What Autonomy and Beneficence Look Like in Action

Ed Quick, MA, MBA, CDMS

Certified Disability Management Specialists

(CDMS) must uphold ethical principles of practice as described in our Code of Conduct

Putting these values into action, however, can be complicated by a regulated environment, such as workers’ compensation, which is governed by state statutes.

There is often a fine line between what the individual—in this case, the employee who has been injured on the job—may want and what the regulations allow. This is particularly challenging when addressing the ethical principles of autonomy, meaning respect for the individual’s rights to make their own decisions, and beneficence, requiring the disability manager to “do good” for others.

Workers’ compensation and other state-regulated programs require specific actions, such as treatment and rehabilitation being completed in a timely manner. If these time frames are not met, significant consequences can result, including loss of reimbursement or denial of the entire workers’ compensation claim. That is why, in my own experience working for large companies, I tell employees who have been injured on the job that they can make their own decisions; however, they need to understand the consequences of those decisions. work-related injury, the health care insurer may reject the claim, thus making the employee responsible for the cost of care—and often without the benefit of negotiated rates or fee schedules that lower the cost.

However, if the underlying condition is a work-related injury, the health care insurer may reject the claim, thus making the employee responsible for the cost of care—and often without the benefit of negotiated rates or fee schedules that lower the cost.

For example, an employee with a workers’ compensation claim may express the desire to be treated by their own health care provider. However, several states restrict injured workers from choosing their providers. Instead, regulations in those states allow employers or their insurers to “direct care”—meaning choosing the treatment providers. If an employer opts to direct care in a workers’ compensation case, employees must understand the consequences of choosing to be treated by a provider other than the one identified by the employer. That decision could result in a lack of reimbursement for out-of-pocket expenses and even the employee being financially obligated for the total cost of care.

When and How an Employee Returns to Work

Autonomy is not limited to decision-making around care and treatment. It also applies to the return-to-work (RTW) process following an injury or illness, particularly when a condition is work related.

All of us have rights in how we report to work each day, whether after a vacation, an extended leave to bond with a newborn, or an absence related to recovery from an injury or illness. In addition, the employer has rights around what to expect from employees when they do report to work.

Ed Quick, MA, MBA, CDMS, is Chair of the Commission for Case Manager Certification (CCMC), the first and largest nationally accredited organization that certifies more than 50,000 professional case managers and disability management specialists. He has more than 30 years of experience in disability and workforce management with Fortune 100 companies, and currently works as a global senior benefits manager. continues on page 34

Sometimes employees will assume that their care can be covered by their regular health care benefits. However, if the underlying condition is a

When advocating for those who are off work due to injury or illness, the disability manager must educate themselves and the employee about the regulations that protect the rights of employees who have a disability. In addition, they also need to understand the essential functions of the work the employee performs and the