Most employers today are required to purchase Workers’ Compensation insurance. Workers’ Compensation is designed to compensate employees for medical costs and wage loss if they sustain a compensable on-the-job injury or illness. But what happens when an employee aggravates a preexisting medical condition during the course and scope of their job duties? In this article, we explore the impact these preexisting conditions have on your claims experience and how to mitigate your total costs through the effective use of a Post-Offer Medical Questionnaire (POMQ) program.
A “preexisting medical condition” can be defined as any prior medical condition, ranging from chronic illnesses to surgeries that an employee has experienced before beginning work with your organization. Quite often, these preexisting conditions have caused some degree of impairment to the employee. Many state statutes indicate that employees who aggravate these conditions during the course and scope of duty must also be compensated for their existing impairment. This fact can drastically increase the cost of a Workers’ Compensation claim. More importantly, newly hired employees deserve to be placed into a position that will not pose a threat to their safety or that of their coworkers. The POMQ is the most valuable tool in your arsenal to ensure employees are properly fitted to the job task; it will also ensure that your claims costs do not escalate unnecessarily.
Uncovering Preexisting Conditions
The POMQ is a tool used during the hiring process to evaluate a person’s medical history and his or her physical ability to meet the essential requirements of a given job with or without accommodations. Designed to assess a candidate’s suitability for a specific role, a POMQ can uncover preexisting conditions that may affect future Workers’ Compensation claims.
The POMQ must be completed following an employer’s offer (“post-offer”) and before a job candidate’s placement into the position. The POMQ cannot be used to discriminate against individuals. However, The Americans with Disabilities Act (ADA) authorizes companies to conduct medical screenings on potential employees if specific criteria are met. In addition, the POMQ questions must be job-related and aligned with company requirements.
The information gathered from a POMQ can be used to make informed decisions about proper job placement, reasonable accommodations, and safety. For example, if a candidate discloses a preexisting condition that could impact his or her ability to perform specific job duties safely, employers can explore potential accommodations or adjustments to minimize the risk of workplace injuries and Workers’ Compensation claims.
Cost Containment and the POMQ
Only a licensed medical professional can evaluate a candidate’s preexisting conditions and whether the preexisting condition would impede him or her from doing the job or whether the job can be performed with specific accommodations and/or restrictions. Furthermore, it is vitally important that the medical professional not ask the applicant about any family medical history as part of a completed POMQ evaluation. Following the medical consultation, the employer must decide if any recommended accommodations can be made so that the candidate meets the essential job requirements without disrupting the business.
Once hired, if the employee is later injured in the same area of the disclosed preexisting condition, the insurance company will pay the medical expenses for treatment. Upon closing out the Workers’ Comp claim, the insurer will quantify the costs attributed to the new injury and can net out the existing disability from the claim. For example, during the POMQ evaluation, let’s say a physician determines that an employee with a shoulder injury from 10 years ago has a 30% impairment rating to the lower back. If the same employee re-injures their lower back while on the job and now results in a 100% impairment rating, the employer’s theoretical Workers’ Compensation will be responsible for 70% of the total disability rating.
Lack of Disclosure in a POMQ
On the other hand, if an employee with a preexisting condition does not disclose that condition in the POMQ, is hired, and later injures the same body part, the insurance company could deny the claim if it can be determined that the employer would not have hired him or her had the condition been disclosed. For example, in North Carolina, if the injury occurs to the same body part, the claim could be denied if the employer was not told about the injury and would not have hired the candidate had the POMQ been done truthfully.
At Prescient National, we believe that well-informed hiring decisions drive down the overall cost of risk. A well-crafted POMQ program is a great tool to help mitigate potential claims. Whether a preexisting condition is disclosed or not, a POMQ works to contain Workers’ Compensation costs. The POMQ aims to uncover potential medical factors so that an employer can better fit the person to the job, prevent further injuries, and provide a safe environment for all employees.
