What time period do these questions address?
These questions cover the time period from when an injury or occupational illness is reported to the time when a recovering employee is determined to have reached the point of Maximum Medical Improvement (MMI).
What is Maximum Medical Improvement (MMI) and who determines it?
As the name implies, Maximum Medical Improvement (MMI) is the point at which the injured worker no longer is expected to improve. MMI is determined by the treating doctor, and represents the doctor’s judgment that the employee’s recovery has progressed as far as is clinically likely. If the employee has sustained residual limitations due to the injury or occupational illness, the physician may prescribe long term or permanent functional restrictions. At this point, the term ”transitional work” no longer applies; options after MMI is reached with permanent restrictions will be addressed in a separate article on ”Alternative Employment”.
What is transitional work?
Modified job assignments during an injured employee’s recovery. Transitional work is also known as limited duty, light duty or modified duty. Transitional work suggests a temporary accommodation while an injured employee recovers.
What are the benefits of transitional work?
Transitional work allows injured employees to remain part of the workforce during recovery, which enables them to recover more quickly and sustain less long term disability. Studies have shown much better long-term clinical and financial outcomes for employees who remain at work in some capacity while recovering.
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How is a transitional work assignment structured?
Work assignment modifications include adjustments to current job functions, the type of job functions, and/or the timing of job functions.
- A worker’s current job function may include lifting. A transitional work assignment may include lifting, but may have restrictions on how much or how high the worker can lift to accommodate a shoulder injury.
- A worker may no longer be able to perform a particular type of job function that includes standing. To accommodate a leg injury, a transitional work assignment may include job functions that only require sitting.
- A worker may have difficulty sustaining job functions for long periods of time. A transitional work assignment may include sitting after 30 minutes of standing to accommodate a back injury, or working 4-hour days to accommodate fatigue experienced during the healing process.
Does the transitional work assignment have to be for the same job position?
No, an injured worker may be assigned to a different job position during recovery to accommodate only those jobs function he or she is capable of performing.
Who determines the functions an injured employee can perform during transitional work?
The treating physician determines the physical and psychological abilities of the injured employee and communicates them in writing to the employee and employer. The employer is responsible for determining what work tasks will be appropriate, based on the physician’s recommendations. The employing agency may call on its Occupational Health, Safety or Industrial Hygiene staff to help translate the physician’s recommendations into an appropriate work assignment.
Example: A physician may state that an individual can lift no more than 30 pounds. The employer would be responsible for modifying or creating a position that meets that restriction. The employee may be placed in an area that does not require lifting items over 30 pounds, or lifting tasks may be delegated to co-workers in the same area. Sometimes equipment can be used to decrease the amount of weight an employee needs to carry.
What can the employer do if the physician recommendations are unclear?
To ensure the transitional job functions are appropriate, the employer may request clarification in writing from the treating physician. Other options are obtaining a review by the employing agency’s clinical staff, who may contact the treating provider in writing, or requesting an agency medical exam, following applicable rules.
In the federal sector, official second opinion exams are arranged strictly by the Department of Labor (DOL), but the employing agency may also request this.
What happens to those workers who are unable to transition back into their previous job assignment?
Options for employees unable to return to their pre-injury job after reaching MMI are discussed on Federal Employees Return-to-Work (Part 2): Alternative Employment (after Maximum Medical Improvement).
What is the duration of transitional work in the federal sector?
Transitional work assignments may range from a few days to a few weeks or more. Some agencies have guidelines limiting the time period allowed for transitional work assignments, (e.g., 30 days, 90 days or 1 year). Others will continue to provide transitional work assignments as long as the injured worker shows potential for further recovery and has not reached Maximum Medical Improvement (MMI). Disability duration guidelines are useful for predicting how long it is likely to take for a worker to recover fully from a specific injury or condition; some disability guidelines account for age, gender, co-existing conditions and area of the country.
What happens at the end of transitional duty?
If the treating physician indicates that the injured worker has returned to full-functioning, the worker can resume his or her previous job assignment. If the injured employee has residual functional limitation at MMI, options include modifying the pre-injury job to accommodate these limitations, assigning a qualified employee to a different job in the same agency, assisting the employee in finding another federal job, or vocational rehabilitation. These options are discussed in more detail on Federal Employees Return-to-Work (Part 2): Alternative Employment (after Maximum Medical Improvement).
What are some common barriers to providing transitional work?
