Injury Prevention: Employer Return-to-Work Testing

Why, When, and How to Apply

By Becky Espinoza, OTC
Area Manager—Onsite Testing, Fit For Work

Are you feeling the pain of increased injuries and illnesses in your workforce?

In 2022, companies reported 2.8 million nonfatal workplace injuries and illnesses, a 7.5% increase from 2021. According to the Bureau of Labor and Statistics, this uptick represented an increase in both injuries (4.5% to 2.3 million cases) and illnesses (26.1% to 460,700 cases).

These cases may range from lifting injuries to long COVID to low back pain, resulting in days off work for employees, costly workers’ compensation claims, and operational challenges for employers.

As these employees begin to heal and prepare to return to work, how can you ensure that they’re ready? And what are the risks if they’re not ready? Let’s explore why, when, and how savvy leaders are employing fitness-for-duty testing as part of their return-to-work programs.

Why Enact Fitness-for-Duty Testing

A fitness-for-duty test is a type of assessment used to determine whether an employee can perform the essential functions of their job post-injury or illness. When people are injured or sick and must take medical leave, they are naturally focused on recovery – for psychosocial and economic reasons. “When can I come back to work and rejoin my team? I need to earn a living.”  At the same time, managers need their people back at work to meet production deadlines and revenue expectations.

Allowing proper time for recovery and ensuring that workers are ready to resume work benefits both employees and employers.

Fitness-for-duty testing helps individuals avoid risks of returning too soon, and employers are protected from the liabilities and other managerial implications associated with these risks:

• Reinjury – Many employees return to work too early due to financial pressures or the misconception that “pushing through the pain” is a sign of dedication. The result is almost immediate reinjury. Just as a broken bone that hasn’t fully mended can break again under stress, an injury that hasn’t healed can be reaggravated. This doesn’t merely set back the recovery process; it can worsen the injury. Without proper healing, the body remains vulnerable, allowing reinjury with potentially more severe consequences.
• Secondary injuries – Individuals often change how they move or perform tasks to protect a weakness or healing injury. This adaptation, while instinctive, can lead to overcompensation in other areas of the body. For example, a worker with an injured left ankle might place more weight on their right side, leading to overuse injuries or strains elsewhere. These secondary injuries might seem unrelated to the original injury but are a direct consequence of returning to work before full recovery.
• Chronic pain – Persistent discomfort can last for months or even years if injuries are not given the proper time and therapy to heal. When chronic pain sets in, employees can turn to pain medications that have adverse effects on their internal organs as well as their safety and performance. Without proper education and treatment, chronic pain can increase risks for both employees and employers.
• Stress – Returning to work while still recovering from an injury can cause acute anxiety for an individual. Every movement becomes a conscious effort, accompanied by worry about causing further pain or injury. This situation increases risk to the worker’s overall wellness and affects their job performance.

Additionally, fitness-for-duty testing is beneficial in returning people to work, as some physicians are hesitant to release an employee back to work when they don’t have a good understanding of the job and its requirements, and thus the employee stays out longer than necessary. It is critical that the care team, employer, and employee are in close collaboration when making return-to-work decisions.

Fitness-for-duty testing is an objective measure of the employee’s abilities to return to work and can be administered through the continuum of care (as many times as necessary), even if the employee is not quite ready for full duty work.

When to Employ Fitness-for-Duty Testing

To address these concerns, modern employers are outsourcing professional testing for people returning to work after injury or illness. When fitness-for-duty testing is part of your standardized testing protocol, employees know what to expect, and this approach negates any subjective factors. “Fitness-for-duty testing is part of our standard policy for returning to work.”

Most employers apply fitness-for-duty testing when an employee has been injured or ill.

For example: A security officer is returning to work after a sports injury impacting the knee. The supervisor wants to ensure that the worker can handle physically demanding emergency situations, such as running, climbing ladders, and performing CPR. Fitness-for-duty testing can ensure that it’s safe for the officer to return to work.   

Another example: A warehouse employee who operates heavy machinery was injured while hiking and is preparing to return to work. The manager witnesses impaired balance, raising concerns about a potential recordable incident such as falling, plus the risk to other team members. The protocol supports scheduling a fitness-for-duty test to determine if the individual can safely return to work or if they need further therapy.

How to Stay Legally Compliant

If an employer chooses to implement fitness-for-duty testing, there needs to be a written policy in place to support the testing. Additionally, the policy must be applied consistently to all workers. Employers should never single out employees for fitness-for-duty testing, as it could be viewed as punitive and/or discriminatory.

The EEOC regulates this testing to ensure proper procedures and protection of the worker’s personal medical information.

Tests should be based on a physical demands analysis (PDA) as defined and verified criteria of job requirements and may include dynamic lifting requirements, physical agility demands, and other job descriptors.

This type of assessment is also regulated by the Americans with Disabilities Act (ADA), as testing may reveal information about an employee’s disability. The only time an employer can request a fitness-for-duty exam for an employee is if the exam is job-related and consistent with business necessity.

As part of our injury prevention services, Fit For Work maintains verified PDAs for all positions and only on medical information regarding injury or illness.

Testing, including a modified musculoskeletal exam and functional testing, is based on the worker’s position and job description. Documentation is recorded via the WorkSTEPS system, and a legally supported summary of results, including a recommendation on the return-to-work status of the employee, is provided to the manager.

In short, Fit For Work acts as a firewall between the employee and the employer – protecting the employee’s privacy and ensuring that only legally allowable information is given to the employer. The manager then communicates the test results to the employee. Based on these results, next steps may include return to work or referral for further medical care.

Conclusion 

Fitness-for-duty testing can benefit both returning employees and employers by helping avoid more days off work for employees, costly workers’ compensation claims, and operational challenges for employers. Enacting a properly designed and documented testing protocol helps care for your valuable workforce while ensuring regulatory compliance – with less pain all around.

To learn more about Fit For Work’s Employee Testing program, click here.

Rebecca (Becky) Espinoza holds a Bachelor of Science in biology from Texas A&M International University and a master’s degree in occupational therapy from the University of Texas Medical Branch. She has worked in a variety of clinical settings within the discipline of occupational therapy, primarily for the U.S. Army Institute of Surgical Research, Shriners Children’s Hospital, and Operation Smile organizations as a Burn and Trauma Rehabilitation Specialist. Becky joined Fit For Work in March of 2020 providing onsite post-offer employment testing support. In July 2021, Becky’s role increased to Clinic Lead Therapist supporting the growth of the Fit For Work San Antonio testing team.

Currently, Becky serves as an Area Manager for Onsite Employment Testing Services for testing teams in San Antonio, Temple, and San Marcos, TX.

When Becky is not working, you are likely to find her attending a music concert of one of her favorite artists, at a local thrift market hunting down vintage denim, or exploring new local eateries and farmer’s markets.