Too much too soon: Resist pressure to return injured workers too early

"This is a tough position for the occ health professional"

You may be pressured to return an injured employee to work as soon as possible by management, human resources, or supervisors. However, returning someone to work too soon can put the employee, the company, and yourself at risk, warns Mary D.C. Garison, RN, COHN-S, CCM, COHC, FAAOHN, an Angleton, TX-based occupational health nurse.

"This is a huge responsibility for occupational health, which is supposed to be the employee's advocate," she says.

There is the potential for re-injury or aggravation to a worker's pre-existing condition. "This can turn out to be workers' comp, even if it is a non-occupational injury or illness," she adds.

There's also the danger of a perception that the company does not care about its employees, which can lead to lack of productivity in the workforce. "Be aware of the message the management is sending to other employees," she advises.

If you're pressured to return an employee to work sooner than you feel is appropriate, Garison advises taking these steps:

• Get the attending physician to support you with a letter stating the employee's need to stay out until healing is complete.

• Request a return to work physical performance evaluation, and provide the physician with an analysis of the physical demands of the employee's job.

• Remember that you are the employee's advocate. "By protecting the employee, one protects the company from any liability that will stand up in court," she says.

Litigation possible

Small employers are often "frantic" about not reporting a legitimate injury to their worker's compensation insurance company, according to Judy Van Houten, director of the Glendale (CA) Adventist Occupational Medicine Center.

"They pressure the occupational health professional to delay treatment, minimize services, and return employees to their 'usual and customary' position far too early," she says.

Months may go by with the injury still remaining unresolved, she says . "Then, they become angry when the injured worker litigates," she says. "There are no easy answers as to how to resolve this phenomenon, especially in this economy."

Small employers are often the biggest deterrent to the occupational health process, because of lack of education and economic pressures, she notes. "The biggest challenge is educating them about what is, and is not, a first-aid claim," Van Houten says.

The best approach is to persuade your employer to provide the injured worker with the treatment and benefits that they are entitled to, she emphasizes. "Reinforce the legal ramifications of not doing so," she says. "This is a tough position for the occ health professional at best."

Act as translator

Communication may be the single most important factor with managing worker's compensation cases. "The occupational health nurse is, by far, the most instrumental person who can facilitate this," she says.

Supervisors or employees may use language to describe tasks that is unfamiliar to occupational health professionals. "Translate this information into language that the primary care provider can better understand," she says.

This "translation" is the key to developing work restrictions or defining modified duty assignments for an injured worker, says Van Houten.

There are many parties involved in the management of a workers' compensation claim, she says. The occupational health professional is "the key to balancing the different needs of the parties, to ensure prompt treatment, prompt recovery, and prompt return to work."


For more information on returning an injured employee to work safely, contact:

Mary D. C. Garison, RN, COHN-S, CCM, COHC, FAAOHN, Angleton, TX. E-mail:

Judy Van Houten, Director, Glendale (CA) Adventist Occupational Medicine Center. Phone: (818) 502-2050. E-mail: