SCIENCE AND FUNCTION

How to Prevent and Manage Workplace InjuriesBy Terry Lawson, PT, CAE

13th Annual ASSE Symposium

Functional Testing

What is Functional Employment Testing?

• A series of medically accepted, scientific, and legally defensible objective tests and measurements performed for the purpose of:

Determining an individual’s ability to safely perform the physical demands of the essential functionsof their job.

Two Main Classifications of Functional Employment Testing

• PRE-EMPLOYMENT– Pre-offer “Agilities” testing (minimal utility)– Post-offer

• Almost any testing- medical, etc...• A contingent job offer…pending completion of…drug screen,

functional test…etc

• POST-EMPLOYMENT (EXISTING WORKERS)– Post-injury

• Determine “legitimacy” and “extent”– Accept or deny case– Accurate transitional (modified) duty– Specify rehab baselines, goals, and progress (FCE)

– Fit for Duty • Uninjured

– Single out “at-risk” employees, determine “fitness for duty” by objectives

• Injured– Occupational or non-occupational upon release to return to full

duty– Functional Capacity Evaluation

Can An Employer Deny Employment To An

Individual Without Liability Under

Anti-Discrimination Laws?

FIRST…CAN YOU DO IT?

YES!!!For Two Reasons...

1. The Employee Cannot PerformThe Essential Functions Of The Job.

- Standards must be related to business necessity.- If an individual is disabled, reasonable

accommodation should be considered. - (they still need to be able to do the essential functions)

An employer is not required to hire or retain an individual who cannot perform the ‘essential functions’ of a job.

(EEOC TAM 4.4)

THE EMPLOYER MUST CONSIDER:

2. An Individual Is In Direct Threat of Harm

- Imminent risk of Substantial harm to themselves or others

- Actual risk, not speculative

An employer is not required to hire or retain an individual who would pose a ‘direct threat’ to health or safety.

(EEOC TAM 4.4)

THE EMPLOYER MUST SHOW:

(EEOC TAM 4.5)

- Based on objective measurements related to “business necessity” (essential functions)

- Valid and reliable- Defensible

Employment TestingMust Be...

Essential Functions:1.Using Hand Tools: Hand tools up to 10

lbs., 0-60”, Constant, 10 ft.2.Lifting Materials for Assembly: Various

Packets of Material up to 43 lbs., 0-36”, Occasional, 10 ft.

3.Lifting Assembled Galley Cabinet: 42 lbs., 36”, Occasional, 10 ft.

NIOSH estimates that over 50% of the workforce will suffer from a repetitive motion injury or disorder...

WHY Do it?

BUREAU OF LABOR STATISTICS

• One carpal tunnel surgery (direct costs).....$ 29K (direct and indirect) ........$100K

• One back injury (direct) .....................$ 24K(direct and indirect) ..........$100K

• One fraudulent claim (direct) ............$ 20-60K (direct and indirect........................$ 75K

• 1/3 of CT cases occur in the first year of employment

• 15% occur in the first 3 months of employment (they already had it...)

• You’re paying for their previous employer’s problem

Work Comp Advisor stated...

PRE-EMPLOYMENTPOST-OFFER

TESTING

POST-EMPLOYMENT or FIT FOR DUTY

TESTING(of existing workers)

Functional testing provides employers with objective functional information

that creates accountability for employees and treating medical

providers.

Post-Injury Programs...

- Provide data on injured workers for objective medical treatment, detection of fraudulent claims, and legal defense.

- Help facilitate safe, early return to work or return to modified duty programs based on objective assessment of functional capability

- Educate injured workers

FIT FOR DUTY TESTING

INJURED or UNINJURED

So… what about the “aging workforce?”

20 40 60Age

PhysicalDemand

Capability

PhysicalDemandOf Job

Fit For Duty-Uninjured(before claim)

• Those who exhibit OBJECTIVE signs of inability to safely perform their job CAN BE SINGLED OUT

– Unexpected physical signs– Complaints of fellow workers– Persistent absence for vague reasons

• BE CAREFUL!!! DO NOT TERMINATE!!!

