By Brad Feldner, DC

There has never been a better time to get involved with industry in your area. Employers are dealing with rising costs, and they are searching for a vehicle that will provide a cost-reduction model that allows them to operate at maximum efficiency while increasing productivity. Employers are looking for “the right fit” as they search for avenues to reduce their workers’ compensation costs. They need a seamless solution to their occupational and industrial needs. That’s where you come in.

Post-offer examinations are one of the services that can act as a door-opener, to make a tremendous positive impact with the employers in your area. Employers are looking for a program that could help eliminate or reduce costs associated with employees’ pre-existing conditions. Many companies do not perform baseline examinations of prospective employees to evaluate whether the employees can perform the functions of the position.

Not surprisingly, many work injuries could have been prevented if the employer had received a thorough understanding of the employee’s capabilities through a post-offer examination. The employers can realize a rewarding return on investment if they implement these thorough examinations for prospective employees. Increasingly, many successful companies are now looking to post-offer examinations to help in the hiring and placement process for their employees. A thorough post-offer examination will evaluate the employee’s physical capabilities, along with the employee’s ability to perform the essential functions and critical demands of the position that’s been offered. A baseline evaluation can be documented for each individual before the first day on the job.

How to Approach the
Decision-Makers
Many employers can relate to employees with pre-existing conditions, and they can also understand the importance of evaluating their prospective employees to ensure they can perform the essential functions of the position.

Many companies currently pay for simple physical examination and/or screenings that do not evaluate the essential functions of the position. These basic screenings do not provide baseline examinations, and they do not give the company a thorough understanding of any possible pre-existing conditions. Therefore, the prospective employees are not receiving a thorough functional, objective examination and the employers are not aware of the employee’s functional capabilities to perform the job.
Are you beginning to question why these companies would pay for basic exams such as these? The answer is, many of these companies are now asking themselves the same thing.

When you contact employers to discuss the post-offer process, it’s essential to emphasize the importance of supplying them with a baseline examination. The human resources and risk and/or safety managers may be invited to come to your clinic to undergo a full examination. This is a great way to build exposure for your clinic, since these people receive a tour and you provide them with a thorough overview of the procedures and ancillary services that are available.

Increased Exposure
The post-offer process involves setting up a job-specific examination procedure that will test the essential functions and demands that must be performed by the prospective employee. A few of these evaluation procedures include testing the frequency of various work postures and work activities such as reach up, reach out, bend, stoop, and squat. Physical demand levels and dynamic lifting procedures are also performed and evaluated.

The post-offer examinations offered within your clinic can provide you with more visibility and exposure. If your clinic provides a company’s post-offer exams, it’s more likely injured employees will think of your practice when they need care.

The Big Picture
Industries are not only concerned with the treatment of injured employees, they are also interested in implementing a preventive approach against rising workers’ compensation costs. Decision-makers are looking for a risk-management approach that targets prevention and cost-reduction procedures.

Specifically, decision-makers are concerned about workers' compensation statistics such as these:

• Every year, nearly 600,000 musculoskeletal disorders (MSDs) that are serious enough to cause time off work are reported to the U.S. Bureau of Labor Statistics by general industry employers, and evidence suggests that an even larger number of non-lost worktime MSDs occur in these workplaces every year.

• The Occupational Safety & Health Administration (OSHA) has estimated that the average health-care costs of
one MSD-related claim are $3,080. In addition, lost production, administrative costs, and other indirect costs to employers bring that average total to $22,546.

• OSHA has reported that workers’ compensation system fraud, based primarily on anecdotal evidence, could range anywhere from 2% to 25% of losses. Unfortunately, many of the fraudulent cases may involve pre-existing conditions.

Do’s and Dont’s
Before you begin post-offer examinations in your office, it’s important to have a handle on the “do’s” and “don’ts” that are involved with this testing process. Many of these guidelines can be found in the information supplied through the Americans with Disabilities Act (ADA). There are specific procedures that must be followed during the post-offer process. Some of these procedures include specific questions that can or can’t be posed to the prospective employee, how to report the findings, reasonable accommodations, and more.

At the post-offer stage, an employer may ask all individuals whether they need reasonable accommodations to perform the job. If an employee requests reasonable accommodations to perform a job, then the employer can require the employee to provide reasonable documentation of the relevant condition(s), covered disability, and any functional limitations.

