A. The current disability management programs evolved from the workers’ compensation programs.

B. In the 1970s and 1980s, many states reformed their workers’ compensation laws because of rising costs. Employers and insurance carriers began to develop cost-effective ways to respond to workers with occupational illnesses and injuries; hence, disability management and occupational health (OH) programs became more common.

C. From the perspective of reducing costs came the implementation of disability management programs, to not only address the needs of those employees, both ill or injured, but also in response to reducing costs and duration of absences from the workplace.

D. By facilitating earlier return-to-work (RTW) activities, the overall cost of disability was not only reduced, but there was also an increase in productivity as well. Gradually, the disability management program expanded to include an integrated approach.

E. The primary mission of disability management programs is to reduce the financial costs associated with all disabilities in a nonadversarial environment of claims administration. This is accomplished through the development of a coordinated program with the focus on the individual’s ability rather than disability.

F. Disability management programs include coordinated access to employer-provided benefit plans and services that impact the employee with a disability. This includes:

G. Internal departments that typically have responsibility for the design, administration, and implementation of one or more programs are human resources, risk management, OH, safety, finance, legal, and bargaining units.

H. External sources or departments that may be involved in the disability management program are the WC insurance carriers, health care providers, third party administrators, life insurance carriers, re-insurers, disability carriers, and managed care providers.

I. The expanding recognition that both nonoccupational and occupational disabilities could be managed effectively and efficiently with the support of employers, supervisors, and caregivers gave rise to the managed integrated disability approach.

J. According to the American Association of Occupational Health Nurses (AAOHN), poor employee health costs about $1 trillion annually, so business executives look to OH nurses and case managers to maximize employee productivity and reduce costs through lowered disability claims, fewer on-the-job injuries and improved absentee rates.

K. Through their recognized value to business, OH professionals commonly take a seat at the management table, providing input about staffing issues, budgetary considerations and corporate policies and procedures that positively impact worker health and safety, and thus contribute to a healthier bottom line.

L. The practice of occupational and environmental health focuses on the promotion and restoration of health, prevention of illness and injury, and protection from work-related and environmental hazards.

A. Assistive device—Any tool that is designed, made, or adapted to assist a person in performing a particular task.

B. Assistive technology—Any item, piece of equipment, or product system, whether acquired commercially or off the shelf, modified or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.

C. Capacity—A construct that indicates the highest probable level of functioning a person may reach. Capacity is measured in a uniform or standard environment, and thus reflects the environmentally adjusted ability of the individual.

D. Clinical practice guidelines—These guidelines are voluntary in nature and may be specific to an institution; some are mandated by state WC laws (e.g., Massachusetts), or they may be voluntary (e.g., New York). There are no nationally promulgated clinical guidelines dictating medical care.

E. Disability—Can be defined in different ways, all referring to a lack of or inability to function in a certain aspect of daily living.

F. Disability case management—The process of managing occupational and nonoccupational diseases with the aim of returning the disabled employee to a productive work schedule and employment. It is also known as limiting a disabling event, providing immediate intervention once an injury or illness occurs, and returning the individual to work in a timely manner.

G. Ergonomics—The scientific discipline concerned with the understanding of interactions among humans and other elements of a system. It is the profession that applies theory, principles, data, and methods to environmental design (including work environments) in order to optimize human well-being and overall system performance.

H. Ergonomist—An individual who has (1) a mastery of ergonomics knowledge; (2) a command of the methodologies used by ergonomists in applying that knowledge to the design of a product, process, or environment; and (3) applied his or her knowledge to the analysis, design, test, and evaluation of products, processes, and environments.

I. Functional Capacity Evaluation (FCE)—A systematic process of assessing an individual’s physical capacities and functional abilities. The FCE matches human performance levels to the demands of a specific job or work activity or occupation. It establishes the physical level of work an individual can perform. The FCE is useful in determining job placement, job accommodation, or RTW after injury or illness. FCEs can provide objective information regarding functional work ability in the determination of occupational disability status.

J. Handicapped—Refers to the disadvantage of an individual with a physical or mental impairment resulting in a handicap.

K. Handicap—The functional disadvantage and limitation of potentials based on a physical or mental impairment or disability that substantially limits or prevents the fulfillment of one or more major life activities otherwise conisdered normal for that individual based on age, sex, and social and cultural factors, such as caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, working, etc.

L. Impairment—A general term indicating injury, deficiency or lessening of function. Impairment is a condition that is medically determined and relates to the loss or abnormality of psychological, physiological, or anatomical structure or function. Impairments are disturbances at the level of the organ and include defects or loss of limb, organ, or other body structure or mental function, e.g., amputation, paralysis, mental retardation, psychiatric disturbances as assessed by a physical.

M. Injury—Harm to a worker subject to treatment and/or compensable under workers’ compensation. Any wrong, or damages done to another; either done to his or her person, rights, reputation, or property.

N. LTD income insurance—Insurance issued to an employee, group, or individual to provide a reasonable replacement of a portion of an employee’s earned income lost through a serious prolonged illness during the normal work career.

O. Mobility—The ability to move about safely and efficiently within one’s environment.

P. Nondisabling injury—An injury which may require medical care, but does not result in loss of working time or income.

Q. Nonoccupational disease—Any disease that is not common to, or does not occur as a result of a particular occupation of specific work environment.

R. Occupational disease—Any disease that is common to, or occurs as a result of, a particular occupation of specific work environment.

S. Occupational health case management—The process of coordinating the individual employee’s health care services to achieve optimal quality care delivered in a cost-effective manner. It may focus on large-loss cases—that is, high-cost, prolonged recovery—or those with multiple providers and fragmented care.

T. Paid time off (PTO) arrangements—A benefit that provides employee with the right to scheduled and unscheduled time off with pay. Full and part time regular employees accrue PTO based on years of service. PTO
days may be used for vacation, personal time, illness or time off to care for dependents. It usually does not include jury duty, military duty, bereavement time for an immediate family member, or sabbatical leave.

U. Partial disability—The result of an illness or injury that prevents an insured from performing one or more of the functions of his or her regular job.

V. Physical disability—A bodily defect that interferes with education, development, adjustment, or rehabilitation; generally refers to crippling conditions and chronic health problems but usually does not include single sensory handicaps such as blindness or deafness.

W. Social Security Disability Income (SSDI)—Federal benefit program sponsored by the Social Security Administration. Primary factor: disability and/or benefits received from deceased or disabled parent; benefit depends on money contributed to the Social Security program either by the individual involved and/or the parent involved.

X. STD income insurance—The provision to pay benefits to a covered disabled person/employee as long as he or she remains disabled up to a specific period not exceeding 2 years.

Y. Time loss management—A proactive process used for the management of employee absenteeism due to sickness and medical leaves. Usually a time loss management program focuses on ensuring employees health, productivity, safety and welfare. It does not aim to prohibit sickness absence; rather, it facilitates a timely return to work.

Z. Vocational assessment—Identifies the individual’s strengths, skills, interests, abilities, and rehabilitation needs. Accomplished through onsite situational assessments at local businesses and in community settings.

AA. Vocational evaluation—The comprehensive assessment of vocational aptitudes and potential, using information about a person’s past history, medical and psychological status, and information from appropriate vocational testing, which may use paper and pencil instruments, work samples, simulated work stations, or assessments in a real work environment.

BB. Vocational rehabilitation—Cost-effective case management by a skilled professional who understands the implications of the medical and vocational services necessary to facilitate an injured worker’s expedient return to suitable gainful employment with a minimal degree of disability.

CC. Vocational rehabilitation counselor—A rehabilitation counselor who specializes in vocational counseling; i.e., guiding handicapped persons in the selection of a vocation or occupation.

DD. Vocational testing—The measurement of vocational interests, aptitudes, and ability using standardized, professionally accepted psychomotor procedures.

EE. Work adjustment—The use of real or simulated work activity under close supervision at a rehabilitation facility or other work setting to develop appropriate work behaviors, attitudes, or personal characteristics.

FF. Work adjustment training—A program for persons whose disabilities limit them from obtaining competitive employment. It typically includes a system of goal-directed services focusing on improving problem areas such as attendance, work stamina, punctuality, dress and hygiene and
interpersonal relationships with co-workers and supervisors. Services can continue until objectives are met or until there has been noted progress. It may include practical work experience or extended employment.

GG. Work conditioning—An intensive, work-related, goal-oriented conditioning program designed specifically to restore systemic neuromusculoskeletal functions; e.g., joint integrity and mobility, muscle performance (including strength, power, and endurance), motor function (motor control and motor learning), range of motion (including muscle length), and cardiovascular/pulmonary functions (e.g., aerobic capacity/endurance, circulation, and ventilation and respiration/gas exchange). The objective of the work conditioning program is to restore physical capacity and function to enable the patient/client to RTW.