• “Not Capable” results must lead to the INTERACTIVE PROCESS to determine what to do next.

Fit For Duty/Return to Work

• “Injured” workers (by job class)

• Those returning from work or non-work related medical conditions.

• BE CAREFUL!!! DO NOT TERMINATE!!!

• “Not Capable” results must lead to the INTERACTIVE PROCESS.

Analyze Statistics

• How many “fails” at what value?• Do functionally tested employees mean

safer employees? Do tested employees get hurt, if so…as badly?

• Compare pre-program stats with post-implementation stats....what is the trend?

• What happens if the program is stopped?

It Works!

A(Hospital)

B(Market)

C(Manufact)

D(Cable TV)

# of tests 191 40 19 56

Costs $11,460 $2,000 $2,850 $8,400

Fails 21 7 3 5

Fail rate 11% 18% 16% 9%

Savings $205,656 $96,589 $33,000 $62,293

Ratio 18 :1 48 :1 12 :1 7 :1

A review of failure rates and projected savings of 4 local and rA review of failure rates and projected savings of 4 local and regional egional employers...employers...

• Since 1997 $1 Million was spent on functional testing. (big company!)

• $30.00 saved for every $1.00 spent

• Saved $30 Million in Direct and Indirect costs.

Nelson Consulting (a New York auditing firm) recently conducted a Return On Investment Study related to functional testing for a major construction company. They report back to the employer:

Functional Testing Results can be impressive…

• Injury frequency was reduced from 32.4 to 6.9 per 100 employees from 1999 to 2006

• The cost of risk for the Texas injuries has been reduced from $2.2 million annually to $631,000 annually

• Nationwide due to lower exposure, reduced Letters of Credit by $10.1 Million

Bill McMahon, National Risk Manager for Fleetwood Enterprises reported at the 2007 Annual RIMS conference in New Orleans…

Injury Frequency

Fleetwood Historical Injury Frequency

32.4028.60

20.10 19.0015.49 14.80 13.89

9.406.90

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

1998 1999 2000 2001 2002 2003 2004 2005 2006

Calendar Year

Num

ber

of In

juri

es p

er 1

00 E

mpl

oyee

Hiring results without functional testing•Fleetwood initiated FEMA project in October 2005.

•Built 10,500 travel trailers and manufactured homes in response to Hurricane Katrina between October 2005 and January 2006.

•Due to the need to hire people immediately to respond to hurricane relief, facilities did not utilize the functional testing process.

•Frequency increased from 56 for the first 9 months (74 annually)… to 108 in the next 3 months. (432 annually) a 584% increase in injuries without functional testing!

It has been an amazing turnaround in our work experience. In our Las Vegas, NV office we have seen a reduction in Workers' Compensation losses from over $140,000 per year to less than $4,000 for the 1st year."

The number of reportable workers' compensation claims was reduced from 112 for the previous year to 64 for our policy year-end June 30, 2003. This is nearly a 50% reduction of reportable injuries in one year. Even better was the reduction in the cost of claims. It went from $874,659 to $220,727, a 75% reduction!

Functional Capacity-Sincerity of Effort Testing

What is Functional Capacity Evaluation without confidence in the accuracy and

credibility of data?

“Credibility Crisis in FCEs”

PTs are having a credibility crisis with functional capacity evaluations (FCEs) in the legal community right now. Just ask an attorney whether he or she finds them useful as medical-legal evidence in a workers’compensation hearing or other court proceeding. (Gwen Simons, PT, JD)

Why SOE?• CA Work Comp Fraud: < 1% or 20%? • Unfortunately, not every claimant is being honest

about their condition• Claimants are not the only ones…

– Employers? (Largest CA WC Fraud Case )– Doctors?– Attorneys?– Adjustors?

• Sincerity of Effort Testing helps keep everyone “on-track” and accountable.

