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Vocational Rehabilitation in Vocational Rehabilitation in Michigan Workers’ Compensation:Michigan Workers’ Compensation:

From “Soup” (for the Soul) to From “Soup” (for the Soul) to “Nuts” (and bolts)“Nuts” (and bolts)

David Campbell, MA, CRCDavid Campbell, MA, CRC

Vocational Rehabilitation ConsultantVocational Rehabilitation Consultant

Michigan Workers’ Compensation AgencyMichigan Workers’ Compensation Agency

MiARP Conference, Oct. 1, 2004MiARP Conference, Oct. 1, 2004

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So much has changed, yet So much has changed, yet much remains the same…much remains the same…

““Although the concept of total rehabilitation has been Although the concept of total rehabilitation has been proven by experience to be good business, policies proven by experience to be good business, policies and attitudes among employers, the employees and attitudes among employers, the employees (themselves), insurance companies, unions, (themselves), insurance companies, unions, hospitals, doctors, attorneys (plaintiffs and hospitals, doctors, attorneys (plaintiffs and defendants alike) and the general public – these defendants alike) and the general public – these policies and attitudes tend to discourage policies and attitudes tend to discourage rehabilitation.rehabilitation.

“Getting the injured employee back to work should be Getting the injured employee back to work should be the number one objective of the workmen’s the number one objective of the workmen’s compensation system.”compensation system.” –Workmen’s Compensation Dept.

Director, William R. Hart, 1962

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Workers’ Compensation Workers’ Compensation Agency Agency

Mission StatementMission Statement

““To efficiently administer the To efficiently administer the Workers’ Disability Workers’ Disability Compensation Act of Compensation Act of Michigan, which includes Michigan, which includes carrier and employer carrier and employer compliance, timely benefit compliance, timely benefit payments, and the prompt payments, and the prompt and fair adjudication of and fair adjudication of claims involving Michigan’s claims involving Michigan’s injured workers.”injured workers.”

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““Provide prompt, courteous Provide prompt, courteous and impartial service to all and impartial service to all customers with timely and customers with timely and objective administration of objective administration of their rights and their rights and responsibilities under the responsibilities under the Workers’ Disability Workers’ Disability Compensation Act.”Compensation Act.”

Workers’ Compensation Workers’ Compensation Agency VisionAgency Vision

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Agency NewsAgency News• Hearing Site Consolidations (10-1-04)Hearing Site Consolidations (10-1-04)

– Ann Arbor site moves to DetroitAnn Arbor site moves to Detroit– Battle Creek site moves to KalamazooBattle Creek site moves to Kalamazoo– Muskegon site consolidated with Grand Muskegon site consolidated with Grand

RapidsRapids

• Lansing hearing site movedLansing hearing site moved– From Okemos to Downtown Lansing, From Okemos to Downtown Lansing,

Ottawa State OfficesOttawa State Offices

• WCAC relocated to Ottawa State OfficeWCAC relocated to Ottawa State Office

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State Average Weekly Wage Minimum & MaximumState Average Weekly Wage Minimum & Maximum

Year State Average Weekly Wage (SAWW)

90% of SAWW (Maximum Benefit)

2/3 of SAWW* 50% of SAWW (Minimum Benefit for Death Cases)

25% of SAWW(Minimum Benefit for

Specific Loss and P&T)

2004 $744.49 $671.00 $496.33 $372.25 $186.12

2003 $724.96 $653.00 $483.31 $362.48 $181.242002 $715.11 $644.00 $476.74 $357.56 $178.782001 $714.46 $644.00 $476.31 $357.23 $178.622000 $678.23 $611.00 $452.15 $339.12 $169.561999 $644.06 $580.00 $429.37 $322.03 $161.021998 $614.10 $553.00 $409.40 $307.05 $153.531997 $591.18 $533.00 $394.12 $295.59 $147.801996 $581.39 $524.00 $387.59 $290.70 $145.351995 $554.22 $499.00 $369.48 $277.11 $138.561994 $527.29 $475.00 $351.53 $263.65 $131.821993 $506.80 $457.00 $337.87 $253.40 $126.701992 $489.01 $441.00 $326.01 $244.51 $122.251991 $477.40 $430.00 $318.27 $238.70 $119.351990 $474.22 $427.00 $316.15 $237.11 $118.561989 $454.15 $409.00 $302.77 $227.08 $113.541988 $440.77 $397.00 $293.85 $220.39 $110.191987 $433.91 $391.00 $289.27 $216.96 $108.481986 $414.70 $374.00 $276.47 $207.35 $103.681985 $397.48 $358.00 $264.99 $198.74 $99.371984 $370.65 $334.00 $247.10 $185.33 $92.661983 $358.89 $324.00 $239.26 $179.45 $89.721982 $340.45 $307.00 $226.97 $170.23 $85.11

*Discontinued fringe benefits may not be used to raise the weekly benefit above this amount.*Attorney fees may not be based on a benefit rate higher than this amount.

