California Forum for Workplace Health and Safety

Panel Friday 2/92001 8:30 a.m. Disability Management & Return to Work

Joan Lichterman
Founder and Coordinator, 1990-1999, East Bay RSI Support Group; VP, CTD Resource Network, Inc. (

Injured Worker Needs
Good morning! I'm glad to be here, and to see so many participants. As mentioned, I am vice president of the CTD Resource Network, which received federal nonprofit status in early 1999. It was created to bring together existing, online educational publications under a nonprofit organization and provide a vehicle to more directly assist those suffering from, or at risk of, cumulative trauma disorders. So far we offer web?based information related to computer injuries and MSDs generally-such as the Typing Injury FAQ, or TIFAQ, website-and links to a wide range of resources; we publish The RSI Network newsletter; moderate several online forums; host web pages for local RSI support groups; and list RSI and injured worker groups internationally. [Ironically, using computers.]

Before co?founding this organization, I founded and led an RSI support group in Oakland for more than eight years, and helped give birth to a number of other such groups throughout the Bay Area. The format was monthly meetings with specialist speakers on topics covering the gamut of issues affecting injured workers. As word of the group spread, I began spending most of my free time listening to and counseling injured workers who phoned from all over the country. One year I received almost 1,200 calls!

With each call I became increasingly angry hearing about
- lives devastated by preventable injuries
- claims officers spending more money on blocking treatment than the treatment would have cost
- sending people to doctors who didn't understand the nature of the injuries they were seeing
- so?called independent medical examiners who have forgotten the beginning of the Hippocratic oath: "First, do no harm"
- Employers discarding injured workers like pieces of trash

This the background for my discussion of four primary needs. [This says nothing about medical needs, which would be the subject of an entire forum in itself.]

I made an acronym to help you remember them: P A I R. Pair has another meaning in the context of work. It takes a pair to accomplish the mutual goals of management and labor. If management and labor are not working together cooperatively, many workers may get injured and a company will not be as effective or as profitable as it could be. If management takes care of its workers, workers will take care of the enterprise.

Now, to the acronym PAIR and four of the needs I see as critical: prevention, accommodation, information, and rehabilitation.

P is for prevention, and there are two aspects to it. The first is preventing work injuries to begin with. The second is preventing reinjury if workers do become injured and ultimately are able to return to work.
I can't say enough about the importance of prevention, and the simple things that can often be done to prevent injuries. Some of them-like musculoskeletal injuries-that haven't been treated early enough, are treated inappropriately, or are not amenable to a quick fix, can become chronic and lead to even more?disabling conditions. They can be catastrophic for workers and their families, for insurers, and ultimately for government entities to which disabled former workers are forced to turn for assistance. If employers had to bear the full costs of injuring workers, sometimes permanently, they would put far more effort into prevention.

A is for accommodation. This can mean accommodating injured workers' new needs to perform the same jobs.

However, there is a second kind of accommodation, which requires more imagination and creativity: assessing workers' strengths and helping them develop other skills, so they can build on their knowledge of the enterprise and continue to be important assets. Accommodation is a win/win for everyone. Workers will be able to reclaim their lives, and will be the most loyal employees.

*Especially* if employers have ignored prevention, they owe it to their employees to go out of their way to accommodate workers' return to the labor force. Many other employers won't even consider hiring workers who need accommodation, despite the ADA.

I is for information, both pre? and post?injury.

When workers are hired, they need to know about the potential dangers of their jobs and how to avoid injury; that they have a right to treatment if they are injured and to predesignate a treating physician; that employers are required to have an Injury and Illness Prevention Program. California should mandate employers to involve workers in these programs; their contributions can be critical in changing problem jobs or work processes. California also needs to monitor compliance.

After an injury and throughout treatment, especially when workers have complex and often misunderstood conditions, information is needed on a wide range of subjects. Finding it is often exceedingly difficult even for highly educated, skilled workers, whether or not they have attorneys.

For unskilled, poorly educated, and immigrant workers-who are a growing part of California's labor force-the situation is disastrous. A great number of them lack access to basic health care, few of them know about Workers' Comp, their entitlement to treatment, how to report injuries, or where they can get care. Rural workers have far greater difficulties getting help navigating through the system and getting fair settlements that will enable them to take care of their future injury?related medical needs. In addition, the method for assessing benefit levels for agricultural and other transient workers with multiple employers doesn't allow enough money to live on.

Once people are injured they need more than piecemeal information about Workers' Comp. They need written information explaining their rights, giving an overview of how the medical?legal process works at different points, and where to get help. I've had to tell people about the *existence* of Information & Assistance offices! The Injured Worker Factsheets prepared for the Commission on Health and Safety and Workers' Compensation by LOHP are a good starting point. I think employers should be required to post them in a visible place, and insurers required to give them to workers as soon as injuries are reported.

As cases progress, injured workers often need much more specific information explaining the medical?legal process, how to change treating physicians, how to select QMEs, their rights to protect themselves from QMEs who may be dishonest or venal; how to appeal decisions; when they may need a lawyer, and so forth. Most of the injured workers I know see the system as a Kafkaesque, wasteful nightmare. Many employers here may share that sentiment. Peer support groups are few and far between, many people can't get to meetings, and these volunteer groups lack the resources to meet more than a fraction of workers' informational needs.

This barely scratches the surface, but it's time to move on to the fourth primary need.

R is for rehabilitation. Rehabilitation is an endangered, yet essential component in returning people to work and making them whole. Vocational rehabilitation needs to be retained, reformulated, and refunded. The present system serves few people well, especially those with serious chronic injuries. These are the people who are least likely to find jobs and the most likely to need help. For example, according to a number of rehab counselors, only a few percent of the available jobs can be done by people with chronic musculoskeletal injuries. More time is needed to develop rehab plans, considerably more money, and more assistance than injured workers get now-including help from trained social workers. This sounds to me like a job for a much better funded Department of Rehabilitation!

Poorly educated people with low?level work skills and limited English?language skills are not even on the charts when it comes to vocational rehab. Not everyone can return to work with a voice?activated computer, and not everyone will find jobs they are able to do. I wonder how many homeless Californians landed in their present situations because of work injuries . . .

And I wonder how long it will take before the expert staff at the agencies that designed this conference will begin a thorough redesign of Workers Compensation, looking holistically at all the interrelated parts-including prevention, in collaboration with occupational health specialists and labor economists in state agencies, the University of California, and elsewhere-and then work to convince state legislators and the governor to take a draught of courage and establish a system whose primary purpose is to help people, and not merely to limit employer liability.