What Doctors Don't Understand About Light Duty: Evidence-Based Work Restrictions

Continuing the theme of what doctors don’t understand about light duty. It’s important to understand that in the current Worker’s Compensation context, the assumption has flipped. Where it used to be assumed that employees would need to go out of work after an injury, now the assumption is the opposite. The assumption is that every employee, despite whatever injury they may have, should be able to do some kind of modified duty work. With a few employers, there are really no limits to that. Some doctors and physicians groups have a practice of not putting anyone on an off duty status. We can debate the merits of that as a policy, but it’s the reality for a lot of injured employees these days.

 

What doctors really don’t understand about light duty is that there are scientific ways of evaluating work status and is no longer good enough just a guess at what somebody might or night not be able to do. A lot of doctors seem to have generic restrictions they work with regardless of the nature of the injury. I see doctors repeatedly  have the same restrictions regardless of the injury and are not thorough in completing the work status forms.

 

The work status forms do not appreciably differ from one another regardless of whether it has a severely sprained ankle, a back injury, a shoulder injury, or a knee injury.

 

A lot of people with a back injury can’t sit for very long without severe and excruciating pain in the lower back and into the legs. It is foolishness to give them the same restrictions as someone with a shoulder injury.

 

Fortunately, there is no reason for a doctor to have to guess as to what the work status restrictions should be. There are evidence based solutions to this problem.

 

First of all, the doctor can use a functional capacity evaluation to determine the employees work status. The functional capacity evaluation is a test which last several hours and puts the employee through various employment related simulations that test of the ability of the employee to perform activities over time. This is important because the employee doesn’t just have to lift an object once at work. The normal work environment is dynamic, with a variety of tasks occurring randomly over the course of a day. Fatigue, altered biomechanics, and pain levels are pertinent to the ability of the employee to continue the work.

 

Similarly, in a contrasting situation where the work is highly repetitive such as a factory installer situation, the body part may be repeatedly stressed by repetitive activities in a way that can be simulated in a functional capacity evaluation to predict employee ability to function in that environment over the course of a shift.

 

There are also statistical guidelines available for doctors to consider, but it is important there for the doctor to look at the whole person in light of other medical variables. In other words, one cannot merely look at a person with a shoulder injury in isolation from the fact that the person also has diabetes, high blood pressure, and an arthritic knee. While the insurance company may not be liable to repair all of those extraneous problems, they are problems the physician should consider in light of the fact that the employee did not have any problem completing required work activities before the injury when all of those comorbidities were active and present.

 

Therefore it is reasonable within the treatment plan to consider the effect of those conditions in terms of work status and delay in recovery. Doing anything else would not only shortchange the patient in terms of the care that can be offered, but also set up the employee for failure and set the employer up for potential additional liability.