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Time for a Change PDF Print E-mail
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Written by Jason Parker   
The current trends in Work Disability are becoming quite alarming.  After decades of talk about early intervention and integrated disability management, Work Disability continues to be an issue for organizations, governments, workers, and society.  Unnecessary Work Disability costs continue to rise.  Watson Wyatt estimates that directs costs of disability amount to about 9% of payroll.  The NPR report, "Unfit for Work.  The startling rise of disability in America" paints a bleak picture of the prevalence and impact of disability in America. 

According to the Integrated Benefits Institute, the total cost of disability is $576 Billion dollars.  That is "B" for Billion.  This number includes wage replacement (both non-occupational and occupational injury/illness), treatment, and lost productivity.  This roughly amounts to a staggering 3.6% of the US GDP.  The US is not alone.  The Conference Board of Canada report "Missing in Action: Absenteeism Trends in Canadian Organizations - 2013", estimates the direct cost of absenteeism to the Canadian economy was $16.6 Billion.  In, 2008, the Australian Safety and Compensation Council updated a previous study and estimated that the total economy cost was estimated to be $57.5 Billion, representing a jaw dropping 5.9% of the GDP.  The United Kingdom has similar numbers to Canada and the US.


1. Rising Costs
2. Stress/Mental Illness
3. Substance Abuse
4. Subjective Disabilities
5. Discretionary and Unnecessary Disability

The human costs are substantial.  Unnecessary Work Disability, or worklessness, is actually harmful.  You are at 2-3x the risk of developing co-morbid conditions (i.e. heart disease, obesity, diabetes), 2-3x the risk of developing mental health conditions (i.e. depression, anxiety), and the real kicker, a 20% increase risk of mortality, meaning you are at risk of dying sooner.  Being out of work unnecessarily is harmful.

The Washington Department of Labor and Industries sent a letter to NIOSH suggesting that 5% of injured workers are associated with 80% of cost and lost time in workers' compensation systems.  They followed up saying, "The majority of these workers end up on long-term disability following injuries that would not be considered serious at their outset."  

This suggests the underlying problem of "we don't know who the 5% are until they become the 5%". 

What are the costs to your organization?

There is a serious need to relook at what WE, as stakeholders in an industry, are doing to help prevent work disability from happening.  What we are currently doing is only working to a point but not containing both the direct costs and indirect costs of disability.  Many new interventions or flavors only seem to stop the bleeding.  Of course this is important but the 'stumbling over the truth' is that we should have been doing that all along.  In a workers' compensation setting injury rates are falling but costs are rising.  Mental Health disability is continuing to rise and is often a co-morbid condition that can impact on duration. 

Everyone has seen the graph that shows that after 12 weeks there is a 50% chance of return to work.  Early Intervention was introduced to solve the problem.  This provided some relief but the unintended consequences of early intervention now introduced new costs to disability.  There is a large percentage of people that that will return to work with very little intervention and yet Early Intervention programs were provided at additional costs.  Presenteeism showed up as well which added to these costs.  According to the Harvard Business Review the indirect costs of presenteeism are 3 times the direct costs of absenteeism.  The ripple effect of returning a person to early impacts the co-workers around them, the department, and ultimately the organization.  Ask any manager of a department, or hear their reluctance to bring people back to work that are not 100%.  This is not to say that Stay at Work and Early Return to Work programs are not valuable, because they are.  Evidence-based early intervention does take a slightly different approach rather than a once size fits them all.  This new approach is Targeted Risk-Based Intervention.  Evidence-based early intervention involves the screening for low risk, medium risk, and high risk claims not just providing early intervention.

The conclusions of evidence based early intervention: 
  • For low risk claims - basically do very little, provide the support they need, and make it as easy as possible for them to RTW.

  • The medium and high risk claims need to be assessed correctly for known predictors of work disability and the appropriate intervention applied - This is called Targeted Risk-Based Interventions.  Otherwise you are just guessing.

The next evolution came in the form of Integrated Disability Management.  Once again this solved many challenges and system problems but in the end the integration of different types of "systems" of compensation (Workers' Comp, FMLA, STD, LTD, paid leave)  has proved challenging.   The "systems" are different and require different processes, different rules, and have different differences.

“You cannot solve the same problem with the same thinking that created It.” – Albert Einstein

This raises the question - How do we manage disability that fulfills the needs of the organization, satisfies duty to accommodate legislation, meet both the medical and non-medical needs of the employee who has become work disabled?  Maybe it is time to look at this in a different way.  Maybe we have been looking at this the wrong way.  Maybe the integrating factor is NOT the systems.

The only thing that is common in the "systems" is the worker and the experience they have in the system(s).  They need to be engaged regardless of the system, involved in problem solving, and actively involved in their "future state".  The current evidence available to us at this time says that experience matters.  When it is good; workers tend to be engaged.  When it is bad; it can be "...cyclical and pathogenic...which influence the development of secondary injury in the form of psychosocial consequences instead of fostering recovery of injured [workers]" (Kilgour et al, 2014).  Experience matters.

Once we recognize the importance of the worker experience and how to create an experience that is engaging we can then develop and adopt what the American College of Occupational and Environmental Medicine point out in their excellent paper, "Preventing Needless Disability by Helping People Stay Employed" - A Disability Prevention Model.

Adopting a Work Disability Prevention Model is much different than a Disability Management Program.  Even the words create a different feel. The word "management" gives a feeling of the process of dealing with or controlling things or people.  The word "prevention" means the action of stopping something from happening or arising.

We are all familiar with the preventing a work place injury.  We have personal protection devices/gear, tie downs, lock out procedures, steel toed boots, vests, protocols, etc.  All geared to preventing injuries from happening.  This same thought process can be applied.  Rather than managing disability we should be focused on preventing work disability.

And more importantly when it comes to preventing Work Disability  preventing discretionary and unnecessary disability is what we should be focused on.  Dr. Jennifer Christian, former chair of ACOEM, said, "The lost days you are out to prevent are not the ones that are medically required."  

How does your program measure up?  Are you managing disability or preventing work disability?  Have you adopted a Work Disability Prevention Model?  Is your program evidence-based?  Have you maximized the effectiveness of your Early Intervention Program utilizing Targeted Risk-Based Interventions?

To find out more how you can enhance your program and learn more about Work Disability Prevention contact us here.

The most difficult disability to deal with.
What do you think is the best predictor of return to work and work disability?
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