Return to work helps recovery for the disabled

Re-establishing normal life is important

Being at work and re-establishing a normal life rhythm is an important part of a successful return to work after someone is disabled.

That's why CIGNA's case managers do everything they can to get their patients back into their normal lives before the illness or injury, says Barton Margoshes, MD, chief medical officer for CIGNA Group Insurance in Bloomfield, CT.

"We try to get them back to as normal a life as they can have. Return to work is a very important part of the treatment strategy," he says. "The real tragedy is when the other problems, such as psychiatric disorders, are not recognized and people aren't able to return to work."

It's important for anyone with post-traumatic stress disorder (PTSD) or any other psychiatric condition to maintain a productive working life, he adds.

"When someone is disabled and can return to work and doesn't, there are profound consequences. It's bad for the individual, bad for the employer, and bad for society in general," he adds.

Case managers, who make frequent contact with patients who are on disability, are in a good position to make sure the patient gets what he or she needs for a successful return to work.

What happens once the case manager picks up on the cues that a psychiatric problem may be exacerbating the physical problem varies from person to person.

The case manager may reach out to the treat-ing physician and tell him or her something else is going on. If the person is having concentration problems or seems agitated at work, the case manager may suggest that he or she see a men-tal health professional.

The case manager may suggest that the person use some of his or her resources at work, such as employee assistance programs (EAPs).

EAP counselors are trained to pick up cues as to what is going on and make the appropriate referrals, Margoshes adds.

"Our case managers' role is to identify something that may not be readily apparent and make appropriate referrals to the EAP or discuss with the treating physician that the person needs additional help," he says.

Sometimes the case manager works with the employers on a workplace accommodation, such as having the member gradually reintroduced to work, starting off part time and working up to full time.

The case managers are careful to maintain confidentiality with their group disability clients. When the case managers call the employer, they don't give out any medical information about the patient's condition or any underlying problems they are having. They tell the client's supervisor that they're working with them and ask if there are any issues at work that may be confounding the situation.

They talk to the employers about adjusting the hours so the employee is gradually reintroduced to work and suggest other workplace accommodations.

If the member is having problems with concentration, the case manager works with the company to give him or her another job that doesn't require the same level of concentration. If the problems are largely with communication, the case manager may recommend a temporary job shift.

If the employer has an on-site EAP, the case managers try to steer the member to a job coach, someone to talk to when things aren't going well.

"If they're having problems at work, the can leave, which is not necessarily the best outcome, or they can call up the EAP which helps them work through the issues," he says.

With PTSD, people experience a lot of anxiety. If a worker is feeling anxious, he or she can call the EAP and get help working through it.