I’m asked quite frequently by business owners and HR personnel what can be done when an employee is injured, but they know the employee had a pre-existing condition. A short answer is “tough luck,” after a legitimate work injury occurs, the best you can hope for is strict mitigation, minimize the lost time indemnity payments, and utilize all the in-network providers possible. All this does, however, is control the cost of the claim. A better approach would be to stop buying the injury in the first place! …
One of the best ways to reduce incidents and costs (premium, deductible losses, and experience mod) associated with workers compensation claims is to not keep employees beyond a probationary period who are more susceptible to injury, or with pre-existing conditions. To accomplish this, top notch employers require post-offer medical screening. This consists of both a post-offer medical history questionnaire and functional capacity physical exam.
Most employers already require a completed job application as part of the hiring process, but I suggest identifying the jobs in the highest hazard areas, outlining the physical requirements demanded, and use these physical demands to create a medical history questionnaire. By nature of the job demands and frequency of claims, this approach is much better suited for very physical, labor intensive positions, rather than clerical or professional services.
I’ve met many HR professionals that are frustrated to learn an employee had a prior back surgery only after they filed a WC claim (usually after 4 months of employment). Isn’t that something you would want to know before keeping someone to work stocking shelves, loading a truck, or lifting anything over 50 pounds? Of course!
To encourage honest feedback on the medical questionnaire, it should clearly state that failure to disclose pertinent information relevant to the applicant’s ability to perform the job is grounds for termination.
The medical questionnaire should, at least, cover the following areas:
- Past surgeries
- Chronic pain issues
- Current medications
- Past musculoskeletal injuries
- Neurological problems
Click here to download a sample post hire medical questionnaire.
So who reviews the application and medical questionnaire? The best scenario is to partner with an independent occupational medical physician or clinic close to the company’s facility. The more the physician gets to know the your business, various job functions, and physical job requirements, the more you’ll get good feedback you can use in making the employment decision.
The usual disclaimer applies… prior to using any pre-employment medical history questionnaire, make sure you have it reviewed by a qualified employment attorney. American with Disabilities Act (ADA) laws can be complex and in no way do you want to trample on an applicant’s confidentiality and disability rights.
The five steps:
- Create a job description that outlines physical requirements of the job (a job safety analysis).
- Create a medical questionnaire with questions based on the physical requirements of the job.
- For the best qualifying applicant, extend a job offer, with a probationary period, that is conditional on the applicant passing a physical examination. The physical exam must be required of all applicants offered employment and must be related to the physical requirements necessary for the job.
- Conduct the physical exam using an outsourced occupational clinic, nurse practitioner, or physician that understands your business and the job requirements. This evaluation should include a functional capacity and/or work simulation. Functional capacity results commonly measure strength, range of motion and flexibility which will help determine the applicant’s capabilities and restrictions. A work simulation will measure the applicant’s ability to perform specific job tasks.
- Review the results and feedback from the evaluating professional.
Physical capabilities that can be tested include the following:
- Exertion
- Lifting capabilities
- Sight (including color blindness where appropriate)
- Hearing
- Balance – especially for workers who would use ladders or other equipment to be elevated
Both functional capacity evaluations and work simulation testing have limitations on their effectiveness. They both measure the employee’s abilities at the given moment, but they do not measure the job applicant’s endurance over a longer period of time. Nevertheless, your company needs to know if the job applicant has the physical ability to do the work in a short time frame. If not, the employee should not pass their probationary period (usually 90 days).
All good companies legitimately want to protect their employees from injury and return them safely to their families the same way the arrived at work. At the same time, good companies should want to protect themselves from elevating costs associated with workers compensation accidents, claims, and premium. Post-Offer Employment Screening of applicants is the most effective way to prevent buying an injury. By not putting someone in a position that may be more susceptible to injury or aggravation, companies can take proactive steps to reduce their risk to workers compensation claims and improving their Experience Modification Rate (EMR).
John Keller, CRM ARM CIC AAI is the Director of Risk Management and Claims at Gulfshore Insurance. John works with a wide range of business clients to deliver strategic risk analysis and guidance. Comments and questions are welcome at jkeller@gulfshoreinsurance.com
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