There is no limit on the length of a vocational program (VR) program voluntarily funded by an insurer. The Office of Education and Vocational Rehabilitation (OEVR) funded programs are limited to fifty-two (52) calendar weeks for pre-12/23/91 injuries and one hundred and four (104) calendar weeks for post-12/23/91 injuries. The insurer often will use OEVR limits as guidelines for the length of the programs that they will support.
The Individual Written Rehabilitation Program (IWRP) is the document which lists the client's vocational goal, the services the client will receive to obtain that goal, an explanation as to why the specific goal and services were selected, and the signatures necessary to implement it. Inasmuch as it is the chief document setting forth the delivery of VR services, it must be drafted clearly and legibly and submitted in a timely fashion by e-mail or Fax to the appropriate Regional Review Officer.
The vocational goal should be one which allows the client to work within his/her restrictions and to earn as close as possible to their pre-injury wage (average weekly wage). OEVR's priority of employment goals should be followed. They are:
(1) Return To Work (RTW) same employer, same job modified,
(2) RTW same employer, different job,
(3) RTW different employer, similar job,
(4) Different employer, different job, and
The provider should have a good knowledge of, or access to, information about employers, labor markets, training resources, funding sources, agencies and other resources within the geographical area in which they work. The RRO's can assist the VR provider with research and development of an appropriate vocational goal for the IWRP.
Particularly in light of the Americans with Disabilities Act (ADA) and other legislation, the provider needs to consider all reasonable accommodations, including light duty or other work modifications before proceeding to other employment goals. Labor agreements need to be considered since they may also impact on the job offer. Although employers at times make verbal offers for modified work, the provider needs to obtain written confirmation of such an offer from the employer along with the job description. If the employer does not want to provide modified work, the provider should procure written confirmation that there is no modified work available from the employer. An appropriate offer for modified employment must be for a permanent position within the client's functional limitations at a pay equivalent to the pre-injury job. Clients who accept a temporary position with the pre-injury employer retain their rights to VR. During a transitional period of temporary modified work, the provider should be reporting to OEVR regarding the necessity of developing an IWRP. An IWRP is not required, nor will it be approved, if placement is not into permanent employment.
The IWRP should be developed jointly with the client. If the client isn't an active participant in this process, the client's investment will be minimal and the chance for a successful VR outcome reduced. Many of the complaints which OEVR receives concern providers who start discussing want ads on the first visit and thereby create a feeling of mistrust on the client's part.
A clear process helps facilitate the VR counseling process. Clients often are confused and uncertain about vocational issues and the role of the provider. An ability to focus the process through the use of interest, aptitude, and other testing can save time and increase the injured worker's confidence in the counseling he/she is receiving. Testing increases the probability that the client's vocational goal is feasible. Testing should be part of the vocational counseling process if an extensive or expensive training program is being considered.
Although the client needs to be actively involved in the development of the vocational goal and plan, the provider needs to remain realistic in the process. It is not appropriate to agree with an unrealistic goal simply because the client won't consider anything else. OEVR should be contacted at such times to help resolve the issue in a team meeting.
The IWRP goal should be as specific as possible, especially if training is being provided. It should be developed within a timely manner. All IWRPs with an employment goal of permanent, modified work must include:
(a) a complete job description of the modified position (including the physical requirements of the position);
(b) a letter from the employer that the job is being offered on a permanently modified basis; and
(c) a statement that the client's treating physician has had the opportunity to review and comment on the job description for the proposed modified job.
Functional capacity issues are important, but some vocational counseling can be initiated based on general limitations arising from specific injuries or diagnoses. If it takes longer than ninety (90) days to develop an IWRP something is amiss with the process and the case should be examined carefully. The RRO will ask the provider to provide reasons for the delay. A Team Meeting may be necessary to expedite the process if the IWRP is not developed within this time frame.
It is inappropriate to provide placement services prior to the development and approval of the IWRP. This is especially true if the client refuses to sign the IWRP. These cases are usually unsuccessful unless the underlying issues are identified and resolved. The injured worker's rights to vocational rehabilitation services remain open if an IWRP is not developed and signed.
VR services, other than vocational assessment and counseling, should not be provided until an IWRP is signed by all parties. OEVR won't sign an IWRP if these services already have been provided, especially if he dates for service deliver have expired or are close to expiring. In these cases, another updated and current IWRP will be required. It is the provider's responsibility to see that the insurer signs and returns the IWRP within ten (10) days. If attempts to do so are not successful, the provider should notify OEVR so that the RRO can take further action.
Issues relative to the IWRP should be discussed and resolved prior to being signed. It becomes much more difficult to resolve issues after plan services are implemented. Training programs in particular need to be clear. The client is entitled to reasonable and related components to the training. These items include books and supplies, fees (including health insurance) if mandated by the school, and specific transportation costs. These expenses should be reasonable and clearly set forth in the IWRP.
OEVR expects that all IWRPs generally will contain at least sixty (60) days of job placement and sixty (60) days of post placement follow-up services. Successful case closure occurs when the client has been employed for sixty (60) days.
The RRO will review and sign the IWRP within ten (10) days of its receipt if there are no issues regarding the IWRP. If such issues exist, the RRO will contact the parties to try and resolve them. An IWRP is not effective until signed by all necessary parties. The RRO will call a Team Meeting and attempt to resolve any issues if any of the parties disagree with a proposed IWRP. If agreement cannot be reached, then the RRO will make a decision and recommendations based on MGL c. 152 and Department regulations and guidelines.
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