The Occupational Safety and Health Administration (OSHA) is devoting more attention to scrutinizing employers' in-house medical programs for general duty clause violations related to alleged medical mismanagement of injured workers. With medical mismanagement claims on the rise, now is the time for employers to thoroughly evaluate their onsite treatment programs and make changes to reduce the risk of citations.

What is Medical Mismanagement?

Medical mismanagement involves failure to properly and promptly evaluate, treat, accommodate and track work-related injuries and illnesses. Examples include delaying beyond a reasonable timeframe referrals to outside physicians, providing insufficient treatment, and prematurely returning injured employees to their regular jobs before they are medically ready.

According to experts, specific issues that have drawn OSHA criticism of in-house medical programs include:

• Inadequate opportunity for injured workers to become conditioned for duties
• Providing minimal information to on-site providers about injuries
• Incomplete medical records which lack details of diagnoses, treatments and referrals
• Lack of follow-up with employees returning to work
• Failure to appropriately refer workers to outside specialists when needed
• Poor accommodation and tracking of injuries upon return to work
• Overly conservative treatment approaches that minimize care
• Vague medical protocols

Recent situations where OSHA has alleged medical mismanagement violations include employees with musculoskeletal disorders such as repetitive motion injuries, COVID-19, and heat-related illnesses.

Important Considerations

In building medical mismanagement cases, OSHA must consider employees' pre-existing conditions and activities outside work that may contribute to injuries. Employers should also assess provisions made for on-site evaluation and care, provider qualifications, timeline protocols for referral to outside physicians, and workers' compensation statute guidance on medical treatment.

Building a Strong Defense

Experts advise that well-designed medical management programs provide employers with their best defense against general duty clause citations for medical mismanagement. Key elements of a strong program include:

• Training workers on properly recognizing and reporting workplace injuries
• Administering on-site care strictly per written physician's orders
• Setting reasonable limits on the duration of site treatment before requiring review by an outside doctor
• Relying on in-house medical staff's professional expertise and licensing
• Maintaining detailed injury records

For any general duty clause violation, OSHA must prove four elements:

1. Exposure to a recognized hazard
2. The relevant industry recognizes the hazard
3. The hazard was likely causing or could cause death or serious physical harm
4. A feasible method exists to correct the hazard

Employers can argue that no clear standards for medical mismanagement have been established nationally.

Action Items

To reduce the risk of OSHA scrutiny and citations, experts recommend employers take these key steps:

• Thoroughly evaluate on-site injury treatment programs and allow timely referrals to outside specialists.
• Align in-house medical protocols with national industry standards.
• Have an independent doctor review the onsite program for gaps.
• Remind in-house medical staff to rely on their professional expertise, training and licensing when treating injured workers.
• Maintain detailed injury reports with information on diagnoses, treatments, referrals and return to work status.

With OSHA's increasing attention on potential medical mismanagement of workplace injuries and illnesses, now is the prudent time for employers to take action. Ensuring your program properly cares for injured workers can help reduce citations and legal issues down the road. Being proactive with your in-house medical program is wise risk management.

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Copyright © 2023 Smarts Publishing. This is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel or an insurance professional for appropriate advice.