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Customer Service & Contested Customer Service & Contested Case Section Case Section

• Bureau’s Hotline – 1(888)396-5041Bureau’s Hotline – 1(888)396-5041– -- Follow-up on constituent inquiries Follow-up on constituent inquiries – Attempt to resolve problems prior to any litigationAttempt to resolve problems prior to any litigation

• Health Care Service Rule facilitations Health Care Service Rule facilitations - 104B hearings- 104B hearings

• Vocational Rehabilitation Vocational Rehabilitation – David Campbell, Vocational Rehabilitation ConsultantDavid Campbell, Vocational Rehabilitation Consultant

• Process all Applications for Mediation or Hearing Process all Applications for Mediation or Hearing – approximately 30,000 in fy 03.– approximately 30,000 in fy 03.– Serve all magistrate/mediator decisionsServe all magistrate/mediator decisions

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REQUEST FOR REHAB UPDATE (BWC-110)REQUEST FOR REHAB UPDATE (BWC-110)

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The Mediation ProcessThe Mediation Process• Alternative Dispute Resolution (ADR)Alternative Dispute Resolution (ADR)• Client may or may not have attorneyClient may or may not have attorney• May involve both attorneys, claimant, May involve both attorneys, claimant,

adjuster, and family membersadjuster, and family members• Informal process, Informal process, notnot on the record on the record• Facts are presented by parties; Facts are presented by parties;

mediator listens, asks questions, mediator listens, asks questions, provides some inputprovides some input

• Ultimate goal: Agreement by all parties, Ultimate goal: Agreement by all parties, not necessarily an “order”not necessarily an “order”

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Claims Assigned to MediationClaims Assigned to Mediation• In response to a decrease in the number of In response to a decrease in the number of

mediators (Nov. ’02), only the following claims mediators (Nov. ’02), only the following claims are assigned to mediation:are assigned to mediation:– Unrepresented partiesUnrepresented parties– Closed period claimsClosed period claims– Medical-only claimsMedical-only claims– Penalty-only applicationsPenalty-only applications– Rate IssuesRate Issues– Vocational Rehabilitation/First Level HearingsVocational Rehabilitation/First Level Hearings

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Resolution of Workers’ Resolution of Workers’ Compensation ClaimsCompensation Claims

• Withdrawal/Dismissal (23%)Withdrawal/Dismissal (23%)

• Voluntary Payment (12%)Voluntary Payment (12%)

• Redemption/Lump Sum Settlement Redemption/Lump Sum Settlement (59%)(59%)

• Opinion/Order (6%)Opinion/Order (6%)

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Vocational Rehab DefinedVocational Rehab Defined

• ““The coordinated and systematic process The coordinated and systematic process of professional services to enable and of professional services to enable and sustain the employment of an injured sustain the employment of an injured worker. The basic components of worker. The basic components of vocational rehabilitation services are vocational rehabilitation services are vocational assessment, goal-setting, vocational assessment, goal-setting, service planning, case management, service planning, case management, service delivery, job placement, and service delivery, job placement, and follow-up.” follow-up.” –Task Force on Vocational Rehabilitation in –Task Force on Vocational Rehabilitation in Workers’ Compensation, 2000Workers’ Compensation, 2000

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VR Division ResponsibilitiesVR Division Responsibilities• Ensuring that employers provide rehabilitation services Ensuring that employers provide rehabilitation services

according to the provisions of the Act, and that the injured according to the provisions of the Act, and that the injured employees accept such services.employees accept such services.

• Housed within the Customer Service/ Contested Cases Housed within the Customer Service/ Contested Cases DivisionDivision

• Handling customer service calls/concerns daily (VR letters, Handling customer service calls/concerns daily (VR letters, vendor issues, etc.)vendor issues, etc.)

