Our first reemployment effort is to return each recovered employee to his or her former job. For employees who are not able to perform the duties of their former jobs following maximum recovery, we help them to find other jobs they are able to do, primarily within TVA. Following is a brief description of how TVA's rehabilitation program works: 1. Most important is what happens during the first week following a job-related injury involving loss from work. This is the critical period during which the injured employee begins to form attitudes which will have a strong bearing on the likelihood of his returning to work following maximum recovery. During these first few days, TVA murses visit the injured employees as needed to provide information and to establish a helping, supportive relationship which continues throughout the rehabilitation process. The majority of these injured workers recover satisfactorily and return to their former jobs. 2. TVA physicians are also essential to the rehabilitation process. They provide medical direction during the entire course of rehabilitation, in cooperation with private physicians. When individuals are ready to return to work but have some residual limitations, TVA physicians assign work restrictions so as to facilitate their return to work while providing for needed individual protection. It should be made clear that the purpose of work restrictions is to place individuals in suitable jobs--not to screen people out unnecessarily or return them to work before they are able. 3. We also provide individualized rehabilitation planning and counseling services to persons who need assistance to prepare for and enter alternate jobs. The primary vocational rehabilitation objective is to return the employee to work in a suitable job. 4. 5. A concerted agency-wide effort is made to find suitable alternate jobs for individuals unable to return to their former jobs following maximum recovery. Jobs are modified or redesigned as necessary and feasible to facilitate placement. 6. Services provided by State vocational rehabilitation programs are utilized whenever applicable. 7. 8. TVA cooperates with the Office of Workers' Compensation Programs to help them to provide and improve the compensation and rehabilitation services they administer for TVA employees under the Federal Employees' Compensation Act. In the process of implementing this rehabilitation service, we have encountered a number of problems. I should like to describe some of those problems to the Committee: It is difficult to develop a work restriction system easily understood by both the medical staff and management in the operation divisions to apply the restrictions in a way that facilitates placement in suitable jobs. We are making progress on this. Secondly, there are limits to the number of workers with significant limitations that can be absorbed in particular work crews without increasing labor costs disproportionately. We continue to look for more effective ways to deal with this problem on a case-by-case basis. Thirdly, placing a union member in an alternate job sometimes involves crossing union lines or taking a non-union job. This requires close cooperation with unions. Also, many of the alternate TVA jobs within the ability limits of an impaired worker pay less than his former job. Even with adjustment payments for loss of wage earning capacity from the Office of Workers' Compensation Programs, individuals are frequently reluctant to accept lower paying jobs. Another problem is that many of the alternate TVA jobs available to impaired workers are so different from their former jobs that individual workers are reluctant to accept them because they think they would feel out of place. For example, most boilermakers or linemen do not want to be clerks in an office setting. I should like to point out that approximately two-thirds of TVA's thirty-six thousand employees are in trades and labor jobs. This results in higher injury rates than would be experienced in office settings, as well as greater difficulty in finding jobs within the agency that can be performed by individuals with impairments. Moving on to external problems, we have found that for many individuals, compensation payments under the Federal Employees Compensation Act continue to be an attractive alternative to going to work, even when they are offered suitable jobs within their ability range. Secondly, delays in administrative action by the Office of Workers' Compensation Programs (a) cause delays in needed treatment for injured workers; (b) limit incentives for accepting suitable jobs by causing individuals to believe they can continue to receive their compensation checks indefinitely if they elect not to go to work; and (c) sometimes penalize the individual who accepts a lower paying job in the expectation that payments for loss of wage earning capacity will begin soon. Some of those people have waited six months or more before receiving their first checks. Word of this gets around to other impaired workers and causes them to be reluctant to accept jobs at pay rates lower than those of their former jobs. Thirdly, some of the amendments to the Federal Employees' Compensation Act, for example the 45-day continuation-of-pay provision which provides for needed services to deserving individuals, also make it easier to abuse compensation services. For example, some individuals use continuation of pay for vacations, rest, and relaxation or even concealed employment elsewhere. Fourth, investigations are sometimes needed to collect the information on specific However, further action is needed to (1) minimize unnecessary delays in obtaining Following are some ideas for achieving these objectives. 1. Encourage cooperative arrangements between the Office of Workers' Compensation Programs and employing agencies in which impaired individuals, not able to do the work of their former jobs following maximum recovery, would be placed in alternate jobs at the pay rate of their former jobs. It would be necessary to get prior agreement from the Office of Workers' Compensation Programs that an individual who tried a new job under this plan could go back on workers' compensation without delay if the new job did not work out in the opinion of either the worker or the employer. This plan would provide incentives for accepting new jobs and avoid penalizing individuals for taking chances. 2. The Office of Workers' Compensation Programs needs help in improving its ability to be responsive to needs and legitimate claims of individuals and minimizing delays in administrative decisions. 3. Safeguards are needed to minimize misuse of the continuation-of-pay provision of the FECA amendments. 4. Investigations of questionable claims should be provided as a regular service. Thank you for giving me the opportunity to present this report to you. Mr. GAYDOS. Thank you very much, Mr. Emily. Could I ask you off the top of my head just exactly what are the duties of the Chief of the Health Resource Development Staff? What do you do? Mr. EMILY. We have a collection of health maintenance services that fall in the nonmedical range of the health services that the TVA provides, including rehabilitation of injured employees, counseling and rehabilitation for people without alcoholism or other drug abuse, health education, and psychological services. We have grouped these under the heading of health resource development. Mr. GAYDOS. I see in your statement you mention 36,000 employees that you deal with. Are you responsible for all those? Mr. EMILY. Only when it comes to the day-to-day administration of these particular services that are assigned to my staff. Mr. GAYDOS. I notice in your statement also that in your approach to the problem involving rehabilitation, you do send a nurse-is that a qualified nurse-to the individual's home, to check on them? Mr. EMILY. We do that. TVA has 85 nurses and 9 physicians. These are the staff nurses mainly of TVA who go to the home, to the hospital, or even out on the creek if the fellow has gone fishing, wherever they can find him. Mr. GAYDOS. Is that their primary duty to go out in the field, or do they originate from an office where they perform their primary duties? Mr. EMILY. The staff nurses, which is this 85 I referred to earlier, have primary duties as general occupational health nurses in our Occupational Health Service program. However, we do have three nurses with special interest and ability in rehabilitation who are assigned to this job full-time, and five other nurses designated to work on rehabilitation about one-fifth of their time each, and they do some concentrated work in this service. Mr. GAYDOS. So in your area, the area of rehabilitation, you have roughly three full-timers that are out in the field all the time? Mr. EMILY. Right. And one other full-time equivalent designated, and about 15 percent of my time in administration. Mr. GAYDOS. Do you think that is a sufficient number, depending on the results they have been achieving, or would you like to have more? Mr. EMILY. We think we probably need 25 or 30 percent more staff to maintain the level of service we desire. We have plans to add one or two of these designated nurses. Mr. GAYDOS. In good conscience, do you think that is a good approach to the problem, that they are performing properly, or if you did have an opportunity would you double or triple their efforts, as far as numbers are concerned? Mr. EMILY. At this time it doesn't look like we need to triple or perhaps not even double the size of our staff. I think we can get the job done by a greater utilization of the regular staff nurses who do a great deal of work on rehabilitation as a part of their regular job. Mr. GAYDOS. What other kind of a program do you have attacking that deficiency, as you described it? I am talking about getting people rehabilitated within a reasonable period of time and getting them back to work. Now, you used the approach of sending out nurses to check on them. I have to presume they are using some type of discussion and cooperation with them. They are not psychologists, I presume. That is one approach. Now, what other approach have you used? Mr. EMILY. One of the other important duties of these rehabilitation nurses is to work closely with the management and personnel officers in the major employing divisions, to try to match an individual with his particular set of abilities, with a job with a certain set of physical requirements, so that these nurses work on the job placement end in cooperation with the employing division. Mr. GAYDOS. Am I correct in presuming that most of these grades are somewhat in the medium range, or low-grade classifications, rather than the upper grade-I am talking about cases that usually qualify for some compensation. Mr. EMILY. A vast majority of them are in the trade and labor group. They are paid in the ranges-I don't know the exact figures, but it is in the neighborhood of $7 or $8 an hour. Mr. GAYDOS. $7 or $8 an hour? Mr. EMILY. Yes, sir, and this results in approximately $10,000 to $12,000 per individual through the workers' compensation program when he gets on that payroll rather than on the work force payroll. Mr. GAYDOS. I don't want you mentioning any specific cases, because we wouldn't ask you that, unless we would have to go into it, but you mentioned that, as far as you are concerned, you have concluded that a lot of the misuses and abuses center around some employees making a little vacation period for themselves, particularly involving the 45-day clause. Is that rather prevalent? Mr. EMILY. I think it starts out to be a small percentage, probably in the range of 5 to 10 percent, and would include all the people who originally set out to con the Government out of money by those means. However, that list can grow. We have found that people who for any reason during the early stages of their disability, if for any reason they began to believe that either the company is not interested in their well being or that the Office of Workers Compensation is not interested in them, then it is very easy for them to rationalize, 'Well, since obviously they don't care about me, why should I make any effort to go back to work?' So, that the 5 to 10 percent can easily build up to 25 percent if both the employing agency and the Office of Workers' Compensation does not come through with their end of the bargain. Mr. GAYDOS. I understand the factors involved that would be an inducement to perpetrating or enlarging that type of activity. May I ask you, do you have any other evidence, factual or otherwise, to sustain your feelings-I am sure they are sincere feelings-that a lot of people are taking advantage of this particular clause? Mr. EMILY. Our evidence is made up of our individual case records. As you indicated, you didn't want me to mention any names. But we have a case record with progress notes and action taken and responses on the part of the individual, on every one of these people we work with. We do find a small percentage of these people initially who know every trick in the book to stay on the compensation rolls. Mr. GAYDOS. Let me be more blunt. If you were forced to prove a case, how would you go about proving that case, against one of those in your file, one of them or any of them? Let me explain why I am asking this. I appreciate your coming down here, believe me. I have to ask you the questions because we have to present a case, and we need facts. Many things that are subjective, or conclusions without proper facts, get thrown out and they are discounted very easily. I am asking you if you were forced to the position of having to prove a case, and take this before somebody, your peers or someone else, how would you go about convincing these people that what you say is true, that these cases you have in there involve faking; they are taking a vacation? Mr. EMILY. All right, I could do that. We have individuals whose own physicians, as well as our TVA physicians, have said they were able to go to work. Mr. GAYDOS. Could I stop you there. Would there be other conflicting medical testimony that said these people are not able to go to work in that particular case? Mr. EMILY. In the example I am using there is no conflicting medical information. The best examples I think are those with nonconflicting medical information. Mr. GAYDOs. Okay. Let's take that. Mr. EMILY. We have some of those where not only our physicians, but their own physician of their choice, say they are able to go to 94-539 O-78-18 |