Should there be an Employer in the Exam Room?

We wear two hats in the occupational medicine environment.  Evaluation and management of injured workers is at times a delicate balance of sometimes misaligned interests.

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Communication is key.  The worker needs to understand the treatment plan, prognosis of the injury​, and that early return to productive work, including modified duty (temporary alternate duty – TAW, temporary transitional duty-TTD) will lead to improved outcomes.

You need to build trust from the employer so they know that you, as their medical consultant, will ascertain that the worker’s condition legitimately arose from the work environment, any time off or physical limitations are appropriate and necessary, and methods are in place to assure progress in the case with ongoing communication to the employer.​

​Kate, an Operations Manager asks:

We have recently had a significant push back against our policy to not allow Supervisors/Safety Managers/Employer in the exam room with the injured worker. We feel that by allowing the employer in the exam room we may be compromising the privacy of the employee. In the past we have allowed employees to sign a waiver to allow the supervisor to be in the room, however it was brought to our attention that some employees felt pressured to do so in fear of what consequences may exist from their employer if they don’t. What are your thoughts on this?​

​In this case, the supervisor/employer may want to be sure of several things:

  • the details of the injury are reported the same way to the doc as what they’ve written on their first report of injury
  • the mechanism of injury is consistent with a work related event
  • any limitations on the exam are correlated with modified duty assignments available and undue time off is not awarded
  • if the case can be treated as “first aid” and thus not “recordable” according to OSHA

The employer does not need to know anything about the worker’s private medical conditions, medications or other PHI except for whatever bearing any of those might have on recovery from the injury.

If an underlying condition has become aggravated due to a work related event, it is still covered under most states’ workers comp programs.

The injured worker has their own legitimate concerns, among them:

  • ​They have a right to privacy regarding their medical history and conditions.
  • ​Will they be out of work, for how long and how will that affect their income?
  • Will they be able to continue working in their same job?
  • Will any permanent disability result from the injury?
  • Their reputation with employer and co-workers.  Will they still be considered a valued member of the team?
  • If they are returned to work, will they re-injure themselves or slow healing time?
  • How will this injury affect their home life, hobbies and other personal activities?

What I would do is let the employer know that in the interests of protecting PHI, getting an accurate statement from the injured worker and getting the additional information you may need to determine if or how it affects the current injury, you will do your initial evaluation alone with the worker.

Explain that you will invite the employer in the exam room to summarize your findings and check that the history matches the story the supervisor got.  Do this without divulging any PHI.

Make sure the worker knows you will be sharing any work related information with the supervisor but will keep PHI confidential.

Next, this is a good opportunity to agree on return to work given any limitations and what specific modified duty assignments are available and appropriate, and a specific follow up plan.

If there is still push back, make sure you understand the employer’s concerns and that you can address them in an appropriate manner.  Often, the supervisor has some other insights into the case that may be relevant.  Perhaps the worker has been disciplined lately, has been reassigned to a less desirable job, has trouble with co-workers, or has knowledge regarding events outside of work leading to current symptoms or complaints.

Red Flags in Workers Compensation Claims

Certain characteristics, behaviors or conditions commonly indicate a fraudulent claim, or one in which the worker may fail to progress as expected.  Here are some resources listing them:

40 Red Flags

Red Flags WC

Reduce Your Workers Comp Fraud

Successful workers compensation evaluation and management includes consideration of the interests of the injured worker, the employer and the payer/claims adjuster.  When there is good communication and trust between all interested parties, almost all situations can be resolved satisfactorily.

What’s your policy on employers/supervisors in the exam room?