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Managing Vocational Rehabilitation
(Part 1 of 2)

Unlike medical treatment and physical rehabilitation, vocational rehabilitation (VR) is not a part of most workers compensation claims. Because it is not used on a regular basis, many employers are not sure where to turn or what to expect when an injured worker needs VR to get back into the work force. This article discusses the evolution of VR, the focus of private-sector VR programs, and some considerations for selecting the right VR service provider.

Evolution of VR

Until the mid- to late 1970s, VR was primarily the province of the public sector. Under the Rehabilitation Act of 1973 (Rehabilitation Act), and subsequent amendments, states receive federal government grants to operate a “comprehensive VR program.” The program’s stated purpose is:

… to assess, plan, develop and provide VR services to eligible individuals with disabilities, consistent with their strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice.

Who Are “Individuals With Disabilities”?

An individual with a disability is defined as someone who:

• has a physical or mental impairment that constitutes or results in a substantial impediment to employment for the individual; and
• can benefit from VR services to achieve an employment outcome.

Individuals receiving Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) are “presumed” to qualify for VR services, but receiving SSI or SSDI does not make an individual automatically eligible. These individuals must also want and intend to achieve employment outcomes consistent with their “unique strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice.”

The Rehabilitation Act requires that these federally mandated, state-operated, VR programs be provided first to those individuals with the most significant disabilities when there are not enough resources to serve everyone who qualifies for VR services.

This “order of selection” obviously can bypass many individuals who would benefit from VR, but who have less severe disabilities. And the Rehabilitation Act is not restricted to work-related disabilities. Individuals with disabilities resulting from nonoccupational accidents and congenital problems are often on the list way ahead of someone who, for example, was a warehouseman, is otherwise fit, but has sustained a work-related back injury and can no longer lift 50 pounds.

Unfortunately, the focus of the public sector remains perilously close to what it was 20 years ago. The primary mandate is to maximize the individual’s capabilities, not necessarily to integrate or reintegrate the individual into the work force.

The Advent of Private-Sector Vocational Rehabilitation

Public-sector VR was proving to be less than satisfactory for many employers. Its primary focus was to improve individuals' status by elevating their level of education. While it might have been laudable for an individual with a high school education to want an undergraduate or graduate degree, such goals required years of education, often resulting in a poor outcome with no employment at the end of the road.

Then, in the late 1970s, a number of states, such as California and Oregon, enacted laws making VR a part of the workers compensation system. Individuals disabled as a result of a work-related injury or illness were now entitled to VR as part of their workers compensation benefits. In response to such legislation and employers’ dissatisfaction with public-sector VR, independent private-sector VR firms began to emerge.

Some sources indicate that the percentage of individuals who partake of public-sector VR and end up in the work force is pitifully small. Add to that the fact that the average cost per individual of public-sector VR is substantially higher than private-sector VR, and it’s easy to see why private-sector VR firms flourished. And private-sector VR firms have honed their skills over the past two decades, achieving ever more effective programs and higher success rates. At this point, many state-run programs have come to expect private-sector VR firms to handle workers compensation claims. For the most part, the state-run programs step in only when the insurer has refused to provide VR services.

The Focus of Private-Sector VR

The primary focus of private-sector VR is to get the disabled employee back to wage-at-injury in a job that accommodates his or her new physical restrictions. This does not always mean finding that employee a new employer — or even a new job. Sometimes retraining or reasonable accommodation in the workplace can put that individual back in the same job. The key is a return to work accomplished as early in the process as possible. VR counselors see their priorities in the following descending order:

(1) return the employee to the same employer at the same job;

(2) return the employee to the same employer at a different job, but at roughly the same pay level; and

(3) return the employee to a different employer at a different job at roughly the same pay level.

None of these are accomplished without some time, effort, and expertise on the part of the VR counselor, particularly when the employee’s injuries and resulting disabilities preclude a return to the same job.

Vocational Testing

When the same job with the same employer is not an option, the VR counselor must then assess the individual to determine what type of employment, either with the same or another employer, is appropriate. If someone wants to be a lab technician, but doesn’t have the aptitude for it, such training would be wasted. If someone has the aptitude to be a computer programmer, but not the inclination, that training, too, would be wasted. To determine both what an individual can do and what an individual wants to do, the VR counselor uses a three-pronged approach:

(1) Interest test: The first prong is an interest test, used to determine what types of work might appeal to the individual being tested. For example, someone with good verbal skills, but who does not like dealing with people, would likely not succeed in sales.

(2) Aptitude test: The second prong is an aptitude test. Someone who is dyslexic and “math-phobic,” for example, would likely not do well as an accountant.