• Approving VR facilities, and monitoring practices of those Approving VR facilities, and monitoring practices of those currently approvedcurrently approved

• Mailing “Right to Vocational Rehabilitation” letters to claimantsMailing “Right to Vocational Rehabilitation” letters to claimants• Holding VR hearings across the state to determine compliance Holding VR hearings across the state to determine compliance

with Section 319with Section 319

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3-Step Approach to VR3-Step Approach to VR

1.1. RTW with same employer, same or RTW with same employer, same or different job, within ee’s capabilitiesdifferent job, within ee’s capabilities

2.2. Direct job placement to appropriate Direct job placement to appropriate alternative employment in community, alternative employment in community, or short-term retraining up to 52 weeks or short-term retraining up to 52 weeks (with possibility of add’l 52 weeks)(with possibility of add’l 52 weeks)

3.3. Self-employment ventures (last resort Self-employment ventures (last resort in most cases)in most cases)

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New ProcessesNew Processes

• New “Med Management Do’s & Don’ts letterNew “Med Management Do’s & Don’ts letter• VR Letter now goes out in 120 DaysVR Letter now goes out in 120 Days

– Why? Early Intervention is THE KEY to effective Why? Early Intervention is THE KEY to effective management of disabilitymanagement of disability

• New Reporting Procedures:New Reporting Procedures:– Monthly provider closure codesMonthly provider closure codes– Monthly provider report formatMonthly provider report format

• Provider VisitsProvider Visits– Review Practices/Compliance with Bureau and professional Review Practices/Compliance with Bureau and professional

obligationsobligations– Maintain open lines of communication and supportMaintain open lines of communication and support

• VR 2VR 2ndnd Level Hearing “Pre-Conferences” Level Hearing “Pre-Conferences”

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RIGHT TO VOC REHAB LETTERRIGHT TO VOC REHAB LETTER

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Current StatsCurrent Stats• VR case closures for fiscal year 2004 VR case closures for fiscal year 2004

(incomplete)(incomplete)

17% 14% 19%

0

100

200

300

400

500

600

1st Q 2nd Q 3rd Q 4th Q

Open

Closed

RTW

Percent RTW

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0

20

40

60

80

100

120

140

160

180

Oct-03

Nov-03

Dec-03

Jan-04

Feb-04

Mar-04

Apr-04

May-04

Jun-04

Jul-04

Aug-04

Sep-04

PROVIDERS REPORTING

PROVIDERS NOT REPORTING

AGENCY APPROVED PROVIDERS REPORTING FYO4

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PERCENTAGE REPORTING FY04PERCENTAGE REPORTING FY04

42%

42%

39%

38%

41%42%

38%

41%

36%

28% 0%0%

Oct-03

Nov-03

Dec-03

Jan-04

Feb-04

Mar-04

Apr-04

May-04

Jun-04

Jul-04

Aug-04

Sep-04

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Relevant CasesRelevant Cases• Nessel v. Schenck PegasusNessel v. Schenck Pegasus

– Defendants wanted Mr. Nessel to meet with their VR Defendants wanted Mr. Nessel to meet with their VR expert as part of pretrial discovery in order to expert as part of pretrial discovery in order to determine extent of disability based on Sington case.determine extent of disability based on Sington case.

– WCAC reversed magistrate’s denial of discovery, WCAC reversed magistrate’s denial of discovery, saying that the burden of proof under Sington makes it saying that the burden of proof under Sington makes it critical to determine claimant’s qualifications/training, critical to determine claimant’s qualifications/training, and how this effects claimant’s ability to work and and how this effects claimant’s ability to work and earn wages.earn wages.

– Significant because rules of discovery per Michigan Significant because rules of discovery per Michigan court rules don’t apply in WC—however, WCAC now court rules don’t apply in WC—however, WCAC now says it is under the proper circumstances.says it is under the proper circumstances.

Michigan Workers’ Comp Reporter, Vol. 13, #11, Jan. 2004

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Relevant CasesRelevant Cases• Suliman v. Ann Arbor Ceiling & Partition (2004)Suliman v. Ann Arbor Ceiling & Partition (2004)

– Fell from scaffolding, injured left armFell from scaffolding, injured left arm– Benefits terminated when he refused the services of a Benefits terminated when he refused the services of a

medical case manager.medical case manager.– Defendants also argued he wasn’t VR candidate, as Defendants also argued he wasn’t VR candidate, as

he had not reached MMI, nor were they happy with the he had not reached MMI, nor were they happy with the fact that plaintiff had chosen the VR provider.fact that plaintiff had chosen the VR provider.

