Explain that light duty is medical decision
Employer must understand it's the clinician's call
Question: A large employer wants us to specify only "light duty" or "no heavy lifting" in general terms like that, rather than saying very specific things like "no lifting more than 20 lbs."
Apparently, the employer wants to retain the flexibility of determining on its own what is acceptable light duty for that worker and that situation. The employer says its supervisors are in a better position to make that determination than we are. We disagree, but this is a very big employer whose business we don't want to lose. What should we do?
Answer: It's time to have a meaningful face-to-face meeting with your contact at this employer. You're right in feeling that part of the employer's demand is unreasonable, but it also sounds like you might need to improve your relationship with this client.
For starters, you are right to think that you cannot comply with the demand to let the employer determine restricted duty criteria. It would be irresponsible to leave that decision to the employer, says William Patterson, MD, MPH, medical director for Occupational Health & Rehabilitation in Wilmington, MA.
"It is the responsibility of the occupational health provider to make specific recommendations about an individual's physical capabilities," he says. "That responsibility cannot be transferred to a nonhealth professional who represents the employer."
Patterson notes he is sympathetic to the sometimes unreasonable demands of employers who fear losing control of their workplaces, "but defining the medical restrictions is the responsibility of the provider, period."
But on the other hand, Patterson points out that the occupational health provider should not go overboard by determining what jobs in the workplace would fit the criteria specified in the restricted duty. In other words, the provider should specify something like "no lifting more than 20 lbs," rather than just saying "no heavy lifting." But the provider should not go a step further and specify that the employee should be assigned to "stocking small parts in the warehouse."
That may seem contrary to the idea that an occupational health provider should be very familiar with the client's workplace and the demands of particular jobs. Patterson explains it is fine for the provider to make suggestions based on that type of knowledge, but a suggestion is very different from specifying that job assignment as part of the restricted duty report. Employers can feel that they are obligated to make that assignment, even if they know of a more useful, more appropriate assignment that also fits the restricted duty criteria.
"Sometimes employers think that if the provider clears the employee for restricted duty, they are required to accept them back for work. If you specify a particular job, that can make things worse because they feel like they have to put the employee there because you said so," he says. "In fact, it is up to the employer to decide whether they can accommodate the employee with the recommended restrictions."
Be especially careful when an employee requests a certain job assignment for restricted duty. While the worker may have good intentions and seem to have knowledge of the job requirements, you still should limit yourself to describing the worker's physical limitations and letting the employer determine the job assignment.
"Normally, employers don't even tell me what job they've assigned the person to. It's not necessary," he says. "They know the jobs best and I trust them to make a good choice based on my recommendations. They may call and ask for some flexibility or whether I agree that a certain job fits the criteria, but the assignment is really up to them."
Once employers understand that you are leaving that part of the decision to them, chances are good that you will encounter much less resistance to your specific recommendations for restricted duty. If the employer fears losing control of the workplace so much that you are asked not to make specific recommendations, then you probably need to establish a better relationship with that client.
"Usually when you get this type of situation, it suggests the need for a face-to-face meeting between the senior representatives of the employer and the occupational health provider. You need to understand more clearly the goals of the employers," he says. "Once you understand why they're resisting your recommendations, you probably will be able to put their minds at ease without having to compromise your care."
[Editor's note: You can contact William Patterson, MD, at Occupational Health & Rehabilitation, Wilmington, MA. Telephone: (978) 657-3826.]
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