(3) Transfer-skills analysis test or review: The third prong is an assessment of the skills an individual has already acquired in his or her job or jobs prior to injury. For example, many jobs now include using a computer, even when working with a computer is not the primary job function. So the ability to work with a computer would be a transferable skill, particularly if the disability did not impair arms, hands, or sight.

Because humans are so variable and so complex, there will always need to be a human element — a VR counselor to administer the tests, work with the disabled individual, and assist in the placement process. But state-of-the-art VR is probably as high-tech as any “people” industry. With the results of these three tests, the VR counselor can literally push a button, and a computer program will synthesize the disabled worker’s interest, aptitude, and skill sets — then print out a list of 20 or so jobs for which the individual may already be qualified or for which that individual can be trained.

Common Misconception

A common misconception about VR is that it always entails expensive training that lasts a long time and costs the employer “big bucks”: temporary total disability plus tuition, room and board, books and materials, and so on. In fact, this is not the case. Often, the VR counselor will determine that the individual can immediately move into another position at the same place of employment or is qualified now, without any additional training, for other jobs available at other firms in the same geographic area. A good VR counselor sometimes functions as a matchmaker, simply connecting the right individual to the right job.

Training Options

Sometimes, though, it’s not so simple. When there are no jobs matching current skill sets that would return that individual to wage-at-injury, the VR counselor and the disabled employee then must turn to the list of jobs for which training will be required. Most states that include VR as a workers compensation benefit place time limits on the training process, generally limiting it to training that will last no more than one year.

Not surprisingly, an abundance of training schools have popped up that can train someone in a whole new profession in 40 to 50 weeks. This is one of the reasons that the interest, aptitude, and transferable-skills tests are so important. If someone has, for example, a background, interest, and aptitude in the medical field, that person may be able to train to become a respiratory therapist, a dental hygienist, or an X-ray technician in less time than someone without this requisite basis.

A high school graduate is not going to come out of VR as a dentist or a surgeon, but he or she will come out with a marketable skill, one that will likely return that individual to the work force. The principle is one of indemnity: returning the individual to the same financial condition that he or she would have been in had the accident or illness not occurred.

Cost Considerations

The cost of VR varies as widely as any other workers compensation claims component. If the VR is a simple skills, interest, and aptitude assessment, followed by placement into a suitable job, the cost will be low. If the VR involves 40 or 50 weeks of training for an entirely new profession, the cost will be higher. On average, though, private-sector VR currently costs about $3,000 per individual — a bargain when compared with the public-sector VR cost.

In some cases, the cost is higher. However, even when VR means a year of schooling, it can be cost-effective in the long run. If a disabled employee is receiving temporary disability anyway — and is likely to continue receiving it for several years in the absence of retraining — a $10,000 or $20,000 outlay for tuition, books, etc., that will get that employee back into the work force a year from now is a lot cheaper than paying temporary total disability benefits for five or ten years — or more.

Success Rates

The public-sector VR success rate is enough to give one pause. The percentage of successful VR cases is slim by private-sector standards. (Of course, this is not a failure when one measures success by the public-sector mandate to maximize an individual’s capabilities, rather than the private-sector mandate to get an individual back to work.) But overall, private-sector VR has been much more successful.

In general, when injured and disabled employees are first referred to VR, the ratio runs about 50-50 between those interested and positive about the idea and those not interested. Once individuals have gone through the three-pronged test and seen the list of possibilities, however, they begin to get excited by the prospect of building a whole new career. This is particularly true when the tests bring to light a whole new field in which they could work, either now or after a brief period of training. At this point, about 90 percent are interested, with only 10 percent resisting the process.

More important than the enthusiasm, though, are the results. Currently, private-sector VR is successful in approximately 50 percent of the cases — a much higher rate than the public sector. The other half consists of:

• individuals referred too early, when they had not yet reached maximum medical improvement;
• individuals referred too late, long after maximum medical improvement, who have, thus, fallen so far out of the work force that they are reluctant to return; and
• that truly small percentage of individuals who simply do not want any part of the process.

Note: Timing is everything. If someone is referred to VR within 90 days, the chances of rehabilitating that individual back into the work force are excellent. If someone is referred to VR after two years, the chances are at best slim.

Read Managing Vocational Rehabilitation (Part 2)

ABOUT THE AUTHOR

The Journal of Workers Compensation is a quarterly review of risk management and cost containment strategies published by Standard Publishing in Boston, Massachusetts. For more information, please visit our web site, www.standardpublishingcorp.com, or contact the editor at 800-682-5759, extension 222, or subscription services at extension 228.

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September 2001