When the doctor says "no" to return to work

Gabrielle Lis

Having a doctor say, “No,” to return to work can feel like running full tilt into a brick wall: its disorienting, and shifting the problem can seem impossible. This article will help you understand what might be behind the doctor’s decision, and hopefully allow you to move beyond your frustration to find an appropriate solution.

There are three key things to consider when a doctor says that return to work is a no-go:

  1. Some injuries and illnesses have a substantial recovery time. Is that relevant to the case in question?
  2. Doctors often take their cues from patients. How does the employee feel about return to work?
  3. Managing return to work takes time, information and good will. Does the doctor have what it takes – and if not, what can you do about it?

Below we discuss each of these three considerations, and provide simple, effective and appropriate methods for chiselling away at the doctor’s resistance, one RTW-preventing brick at a time.

Some injuries and illnesses have a substantial recovery time.

If there is a clear, medical reason for the delay – for example, a compound fracture or a serious mental health episode – placing pressure on an employee to return before getting the go-ahead from treating professionals may impede their recovery.

Instead of pacing around in front of the proverbial brick wall you should ask the doctor for:

  • A “natural history” of the relevant injury or illness, that is, an explanation of the symptoms, progression and recovery expectations, including expected recovery time; and
  • Information about how you and the employee can best plan for safe, durable return to work.

If RTW is not yet appropriate you need to abide by that decision – which isn’t to say that you can’t start planning for the future, when the employee will be ready to return.

On the other hand, if the condition’s “natural history” does not match the diagnosis given for this particular employee, you can be more confident that there are other, non-medical barriers to return to work.

How does the employee feel about return to work?

We’ve often noted that, if it comes to choosing sides between an employer and an employee whom they are treating, doctors are likely to be loyal to their patient. This means that if the employee has gripes about the workplace, their doctor may be less likely to certify them to return.

A doctor’s refusal to give the ok for return to work could be a sign that the employee is unhappy with some aspect of working life, possibly:

  • Interpersonal conflict with a coworker or supervisor or even (God forbid!) you;
  • Dissatisfaction with current duties / pay / level of recognition;
  • Concerns over safety, especially if appropriate changes have not been made to the
  • workplace following an accident; and
  • The level of support they believe they will get when they return, or the modified duties on offer.

 Although it might seem as though the doctor is the one erecting barriers, having a chat with the employee at this point can be very worthwhile. Ask:

  • “From your point of view, what are the barriers to return to work?”
  • “What can we do to get you back to work quickly and safely?” and
  • “What kind of support do you need that you’re not currently getting?”

Encourage the employee to share their concerns – and the solutions you generate together – with their doctor. This will let the doctor know that there are people in the workplace who are approachable, supportive and accommodating.

It may also be a good idea to check whether the employee is aware of the step-downs in payment they can expect throughout the duration of a long term claim, and the extremely negative health consequences of lengthy work absence. Again, encourage them to share this information with their doctor.

Finally, make it clear to the employee that they are missed by management and coworkers. Knowing that they are valued and appreciated can make a huge difference in an individual’s motivation to make it back to work, and when the employee’s attitude changes, there is likely to be a corresponding shift in the attitude of the doctor.

Does the doctor have the necessary time, information and goodwill?

Managing return to work can be time consuming, daunting and demanding for doctors. Provided the workplace is supportive, most are up to the challenge – but you may need to provide them with the tools they need to get the job done.

Ensure that the doctor:

  • Knows enough about the modified duties available and that this information has been presented in an accessible format. Ask:
    • “Would you like to come out and inspect the work environment?”
    • Have you given them clear and accessible information about tasks and physical requirements / accommodations?
  • Understands the health benefits of early RTW.
  • Is being paid appropriately for their time.
  • Has the opportunity to give you there perspective on barriers to RTW. Ask:
    • “From your point of view, what do we need to do to get Joe Bloggs back in the workplace?”
  • Realises that the worker is missed. Say:
    • “Everyone’s been asking when Joe will be back at work. He’s a great guy and a good worker. What can we do to get him back safely?”

Sometimes, speaking directly to the doctor won’t be enough, or you may simply wish for an independent verification of their views on the situation.

There is nothing wrong with seeking a second opinion, although it is important to do so in a way that does not undermine trust. Your options include:

  • If there are other treating practitioners involved in managing the case – for example a physiotherapist or specialist of some kind – it can be helpful to seek their perspectives on the employee’s workability. Where appropriate, involve the employee in this discussion: you don’t want them to assume you’re going behind their back.
  • Request an Independent Medical Examination (IME). If the work-relatedness of the claim is not being investigated, make sure the employee knows this. Stress that the intent is to get more input on how best to manage RTW.
  • Encourage the employee to get a second opinion, in the context of return to work being good for his or her long term health.