HH. Work hardening—A highly structured, goal-oriented, and individualized intervention program that provides clients with a transition between the acute injury stage and a safe, productive RTW. Treatment is designed to maximize each individual’s ability to RTW safely with less likelihood of repeat injury. Work hardening programs are multidisciplinary in nature and use real or simulated work activities designed to restore physical, behavioral, and vocational functions. They address the issues of productivity, safety, physical tolerances, and worker behaviors.

II. Work modification—Altering the work environment to accommodate a person’s physical or mental limitations by making changes in equipment, in the methods of completing tasks, or in job duties.

JJ. Work rehabilitation—A structured program of graded physical conditioning/strengthening exercises and functional tasks in conjunction with real or simulated job activities. Treatment is designed to improve the individual’s cardiopulmonary, neuromusculoskeletal (strength, endurance, movement, flexibility, stability, and motor control) functions, biomechanical/human performance levels, and psychosocial aspects as they relate to the demands of work. Work rehabilitation provides a transition between acute care and RTW while addressing the issues of safety, physical tolerances, work behaviors, and functional abilities.

KK. Workers’ compensation—An insurance program that provides medical benefits and replacement of lost wages for persons suffering from injury or illness that is caused by or occurs in the workplace. It is an insurance system for industrial and work injury, regulated primarily among the separate states, but regulated in certain specified occupations by the federal government.

A. Disability has been defined in a variety of ways for the purposes of programs, policies, and the law.

B. In a recent report by the Cherry Engineering Support Services, Inc., Federal Statutory on Definitions of Disability prepared for the Interagency Committee on Disability Research (2003), it was noted that there are 67 separate laws defining disability for federal purposes.

C. Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA) of 1990 have adopted a definition that takes into consideration the individual, the physical surroundings, and the social environment.

D. From a legal, benefit, and social program perspective, disability is often defined on the basis of specific activities of daily living (ADLs), work, and other functions essential to full participation in community-based living.

E. To be found disabled for the purposes of Social Security Disability income benefits, the individual must have a severe disability that has lasted, or is expected to last, at least 12 months, and which prevents the individual from working at a “substantial, gainful activity” level.

F. Both Section 504 of the Rehabilitation Act of 1973 and the ADA of 1990 define a person with a disability as someone who:

A. The Certification of Disability Management Specialists Commission (CDMSC), the only nationally accredited organization that certifies disability management specialists, recently completed a role and functions study tracking the changes in disability management. Three specific practice domains were identified:

B. Disability case management programs highlight the following functions or activities:

C. Disability prevention and workplace intervention consists of the following activities or functions:

D. Disability case management program evaluations consist of the following activities:

E. Disability case management is not only an important workplace productivity program but also addresses more advanced workplace productivity concepts. These include:

F. Disability managers are a part of a multidisciplinary team involved in integrated benefit practice, productivity enhancement, and health and wellness programs.

G. Increased emphasis on early intervention and job accommodation reduces disability-related costs.

H. The U.S. Surgeon General, Richard H. Carmona, through the United States Department of Health and Human Services has issued a “call to action to improve the health and welfare of persons with disabilities (2006).” This call to action has four main goals that are consistent with the goals and objectives of a disability case management program:

A. It is important to recognize that from a disability case management perspective the number of workers 55 and older is expected to grow 48% by the year 2008 and that the incidence of disability increases with age.

B. The number of employees with work-limiting disabilities increases with age, particularly in the 50- to 59-year-age group.

C. The U.S. Census Bureau in 2002 reported that approximately one out of ten persons with disabilities has a severe disability. In the prime employable years of 21 to 64, 26% of those individuals with severe disabilities are employed.

D. The aging workforce will demand more services, especially because of the increasing number of people with disabilities. This trend positions disability case management to be a key strategy in prevention and wellness programs.

E. The Society for Human Resource Management (SHRM) released the results of a survey in 2003 related to employers’ incentives for hiring individuals with disabilities.

F. It should be noted that seven different tax credits are available to companies who hire disabled workers. However, fewer than 20% of human resource personnel surveyed reported being “very familiar with any of these tax credits.”

G. Research findings from the John J. Heldrich Center for Workforce Development at Rutgers University, New Jersey, indicate that many employers do not provide any training to their employees regarding working with people with disabilities.¹

H. A survey of 723 companies by Mercer Human Resource Consulting found that many employers have experienced significant increases in the incidence of LTD and STD.²

A. The ADA is both a challenge and a resource in disability management case management.

B. The ADA took effect on July 26, 1992. Title I of the ADA prohibits private employers, state and local governments, employment agencies, and labor unions, from discriminating against qualified individuals with disabilities in job application procedures, hiring, firing, advancement, compensation, job training, and other terms, conditions, and privileges of employment.