According to the ADA, a post-offer examination can only be performed after the prospective employee has received a “real job offer.” A job offer qualifies if the employer has evaluated all relevant non-medical information that it reasonably could have obtained and analyzed prior to giving the offer. After a real job offer has occurred, an employer can ask disability-related questions and require medical examinations.

Of course, an employer must comply with the ADA when taking people out of the pool to fill vacancies. The employer must notify an individual (orally or in writing) if his or her placement into an actual vacancy is in any way adversely affected by the results of a post-offer examination or disability-related question.

If an individual alleges that the disability has affected his or her placement into an actual vacancy, the U.S. Equal Employment Opportunity Commission (EEOC) will carefully scrutinize whether disability was a reason for any adverse action. If disability was a reason, the EEOC will determine whether the action was job-related and consistent with business necessity.

After giving a job offer to an applicant, an employer may ask disability-related questions and perform medical examinations. The job offer may be conditioned on the results of post-offer disability-related questions or medical examinations.

At the “post-offer” stage, an employer also may ask about an individual’s workers’ compensation history, prior sick leave usage, illnesses/diseases/ impairments, and general physical and mental health. Disability-related questions and medical examinations at the post-offer stage do not have to be related to the job. However, if an individual is screened out because of disability, the employer must prove the exclusionary criterion is job-related and consistent with business necessity.

If an employer asks post-offer disability-related questions, or requires post-offer medical examinations, these procedures must be followed: all entering employees in the same job category must be subjected to the examination/inquiry, regardless of disability; and medical information obtained must be kept confidential.

For example, at the post-offer stage, an employer asks new hires whether they have had back injuries, and learns that some of the individuals have had such injuries. The employer may give medical examinations designed to diagnose back impairments to people who stated they had prior back injuries, as long as these examinations are medically related to those injuries.

On occasion, applicants may disclose disability-related information in responding to an otherwise lawful pre-offer question. Although the employer has not asked an unlawful question, it still cannot refuse to hire an applicant based on disability unless the reason is “job-related and consistent with business necessity.” (See “Post Offer Points to Remember” on page 23 for more do’s and dont’s.)

Doing Your Homework
An important component of the post-offer process involves the clinician having a thorough understanding of the essential functions and demands that must be performed. If the employer has a functional job description in place, you will need to review that information so a thorough examination process can be created. If necessary, you should contact the referral person at the company for clarification.

This process may involve a walk-through of an employer’s facility. Employers usually like to show off their facilities, and it’s important to listen, evaluate, and digest the information they share. Allow the decision-makers to have the stage, and they will show you around their facility so you can evaluate the employees’ work environment.

Part of the clinician’s role is to review job descriptions with the candidate and explain the purpose of the post-offer testing. It will be your responsibility to explain to the candidate that the clinic will provide the findings of his or her physical suitability to perform the job to the potential employer. You should tell candidates that the goal is to make sure they can perform the job without causing harm to themselves or others. This pre-exam discussion helps the candidate to feel comfortable with the examiner, and it also allows the candidate to understand that you are familiar with the demands of the job he or she has been offered.

Reporting the Findings
Following the examination process, it will be your responsibility to review and report the findings to the employer.

Each potential employee can be placed in one of the following categories:

• The individual is able to perform the job task safely without causing harm to himself/herself or others.

• Reasonable accommodations are required.

• The individual is found to be unable to perform the specific job task without causing harm to himself/herself or others.

This information can be used by employers during the placement process to ensure the right people are being hired for the job. The decision-makers need to feel comfortable with the results, and they must especially understand if prospective employees can perform the functions of the job without causing harm to themselves or others.

Opportunities for Growth
As you begin to open doors with companies in your area, there will be many more opportunities that arise. Decision-makers everywhere are looking to develop working relationships with clinicians that can help identify and assist them with their needs.

Many companies are looking for health-care professionals to give safety talks, and to have a presence at their health fairs or wellness screenings. If you focus on services that can provide positive results for industry in your area, your clinic will be well on its way to further growth and expansion. There has never been a better time to get involved with local industry.

Dr. Feldner is the national sales director for Corporate Health of America (CHA), a national leader in occupational and industrial medicine. CHA trains and credentials multi-discipline clinics in 14 states to deliver occ/med services to industry. Dr. Feldner can be reached at 800-729-8922, at bfeldner@corphealtham.com; or sign on to CHA’s website at www.corphealtham.com