COHN Disability and Return-to-Work 3 — Questions and Answers
Question 1: When an employee's physician releases them to 'modified duty' but the employer has no modified positions available, the COHN should FIRST:
- Inform the employee they must remain off work until full duty is cleared
- Consult with management to explore creative job modifications or temporary reassignments (Correct answer)
- Contact OSHA to report the employer's non-compliance
- Advise the employee to seek employment elsewhere
Correct answer: Consult with management to explore creative job modifications or temporary reassignments
The COHN should work proactively with management to identify possible modifications, temporary reassignments, or job restructuring before concluding no options exist.
Question 2: Which factor is MOST predictive of a prolonged disability and delayed return to work?
- Severity of the initial physical injury alone
- Psychosocial factors such as fear-avoidance beliefs, job dissatisfaction, and depression (Correct answer)
- The employee's age at time of injury
- The type of workers' compensation insurance carrier
Correct answer: Psychosocial factors such as fear-avoidance beliefs, job dissatisfaction, and depression
Research consistently shows that psychosocial factors — including fear of re-injury, depression, job dissatisfaction, and poor social support — are the strongest predictors of prolonged disability.
Question 3: Under HIPAA, an occupational health nurse may share an employee's medical information with the employer:
- At any time, as employment relationship creates implied consent
- Only work-related medical information necessary for determining work restrictions and accommodations (Correct answer)
- Only with written authorization from the employee for any disclosure
- Freely, as HIPAA does not apply to occupational health settings
Correct answer: Only work-related medical information necessary for determining work restrictions and accommodations
Under HIPAA and ADA, only work-relevant medical information (work restrictions, accommodation needs) may be shared with the employer; diagnostic details remain confidential.
Question 4: A 'job analysis' in occupational health is best described as:
- A psychological assessment of an employee's job satisfaction
- A systematic documentation of the physical, environmental, and cognitive demands of a specific job (Correct answer)
- A financial analysis of the cost of replacing an injured worker
- A legal review of an employee's job description for ADA compliance
Correct answer: A systematic documentation of the physical, environmental, and cognitive demands of a specific job
A job analysis systematically documents the essential functions, physical demands, environmental conditions, and cognitive requirements of a specific position.
Question 5: Which of the following best describes the 'disability prevention' philosophy in occupational health nursing?
- Focusing solely on acute treatment after an injury occurs
- Proactively addressing risk factors and intervening early to prevent injury progression into chronic disability (Correct answer)
- Ensuring all injured workers receive the maximum disability benefits they are entitled to
- Limiting workers' compensation costs by discouraging claims
Correct answer: Proactively addressing risk factors and intervening early to prevent injury progression into chronic disability
Disability prevention involves early intervention, addressing psychosocial barriers, and proactive case management to prevent acute injuries from becoming chronic disabilities.
Question 6: An employee with a shoulder injury is cleared for modified duty but refuses to return, citing fear of re-injury. What is the COHN's BEST initial response?
- Report the employee's refusal to HR for disciplinary action
- Conduct a motivational interview to explore concerns and provide education about safe return to work (Correct answer)
- Contact the workers' compensation carrier to terminate benefits
- Require the employee to undergo a psychiatric evaluation
Correct answer: Conduct a motivational interview to explore concerns and provide education about safe return to work
Motivational interviewing and education address fear-avoidance beliefs compassionately and are the most effective initial approaches to overcome psychological barriers to RTW.
Question 7: In the context of return-to-work, 'vocational rehabilitation' is MOST appropriate when:
- An employee needs a brief rest period before resuming their original job
- The employee cannot return to their pre-injury occupation and needs retraining or job placement (Correct answer)
- An employer wants to reduce workers' compensation premiums
- The employee requests a salary increase after returning from leave
Correct answer: The employee cannot return to their pre-injury occupation and needs retraining or job placement
Vocational rehabilitation is indicated when a worker's permanent restrictions prevent return to their former occupation and they need retraining, education, or job placement assistance.
COHN Disability and Return-to-Work 3
When an employee's physician releases them to 'modified duty' but the employer has no modified positions available, the COHN should FIRST: