discipline were as follows: 64 rehabilitation counselors, 30 plaintiff attorneys, 15 defendant attorneys, 19 nurses, 22 insurance claims personnel, 9 vocational evaluators, and 97 others com-prised of psychologists, educators, and those who did not identify their profession. Any deviation from the median score of 3.0 resulting in a mean respondent's score of3.5 or above or 2.5 or below was inter-preted as being a significant total group agreement or disagreement with the pre-sented statement. Significant issues identified were as follows: Clarity The lack of understanding of workers' compensation law was consistently identi-fied as a problem. Confusion among pro-fessionals because of a lack of standardized definitions among disciplines was identi-fied as a problem. For example, when a doctor limits an injured worker to "light" work, is this a reference to the standardized definition of work exertion established by the Department of Labor or an unquanti-fied recommendation? The lack of clear criteria for referring an individual for vo-cational rehabilitation is also identified as a problem. Similar questions are raised about case closure standards in vocational rehabilitation. Professionals working with injured workers are identified as not under-standing the workers' compensation pro-cess. The complexities of the process itself is thought to be a contributing factor to the anxiety felt by the injured worker. Timeliness Respondents felt strongly that timeliness of vocational rehabilitation services is a critical factor in successful case outcome. The lack of clear criteria for referral to vo-cational rehabilitation likely impedes the ability of referral sources to make timely referrals. The respondents felt that psy-chological evaluations and vocational eval-uations do not occur in a timely manner. The results suggest that when the Workers' Compensation Commission makes voca-tional rehabilitation referrals, it should oc-cur within a strict time frame. Medical evaluations were judged to occur in a timely manner which likely shows that worker's compensation continues to focus more on medical management than case manage-ment. Process/System The respondents felt strongly that re-turning an injured worker to any job (job stuffing) should not be considered success-ful vocational rehabilitation. There was also the strong feeling by respondents that the workers' compensation law in Mary-"The respondents felt strongly that returning an injured worker to any job (job stuffing) should not be considered successful vocational rehabilitation. " land has disincentives for injured workers to seek to re-enter the work force. The cur-rent lack of a uniform workers' compensa-tion rehabilitation system discourages fair and timely services to clients. Finally, there is strong feeling that comprehensive vocational assessment at the beginning of vocational rehabilitation is an important contributor to successful vocational re-habilitation. Professional Disciplines Specific concerns are expressed by re-spondents about the disciplines involved in workers' compensation rehabilitation. Respondents felt that state vocational re-habilitation should be involved in workers' compensation cases. Respondents also felt that state vocational rehabilitation coun-selors and private vocational rehabilitation counselors can and should work coopera-tively on workers' compensation cases. Al-though previous responses reported indi-cate that there are many problems with the rehabilitation process, respondents appear to appreciate the complexity of the system and the need for professional counselors to work cooperatively as a team with a goal of helping an injured worker return to pro-ductive activity. The respondents felt that the role of rehabilitation counselor should go beyond simply obtaining a job for a client. Other Issues The questionnaire presented a variety of independent issues, some of which drew significant response. Respondents indi-cated that temporary total benefits should be paid during the vocational evaluation process. Respondents also indicated strongly that pre-injury salary and employment status of an injured worker should be con-sidered in developing a rehabilitation plan. Workers returning to the work force, earn-ing less than before their work injury, should receive compensation for the wage differential as part of their benefit. Re-spondents felt strongly that a "practices" manual specifying rules, procedures, and terms pertinent to the rehabilitation of in-jured workers would prove beneficial to all professionals in workers' compensation. Summary A questionnaire was distributed by the Task Force on Injured Workers' Rehabili-tation to more than 1,000 professionals involved in Maryland workers' compensa-tion. Two hundred and fifty-six question-naires were returned. Respondents identified clarity, timeli-ness, process and relationships among pro-fessional disciplines as problems in the workers' compensation process. It must be recognized that clarification of responsibility in workers' compensation goes beyond possible changes in statute and regulations. The Task Force is in the process of com-pleting a "practices" manual that should prove beneficial to professionals in gain-ing a better understanding of the workers' compensation law, terms and process. In the next year, the Task Force may be addressing the following issues: Ongoing training programs Interdisciplinary analysis of question-naire Expansion of Task Force Follow-up study of impact of injured workers MRA/CARRPS have made standing committee Further study definition ofVR Winter, 1987IThe Law Forum-35 Metropolitan International OFFICES COAST TO COAST Excellence in the Fields of Investigative and Security Services for over 50 Years SECURITY • Building and plant security • Uniformed officers • Trained and equipped Strike Control Unit • Armed or unarmed • Strict physical standards • Male/Female • With or without K-9 • K-9's for buildings and warehouses P.o. BOX 250 TIMONIUM, MD. 21093 INVESTIGATIVE • Civil/Industrial/Personal/ Domestic • Criminal-theft, fraud, extortion • Accident-Industrial, Motor Vehicle • Employees background • Motion & stili photography • Undercover agents • Polygraph • Surveillance • Fingerprinting • Ultra-modern Computerization Call 24 hours a day (301) 561-0220 HARBOR PRINTING Xerox Center THE VERY BEST IN XEROX AND OFFSET PRINTING WE SPECIALIZE IN APPELLATE BRIEFS & RECORDS RESUMES XEROX COPYING 24 HOUR SERVICE Printing Center 3 East Redwood Street Baltimore, Maryland 21202 576-8656 33 South Charles Street Baltimore, Maryland 21201 685-7121 36-The Law Forum/Winter, 1987 

Workers\u27 Compensation Rehabilitation in Maryland: An Attitude Survey

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Workers\u27 Compensation Rehabilitation in Maryland: An Attitude Survey

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