Let’s help Americans keep their jobs after injury, illness

Millions of hard-working Americans lose their jobs every year because of injuries or illnesses, most of which are not job-related. Given that many of these workers seek public benefits, the resulting costs are steep—a critical concern with the pending exhaustion of the Social Security Disability Insurance (SSDI) Trust Fund.

These costs could be dramatically reduced by wider adoption of strategies to support people who now fall through the cracks of our fragmented system and to help them continue to work.

{mosads}Unfortunately, significant numbers of injured or ill workers  are left to navigate, on their own, various uncoordinated service providers and programs that are generally poorly equipped to deal with their situations or are plainly too late to help. However, the Stay-at-Work/Return-to-Work Policy Collaborative, an initiative funded by the Office of Disability Employment Policy in the Department of Labor, has found that there are promising, practical solutions that can be implemented quickly. These encouraging findings can help policymakers develop ways to help people stay at work.

Workers today confront frustrating obstacles in dealing with illness or injury. Even if a medical condition is job-related and covered by workers’ compensation, those affected often face legal battles before they receive any cash benefits or other supports. And even if the claims are not contested, the level of benefits and quality of care vary widely across states, and the types of return-to-work support and their outcomes vary by employer.

For cases not covered by workers’ compensation, the scenario is often more dire. In 2014, only 39 percent of private-sector workers had short-term private disability insurance for non-occupational conditions, and only 33 percent had long-term coverage. Here, too, provision of return-to-work services and supports varies widely. Workers who don’t have private disability insurance are disproportionately employed in low-skill, low-wage positions, and are the most likely to apply for SSDI benefits.

U.S. workforce development and vocational rehabilitation systems have not traditionally focused on workers who are at risk of losing their jobs because of injury or illness. When these workers seek medical attention, physicians typically focus more on healing the condition than on helping the patients keep their jobs, and often do not follow best practices known to optimize the chances of both outcomes.

Take, for example, a janitor who develops chronic lower back pain that makes it difficult to work. A doctor may prescribe painkillers that offer short-term relief but do not address the root condition or provide a long-term solution to help him regain his ability to work. Without support services to help him return to work, he could become dependent on the painkillers to get through the day, risking a spiral into addiction.

The widespread lack of effective return-to-work services leads many workers to SSDI’s doorstep. They may have run out of other benefits and employment options, or may have been referred to SSDI by a private disability insurance carrier, vocational rehabilitation agency, health care provider, welfare agency, or lawyer seeking to represent their cases. If they qualify for SSDI, they will receive modest cash benefits and eventually Medicare. Those with low incomes may also qualify for Supplemental Security Income, Medicaid, and various in-kind supports. Either way, the cash benefits are low—poverty rates among beneficiaries are high and very few return to work, partly because the incentives to do so are weak.

These workers—and our society—pay a high price. Their standard of living drops, they rarely get appropriate care for their condition, and they are marginalized from society. The government loses tax revenue and foots the bill for any public disability, health, and welfare benefits the workers receive—a bill that now totals on the order of half a trillion dollars per year, about 80 percent federal and the rest state.

Evidence shows it does not have to be this way. For example, a large body of research has shown that early intervention services for workers are particularly effective for those with lower back pain. However, in 2013, 36 percent of SSDI awards to disabled workers went to individuals with “diseases of the musculoskeletal system and connective tissue,” the majority of which are likely lower back pain. The Centers of Occupational Health & Education program in Washington State, which provides care coordination services and financial incentives to facilitate return to work within the state’s workers ’ compensation system, offers a promising example of how to prevent long-term work disability in these and other cases. A 2011 study of 47,000 workers who received services through this program shows that, on average, they missed fewer work days and incurred lower disability and medical costs compared to 59,000 workers who did not have access to such services.

Extensive evidence indicates that well-targeted expansion of early intervention services would benefit workers, taxpayers, and employers. Policymakers must now harness this knowledge to create better outcomes for all.

Ben-Shalom, a senior researcher at Mathematica Policy Research’s Center for Studying Disability Policy, is project director for the Department of Labor’s Stay-at-Work/Return-to-Work Policy Collaborative.