How Does SOE Effect A FCE(and other medical evaluations) ?

Why Does it Matter?

FCE needs SOEThe bad news...

Current FCE Tests for

Sincerity of Effort

1. Coefficients of Variance, 3-Repetition Grips, Bell-shaped Curve, Rapid Exchange Grip

2. Isometric Sincerity of Effort and Strength Tests

3. Visual Estimation by evaluator of Maximal and Submaximal Effort/Strength

Current FCE Tests for

Sincerity of Effort

Coefficients of Variance, 3-Repetition Grips, Bell-shaped Curve, Rapid Exchange Grip• 1998 literature review showed these as

unreliable and invalid• APTA, AOTA do not endorse use of these in

determining sincerity of effort

Current FCE Tests for

Sincerity of Effort

Isometric Sincerity of Effort and Strength Tests• Have been used for over 20 years by most FCE

protocols• NO studies that show accuracy in SOE or prediction

of strength• 2010 studies show not accurate in determining

sincerity of effort or safe work ability

Current FCE Tests for

Sincerity of Effort

Visual Estimation by evaluator of Maximal and Submaximal Effort/Strength• 2011 study showed visual estimation is not able

to determine safe lifting ability or sincere effort

Scientific Sincerity of Effort Methods1. Multiple repeated measures of hand strength with

distraction net a 99.5% accuracy in distinction between valid and invalid participants

– Evaluates 7 peer-reviewed research based criteria in determining sincerity of effort

– Can accurately calculate combined odds up to 1 in 25 TRILLION!

2. Dynamic Lifting Test with multiple repeated measures (Lever Arm)

– Evaluates 4 scientific criteria of reliability and validity comparing 2 methods of material handling/lifting, NIOSH Dynamic Box Lifting and XRTS™ Lever Arm variable lifting device.

– Uses 3500 year-old science of Class II lever arm with unknown weights compared to standard box lifting

Legal

1. Knapp v. McKay, Macon County Illinois Case No. 97L25 (finding for defense, zero $$)

2. Illinois Industrial Commission, 05 IL.W.C. 21727, Aug 15, 2011 (finding for plaintiff (applicant) with award)

3. DZEVODA IBRAHIMVOC vs. WAL-MART STORES INC., Iowa Workers’Compensation Commissioner, Jan 17, 2012 (finding for defense, zero $$)

Measurement of Final Impairments• There are specific, objective, and required methods of

measuring range of motion, functional ability, hand strength, material handling strength for CA w/c cases.

• These are described in AMA Guides, 5th Edition, NIOSH standardized lifting, etc…

• CA physicians are NOT using these objective means of determining functional status.

• You are NOT getting accurate final report- impairment data (PR-4)

• You ARE losing serious $$– Medical, disability, settlement, possible income replacement

Conclusion1. FET is legal and compliant with Federal ADA/EEOC and CA FEHA

regulations.2. FET is cost-effective with positive cost-benefits ratios3. FET consists of pre-employment, post-injury, fit for duty, and

Functional Capacity Evaluation (FCE)4. FCE must have valid Sincerity of Effort(SOE) tools to insure

credible data5. There are traditionally accepted FCE/SOE measures that are not

accurate or defensible.6. There are peer-reviewed, published studies that show multiple

repeated measures with distraction ARE accurate in determining SOE and insuring credible, accurate data useful for case management, closure, and costs savings!

7. Most Final Reports/Impairment Ratings are based on inaccurate, improperly gathered data costing $$$

8. For your protection, make sure you are getting Valid, Reliable, Accurate, and Appropriately measured data

“It’s Like Putting Money in the Bank”

• Won’t Let You Hire Your Next Injury Claim• Keeps Your Workers Safe• Stops Injury Fraud and Abuse• Closes Cases Appropriately

Functional Testing

QUESTIONS?

Terry Lawson, PT, CAE

Integrated Injury Management Services, Inc.

In Cooperation with

Memorial Occupational Medicine-Bakersfield

Toll Free: 800-515-4552