Following are some of the more common barriers to providing transitional work:
- The severity or complexity of the medical or psychological condition
- Underlying medical conditions or pre-existing conditions
- The physical requirements of the job
- The employer’s staffing needs
- Union contracts that make it difficult to shift to another craft
- Friction between the employee and employer
- Poor motivation for recovery
- Unclear physician recommendations
What are additional barriers to providing transitional work found in the federal sector?
In addition to the above referenced barriers, additional barriers in the federal sector are the result of federal regulations and structural bureaucracy, treating physicians unfamiliar with federal employment and regulations, communication delays between agencies and the Department of Labor, extended time to clarify medical restrictions through second opinions and referee examinations, variations in uses of terminology by different agencies, lack of universal approach of assisting the injured employee to find alternative federal employment, and limitations within the Vocational Rehabilitation process to find jobs with comparable salaries. The federal system does not routinely use standardized disability duration guidelines, which are used routinely in the private sector, to help guide case management even though they can be used as a predictor of time out of work.
How can barriers in the federal sector be overcome?
Here are some tips for overcoming the common federal sector barriers to use of transitional work:
- Make sure agency representatives responsible for workers’ compensation programs have comprehensive knowledge and understanding of the FECA system and rules.
- Educate the injured employee on rights and responsibilities.
- Assist the employee in identifying physicians who are familiar with FECA.
- Educate health care providers about the FECA system.
- Establish effective and frequent communication among the employee, supervisor, WC staff and health care providers to share progress in recovery, discuss problems and plan progression during the transitional work.
- Collaborate with the DOL claims team to address access to care, delivery of benefits and problems that may cause delays in recovery.
- Provide carefully structured and monitored transitional duty assignments with close attention to the restrictions established by a physician and a means of progressing an employee’s tasks to a higher level of functioning.
- Provide meaningful work that contributes to the agency’s mission.
- Request help from nurse case managers and occupational medicine advisors
- Use clinical standards and practice guidelines, such as Medical Disability Guidelines and American College of Occupational and Environmental Medicine (ACOEM) practice guidelines to provide objective measurements to help reduce clinical barriers and clarify expectations. Industry standards also provide a basis for establishing realistic short and long term occupational goals with time frames, such as, when is return to full duty anticipated.
- Obtain more clinical information when needed to clarify the physical abilities of a recovering employee. Options include:
- Asking the treating provider to order a functional capacity evaluation (FCE)
- Arranging for an agency directed medical exam
- Or asking the DOL for a second opinion exam.
- Use the Computer/Electronics Accommodations Program (CAP) to obtain needed equipment or ergonomic furniture for recovering federal employees.
What is the role of the DOL in transitional work?
Depending on the duration of transitional work, the DOL may pay partial compensation to the injured employee working in a transitional job which does not pay the same amount as the date of injury salary. The DOL claims examiner may assign a field nurse to assist the agency with re-employment efforts. The DOL also assists the agency and injured employee in clarifying work restrictions through document review, second opinion or referee examinations. When disagreement exists between the injured employee and employer regarding the suitability of a particular transitional job, the DOL will determine whether the job is suitable based upon available medical documentation in consideration of FECA regulations. The DOL may also provide assistance in obtaining a Functional Capacity Evaluation.
Where can federal agencies get more information on returning injured employees to work?
The Department of Labor has some new resources for assisting agencies in modifying jobs for employees recovering from a work injury. One resource is Employer’s Return-to-Work Toolkit, offered by the Office of Disability Employment Policy (ODEP). Another is a presentation describing the requirements for making job offers for employees with work restrictions, Returning Injured Employees to Suitable Employment. This presentation provides details about the regulatory basis and mechanisms for re-employment in the federal sector, and will help federal agencies educate their operations and human resources teams.
DOL provides additional information and guidance through their website www.dol.gov/owcp. Specifically FECA Part 1, Part 2 and Part 3 address regulations and guidelines related to the return-to-work process.
Read Part 2 – Alternative Employment: Federal Employees Return-to-Work (Part 2): Alternative Employment (after Maximum Medical Improvement)
Many thanks to Managed Care Advisors (MCA) for their help preparing the material on this page. MCA is an innovative, woman-owned small business enterprise specializing in managed care, employee health benefits and workers’ compensation consulting and case management services. MCA currently holds two (2) Federal Supply Schedules; MOBIS Contract GS10F0323P and HREEO Contract: GS-02F-0128W.
Find Managed Care Advisors at Federal Workers’ Compensation System (FECA) Directory.