Return to Work - American Osteopathic College of Occupational and Preventive Medicine 2015 Mid Year Educational Conference

Sep 18, 2026

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Educational conference material on return-to-work decision making after occupational injury, focusing on risk considerations to public safety and other workers, medical instability, capacity limits, and tolerance barriers. Covers RTW screening and obstacle/molehill questioning, role and appropriate scope of IME physicians, and how to communicate restrictions to employers with clear examples of light duty limits. Explains RTW workflow, functional capacity evaluation concepts, and pre-employment functional analysis.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Return to Work - Issues to Consider

Risk

Capacity

Tolerance

Likelihood of Return to Work

Return to Work after Occupational Injury

RTW “Tests” and Problem Framing

RTW Screening Test

Grocery Store Test

Obstacle Question

Molehill Sign

Roles and Communication

Role of IME Physicians

Communicating with Employers

“Light Duty” Examples

RTW Flow (2000 Style)

Functional Capacity Evaluation (FCE)

What Questions an FCE Can Answer

Intuitive Benefits of Functional Capacity Testing

Assessing Work Capacity and Pre-Employment

Generalities about FCEs and PEFA

American Osteopathic College of Occupational and Preventive Medicine 2015 Mid Year Educational Conference, Ft Lauderdale, Florida | Return to Work | | | | --- | --- | --- | | | | | | Carl Werntz, D.O., MPH | | | | WVU Occupational Medicine | | | BLACK BOX WARNING Issues to Consider •Risk •Capacity •Tolerance Benefits of Work • Income • Benefits (Health Insurance, etc. ) • Camaraderie with co-workers • Purpose • Economic Independence Likelihood of Return to Work Return to Work after Occupational Injury 0 4 8 12 16 20 24 28 32 36 40 44 48 52 Weeks Away from Work Risk … • To Public Safety –Sudden Incapacitation –Impaired function –Inability to maintain Food Handler with open sore on their hand –Pilot with increased sudden incapacitation risk • To other workers / Employer American Osteopathic College of Occupational and Preventive Medicine 2015 Mid Year Educational Conference, Ft Lauderdale, Florida Risk … • Of Medical Instability –Recurrent Seizures –RECENT Cardiac Procedures –Recurrent Hypoglycemic Episodes Capacity • Essential Job Functions? – Can patient actually do essential job functions? – Complete emergency actions required by job – ADA • Need employer assistance with identifying truly essential functions • Could they do majority of functions (>80%) • Must be capable of all “essential functions” RTW“Tests” • RTW Screening Test – Ask worker what impact disease/limitations will have on work ability, and potential work-arounds • Grocery Store Test – Consider: If patient owned small store without employees, could they be able to get to work and do job safely? – If yes, then no reason to keep totally off work Risk … • To treatment efficacy –Immobilization –Medications –External orthopedic appliances Tolerance • The bane of most RTW decisions • Potential Approaches – Scribe whatever patient reports – Educated Guess by provider – Functional Capacity Evaluation • Useful if you are concerned about patient actually having the abilities they report • Less useful if you suspect patient can do more than they report they can do RTW“Tests” • The Obstacle Question – Ask worker “what specifically is an obstacle keeping you from working today?” – Then focus on overcoming these obstacles • The Molehill Sign – Consider: Is a fairly minor health condition having a major impact on the patient’s life? – If yes, then MOTIVATION is likely a major issue, which can have many involved factors American Osteopathic College of Occupational and Preventive Medicine 2015 Mid Year Educational Conference, Ft Lauderdale, Florida Role of IME Physicians • Appropriate to comment on – Work status – Work capacity – Needed Restrictions – Potential Accommodations • NOT appropriate for IME doc to actually release examinee for RTW Communicating with Employers • Restriction Examples –May lift up to 25 Lbs Continuously –May lift up to 50 lbs twice per hour –Do not use right arm above shoulder level –May not operate commercial vehicles –May not drive –Left arm to be in sling at all times Communicating with Employers “Light Duty” Communicating with Employers •Employer is Entitled to Know: •Diagnosis •Work-related or Not •Capabilities of Worker •Safety-based concerns •Dates for any “Restrictions” Communicating with Employers • Do you comment on their current job? – If I know about details of job – then yes – Ex: Hospital Nurse • Lifting limit 25 lbs • May perform all nursing skills • Will require assistance with patient lifting – Goal is not to tell employer what to do . . . . . . But to tell employer what worker can do in terms the employer can better understand RTW Flow (2000 Style) • Injury Lets look at this • Medical Care process . . . • MMI • FCE • Vocational Rehabilitation • Search for job within the FCE-determined restrictions • RTW in an appropriate j

FAQs

What main issues should be considered when planning return to work after occupational injury?

Focus on risk, capacity, and tolerance. The material distinguishes risks to public safety and other workers, evaluates essential job functions, and addresses tolerance barriers that can undermine RTW decisions.

How can RTW screening questions help identify work barriers?

Use the RTW screening test to ask how disease or limitations affect work ability and possible work-arounds. The obstacle question targets what specifically prevents working today, and the molehill sign evaluates whether a minor condition is causing major life impact, often indicating motivational factors.

What is the appropriate role of IME physicians and how should employers receive restrictions?

IME physicians may comment on work status, work capacity, needed restrictions, and potential accommodations, but they are not appropriate to directly release an examinee for RTW. Employers should be informed about diagnosis, whether work is related to it, safety concerns, dates for restrictions, and capabilities in employer-understandable terms.

Sep 18, 2026

Upload by Aldword