Occupational Medicine

The Steps Involved
  • Returning to Work
  • Maximum Medical Improvement
  • Impairment Rating
  • Functional Capacity Evaluation
The People Involved
  • Adjusters
  • Case Managers
  • Safety Officers
  • Occupational Doctors and Nurses
  • The Treating Doctor
Returning to Work

Our goal is to rehabilitate patients well enough to allow them to return to a productive earning capacity for themselves and their families. Some patients will be able to return to their original jobs. Other patients may require vocational retraining or the assistance of the Texas Rehabilitation Commission. At the end of each office visit the doctor must fill out a work status form putting the patient either off work, on restricted duty, or back to full duty. The choice of work status is based foremost on what is safe for the patient’s medical condition, but in most cases some form of work is possible even if it is only clerical. One exception to this general rule is post-surgical patients who must be off work specifically to perform an intensive every-hour-on-the-hour motion therapy program to prevent permanent stiffness and loss of function. Otherwise, the work status is advanced as the patient’s medical condition permits with a goal of reaching full duty status as soon as possible. Most injuries and surgeries set in motion a typical three month cycle of the body repairing itself with only strength and endurance conditioning remaining after that.

Maximum Medical Improvement

Maximum Medical Improvement (MMI) is a time that is reached near the end of treatment for work related injuries. The doctor usually declares that MMI has been reached when there is no surgery planned, the therapy techniques are not going to be changed, and the tissues are not expected to heal any further. MMI does not mean that the patient is expected to feel fully cured, and patients may still have a number of symptoms.

Impairment Rating

The impairment rating is a required process at the end of treatment for some work related conditions. The rating is a percentage number. The number is meant to measure how much the worker as a whole person has been permanently damaged by the result of the medical condition. The rating does not measure symptoms such as pain; it only counts abnormalities in the patient that can be physically measured with numbers. These numbers come strictly from a national set of charts and tables published by the American Medical Association and cannot be influenced in any way by your doctor or therapist.

Functional Capacity Evaluation

A functional capacity evaluation (FCE) is a test of the patient’s capabilities to do specific types of movements using various amounts of force for periods of time. After the FCE is completed, a report is generated on how well the patient performed. This report is useful as a guide to help the doctor and employer determine what type of work activities the patient may be capable of doing at that moment in time. An FCE is usually performed at the beginning and end of a conditioning program.


The adjuster is a person employed by the insurance company who is responsible for overseeing that the proper care is given to an injured worker. The adjuster also monitors the patient’s work status and follows the rules set by the Texas Workers Compensation Commission. If the adjuster is concerned about something, he or she has the authority to send the patient to another doctor for a one time required medical examination or a second opinion regarding the ongoing treatment. The adjuster also has the authority to deny certain aspects of the treatment that do not relate directly to the specific condition being treated. Workers’ compensation medicine is different than group health coverage. Only specific body areas or conditions are authorized for treatment. Even if other problems exist, they cannot be addressed under the work related insurance plan.

Case Managers

The case manager is a representative assigned to the patient to ensure that the appropriate care is given. The workers’ compensation system is confusing to many patients. Case managers are able to answer many but not all questions. They help in the transition back to work, in vocational rehabilitation decisions, and in coordination of various diagnostic and treatment services.

Safety Officers

Safety officers work to prevent injuries form occurring in the first place. When an injury does occur, the safety officer ensures that the worker receives prompt and complete medical attention. Once treatment for the injury is underway, the safety officer will coordinate with the doctor to determine a safe job position for the worker to return to at each stage of healing.

Occupational Doctors and Nurses

Occupational doctors and nurses are experts in occupational injuries and conditions. They are often both the first and the last medical professionals to treat the patient. They have an excellent understanding of how the stresses of the job duties interact with the healing of the medical condition. They give valuable guidance to the surgeon in determining a safe work status and in the timing of return to work.

The Treating Doctor

Each patient in the workers’ compensation system must have an assigned treating doctor after 60 days. The treating doctor can be changed later by filling out a form for approval by the commission. The treating doctor is ultimately in charge of determining work status, maximum medical improvement, the impairment rating, and what treatments will be administered or withheld. The surgeon will not always be the treating doctor.

Houston Hand and Wrist