– Magistrate denied these positions; WCAC affirmed.Magistrate denied these positions; WCAC affirmed.• The Act does not allow for the termination of benefits on the

basis of “non-cooperation with a case manager”.• MMI does not have to be reached before beginning a rehab

program

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• Charles Sington v. Chrysler CorporationCharles Sington v. Chrysler Corporation (July (July ’02)’02)

• General background:General background:– Worked as floater for 15 yrs.; picked up parts 30lbs.; Worked as floater for 15 yrs.; picked up parts 30lbs.;

injured L shoulder. Later injured R shoulder in non-injured L shoulder. Later injured R shoulder in non-work injury. work injury.

– Each time, employer able to accommodate; Each time, employer able to accommodate; same same wages; wages; Then had a non-work stroke and never Then had a non-work stroke and never returned to work. returned to work.

– Basis: Sington said that he was still disabled from Basis: Sington said that he was still disabled from his work-related shoulder, and that work he was his work-related shoulder, and that work he was doing at the time was “favored work.” Therefore, doing at the time was “favored work.” Therefore, under 301(5), he had lost his job for “whatever under 301(5), he had lost his job for “whatever reason” and should be paid benefits. However, reason” and should be paid benefits. However, Supreme Court remanded case and benefits were Supreme Court remanded case and benefits were not awarded.not awarded.

Relevant CasesRelevant Cases

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Specific Sington Determinations:Specific Sington Determinations:1.1. Has plaintiff established the universe of jobs for Has plaintiff established the universe of jobs for

which he is qualified and trained, as well as how which he is qualified and trained, as well as how much the jobs pay?much the jobs pay?

2.2. Has plaintiff established a work-related physical or Has plaintiff established a work-related physical or mental impairment which prevents him from mental impairment which prevents him from performing jobs within his qualifications and training performing jobs within his qualifications and training and which is causing him to lose wages?and which is causing him to lose wages?

3.3. Has plaintiff established that he was either unable to Has plaintiff established that he was either unable to perform the jobs within his qualifications and training perform the jobs within his qualifications and training or that he was unable to obtain such jobs because or that he was unable to obtain such jobs because they were not reasonably available?they were not reasonably available?

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Sington and the WC ActSington and the WC Act• Is a “Sington Eval” voc rehab, as defined in Sec. 319?Is a “Sington Eval” voc rehab, as defined in Sec. 319?

– Not in our opinion. Not in our opinion. – Purpose under Sington is not to rehabilitate per se, but to provide Purpose under Sington is not to rehabilitate per se, but to provide

evidence and information regarding the broadest array of jobs within evidence and information regarding the broadest array of jobs within qualifications and training (I.e., Labor Market Survey)qualifications and training (I.e., Labor Market Survey)

• If not, what do we call it?If not, what do we call it?– We might call it We might call it Forensic EvaluationForensic Evaluation, in that it is used to produce , in that it is used to produce

objective findings which may or may not include examination of the objective findings which may or may not include examination of the individual with a disability (from CRCC Code of Ethics)individual with a disability (from CRCC Code of Ethics)

– VR counselors could be used to provide VR counselors could be used to provide expert vocational testimonyexpert vocational testimony as to the employability and placeability of the client given his/her as to the employability and placeability of the client given his/her qualifications and training. qualifications and training.

• Many times, your eval may be used to open a formal VR Many times, your eval may be used to open a formal VR case.case.

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Ideas on Approaching Sington:Ideas on Approaching Sington:

• Determine the scope of your interaction with Determine the scope of your interaction with Sington-related workSington-related work– Will you, or won’t you do the evalsWill you, or won’t you do the evals– What will your eval encompassWhat will your eval encompass

• When asked to do a Sington Eval, and it is When asked to do a Sington Eval, and it is not within your scope, your options might be:not within your scope, your options might be:– Turn down the referralTurn down the referral– Tell the referral source that you’ll do it, but Tell the referral source that you’ll do it, but

only within your scope of practiceonly within your scope of practice

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EMPLOYEE MOST FAQ & CONCERNSEMPLOYEE MOST FAQ & CONCERNS• ““My adjuster won’t call me back”My adjuster won’t call me back”• ““My check is late!”My check is late!”• ““How far do I have to drive to look for work?”How far do I have to drive to look for work?”• ““What if I find a job that pays less?”What if I find a job that pays less?”• ““How can I get retrained for another occupation?”How can I get retrained for another occupation?”• ““I have been in VR job placement for 2 years now, and I have been in VR job placement for 2 years now, and

haven’t found a job. Is this a long time?”haven’t found a job. Is this a long time?”• Want to go back to work, but employer won’t let them Want to go back to work, but employer won’t let them

until 100%until 100%• My nurse case manager says I My nurse case manager says I havehave to let them attend to let them attend

my doc appointments.my doc appointments.

