Employers turn to CMs for help with OSHA

How to provide value-added service

Employers spend a lot of time complying with reporting requirements of the Occupational Safety and Health Administration (OSHA) in Washington, DC. Case managers who can help with OSHA record-keeping and compliance may gain new business as more employers outsource all aspects of their health services.

"Employers are asking case managers to help them comply with OSHA. If external case managers can understand the issues employers face and can help with OSHA reporting and com- pliance, they’ll get the business before their competitors when employers outsource," says Deborah DiBenedetto, BSN, MBA, RN, COHN-S, senior consultant with Watson, Wyatt Worldwide, a management consulting company in New York City. "Many employers don’t have nurses on site and are turning to their workers’ comp case management companies to help with OSHA reporting."

OSHA requires that employers track any employee illness or injury from the first lost day of work through return to full employment either at the same job or a new job, DiBenedetto says. "Employers must keep a log. When employees return to work at restricted or light duty, they must be tracked for OSHA until either the doctor determines the disability is permanent, or the employee becomes permanently accommodated in his or her old job or a new job."

Also, if three or more employees suffer the same injury or are admitted to the hospital, employers must report the events to OSHA, DiBenedetto says. If a death occurs on site, employers must report to OSHA within eight hours.

However, even case managers who don’t help employers with OSHA reporting must understand OSHA’s safety requirements to properly handle workers’ comp claims, she says. "OSHA basically requires that employers provide a safe working environment. Case managers must understand all of the employees’ job requirements and how the employee’s health condition impacts his or her ability to work in that environment in order to avoid risk of reinjury or exacerbation of health conditions and determine the employee’s fitness for work."

For instance, many jobs require employees to wear respirators. "In that case, you’d want the doctor to perform a pulmonary function test before the employee returned to work after a respiratory problem. If there was residual wheezing, the employee probably shouldn’t return to full duty."

Case managers should consider all aspects of the working environment when determining fitness for work, she says. Those include:

1. Exposure to extreme heat or cold. Questions she suggests case managers ask include: Does the job require that the employee go outside routinely to inspect the building’s exterior? "Case managers must thoroughly understand every aspect of the job," DiBenedetto says. "Many security guards and maintenance workers have job duties which require spending time outside. if the worker is located in New York in mid-winter, there are many issues to be considered. For example, what is the outside temperature? Does the employee sit in the lobby close to an exterior door that constantly lets in blasts of cold air?"

2. Exposure to dust or contaminants. Questions case managers should ask include: What chemicals does the employee work with? "For example, an employee returning to work with anemia or following chemotherapy shouldn’t be exposed to lead," she says.

3. eed to wear personal protective equipment (PPEs). Questions case managers should ask include: What type of PPEs must employee wear? "If the employee must wear a respirator, make sure you know what kind. Respirators can range from simple dust masks to canisters. The real concern is that an employee with a respiratory condition may feel so restricted by his respirator that he removes it and is exposed to the contaminant it is meant to protect him from."

4. Exposure to high noise levels. Questions case managers should ask include: What is the noise level in the workplace? How much of the employee’s workday is spent in an environment with high noise levels? "Extreme levels of noise can exacerbate conditions such as hypertension and gastric conditions," DiBenedetto says. "A doctor may release an employee for return-to-work only to have the condition exacerbated by the employee’s work environment."

5. Exposure to heavy physical duties. Questions case managers should ask include: Does the job require any heavy lifting? Does the job require any other strenuous activities? "The employee may be a maintenance worker whose job includes shoveling snow or lifting bags of rock salt," she says. "The employee may be in a custodial position that requires the use of a heavy-duty commercial vacuum weighing 60 lbs or more.

"Without full understanding of the work environment, case managers can’t effectively return employees to the workplace. Lack of that understanding can lead to exacerbations of health problems and unnecessary costs."

To keep on top of OSHA reporting requirements and changes in regulation, DiBenedetto recommends that case managers use OSHA’s Web site at www.osha.gov. "The Web site contains links to the Federal Register and bulletin boards of free information. You can search for specific standards or do a key word search. It’s a great resource for case managers."