Rehab Cell

Physical Medicine and Rehabilitation

Guidance for physiotherapists: Certifying “no capacity for employment”

Guidance for physiotherapists: Certifying “no capacity for employment”

Welcome to this webinar that will review when certifying “no capacity for employment” is medically necessary. Although we’re focusing on return to work in this webinar series. we need to keep in mind that there is indeed a time and place when being off work is required. The concepts in this section are adapted from the American College of Occupational and Environmental Medicine’s 2005 report titled “Preventing Needless Work Disability by Helping People Stay Employed”. In a moment, we’ll explore when certifying “no capacity for employment” is: medically necessary, where it is essential, indispensable or requisite; when it’s discretionary, where it has been left to someone’s own discretion or judgement, typically the certifier; or when it’s unnecessary, in other words, where it is not essential. Certifying “no capacity for employment” is medically necessary when an injured worker is totally incapacitated due to hospitalisation or strict bedrest. It also occurs when being at work, or activity, is medically contraindicated. Time off work under these situations ensures that the injury will not significantly deteriorate, the recovery will not be delayed, and significant harm is not caused to the person, others, or even equipment. Severe injuries do occur and some injuries result in low functional capacity. But it’s generally uncommon for an injured worker to have absolutely no functional capacity, or that work will cause them significant harm. It’s estimated that this would occur in about 5% of work-related injuries, and typically high with motor vehicle accidents due to the potentially more severe nature of injuries that could be sustained in those circumstances. It’s important to avoid certifying “no capacity for employment” when the reasons are not medically necessary, and are perhaps discretionary based on incorrect assumptions. These situations can occur when the certifier thinks that the patient could go back to work, but has some situational reservations such as: The patient can’t get to work. Certifying “no capacity for employment” means they will not work, however certifying with some capacity and indicating an inability to drive or travel could result in arranging taxi transport, or possibly work from home if possible. Thinking that the patient will not be too productive or that there is no work to do. Oftentimes we are unsure what meaningful suitable work is available, however certifying “no capacity for employment” means they will not work, however certifying in some capacity gives the employer the opportunity to see what suitable work could be available. Or thinking that there is too much effort to support the patient back to work. It is not the certifier’s role to determine what effort others will go to to assist in helping someone return to work. If a patients is medically fit to work with some capacity, then these other issues can usually be resolved with effective communication and effort. Simply certifying the patient’s capacity related to the injury rather than the situation is the best strategy. Additionally, if there’s no work available that is suitable, the patient will not return to work. Finally, here is a situation where certifying “no capacity for employment” is unnecessary. It’s not usually based on incorrect assumptions, but rather due to a range of factors such as poor accountability, waiting for information that may not necessarily change the management, employer ignorance or resistance that influences the certifier or other problems that do not relate directly to the injury, such as job dissatisfaction, anger or other psychosocial factors. Here are two real examples of where certified “no capacity for employment” may be questionable and may not be medically necessary. The first is a WorkSafe Victoria case certified “no capacity for employment” for a month, for a right shoulder impingement. The second is a TAC case certified “no capacity for employment” for two months with a thumb injury. Although it may be reasonable to limit the use of the injured extremity, it is unlikely that there is some capacity to sit, to stand, to use the other extremity, where some suitable duties could be provided if available. We hope you enjoyed this webinar and that you have a look at the others in this series. Remember that due to the physical, psychological and social benefits, we really should see return to work as treatment, rather than a goal of treatment.

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