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VR COUNSELOR MOST VR COUNSELOR MOST FREQUENT ISSUESFREQUENT ISSUES

• ““Is there a defined radius of travel for Is there a defined radius of travel for clients?”clients?”

• ““The plaintiff attorney is asking for a copy The plaintiff attorney is asking for a copy of my records. Do I have to give them?”of my records. Do I have to give them?”

• ““Plaintiff attorney won’t let me meet with Plaintiff attorney won’t let me meet with client.”client.”

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Specific Concerns Today:Specific Concerns Today:• Adjusters cutting benefits for “non-cooperation with VR”Adjusters cutting benefits for “non-cooperation with VR”• Benefits cut for marginal reasons (i.e., didn’t “make Benefits cut for marginal reasons (i.e., didn’t “make

weight”)weight”)• Job Placement for 2 years or more continuouslyJob Placement for 2 years or more continuously• Keeping VR files open just because the “account” says Keeping VR files open just because the “account” says

so, even when it’s of no help to client.so, even when it’s of no help to client.• Counselor making recommendation to adjuster to “file Counselor making recommendation to adjuster to “file

for hearing”for hearing”• Getting involved in settlement discussionsGetting involved in settlement discussions• No apparent client input into written rehab planNo apparent client input into written rehab plan

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The Soap Box…The Soap Box…• Vocational Rehabilitation Counseling is a Vocational Rehabilitation Counseling is a

noble profession, but often thankless.noble profession, but often thankless.• It requires tactfulness, patience, It requires tactfulness, patience,

compassion, loads of energy, empathy, compassion, loads of energy, empathy, and courage.and courage.

• As a counselor, you subscribe to a As a counselor, you subscribe to a professional process, with defined steps, professional process, with defined steps, services, and goals. But you’re dealing services, and goals. But you’re dealing with people, so the process must stay with people, so the process must stay flexible in order to stay on track.flexible in order to stay on track.

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The Soap Box…The Soap Box…• There are multiple players = external There are multiple players = external

pressures trying to direct flowpressures trying to direct flow• Difficult at times to remember that Difficult at times to remember that

there is only one true “Client” there is only one true “Client” • Above all, you listen. Sometimes it’s Above all, you listen. Sometimes it’s

happy stuff. Most of the time it is a happy stuff. Most of the time it is a concern, a problem, or a crisis in your concern, a problem, or a crisis in your client’s life. This is the key to your client’s life. This is the key to your job though, it’s what sets you apart…job though, it’s what sets you apart…You’re a You’re a COUNSELOR!COUNSELOR!

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It’s Rehabilitation It’s Rehabilitation COUNSELING, not COUNSELING, not

Rehabilitation Placement!Rehabilitation Placement!• The fact that you are a counselor makes you different The fact that you are a counselor makes you different

from other “specialists”from other “specialists”• We are forced to decide at times (by these external We are forced to decide at times (by these external

pressures) whether we should compromise the process pressures) whether we should compromise the process and our ethics and our ethics

• As long as there are those in our field who will shortcut As long as there are those in our field who will shortcut the process, there will be those looking for their the process, there will be those looking for their services. Don’t be one of them, and change the system.services. Don’t be one of them, and change the system.

• Don’t get caught up in the “NASCAR Mentality”Don’t get caught up in the “NASCAR Mentality”

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A few years ago, at the Seattle Special Olympics, nine contestants, all physically or mentally disabled, assembled at the starting line for the 100 yard dash. At the gun, they all started out, not exactly in a dash, but with a relish to run the race to the finish and win. All, that is, except one little boy who stumbled on the asphalt, tumbled over a couple of times, and began to cry. The other eight heard the boy cry. They slowed down and looked back. Then they all turned around and went back. Every one of them.

One girl with Down’s Syndrome bent down and kissed him and said: “This will make it better. Then all nine linked arms and walked together to the finish line. Everyone in the stadium stood, and the cheering went on for several minutes.

People who were there are still telling the story. Why? Because deep down we know this one thing: What matters in life is more than winning for ourselves. What matters in this life is helping others win, even if it means slowing down and changing our course.

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How Do YOU Provide Voc Rehab?How Do YOU Provide Voc Rehab?

VS.