Employment after Burn Injury

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Returning to work after a burn injury can be an important phase of recovery that helps you return to a routine. Work not only provides you with an income and other benefits, but can also give you a sense of purpose and confidence that is critical in maintaining a higher quality of life. Returning to work, even if you were not injured on the job, can be accompanied by a confusing range of emotions, such as feeling both excitement and anxiety.

• You may not feel you are physically or mentally ready to return to work and do not have the stamina to work the same amount of hours or perform the same physically demanding tasks that you did before you were injured.
• If you were injured on the job, then returning to the same place of injury and/or the same tasks that you were doing when you were injured, may lead to fears or anxiety related to the injury.

Many people have found it was helpful for them to start work gradually, even before they were fully recovered. This is because returning to work can be emotionally and physically therapeutic.

There are many resources available to help you return to work. Some of these resources vary according to your state law and whether or not you were injured on the job. Your eligibility for resources depends on your unique circumstances such as the severity of your burn injury and the demands of your job.

Remember that you are not alone. It is important to get assistance from the burn center, your employer, or other community resources to help you take the steps necessary to return to work safely and successfully.

Are You Ready to Return to Work?

There are some important things that you can do to help make the process of returning to work easier:

• See your health care providers regularly and follow through with treatment. Success with getting back to work requires active participation on your part.
• Talk with your health care providers about your readiness to return to work. He or she can help assess your current strengths and limitations and a reasonable time frame for returning to work.
• Spend time during your recovery period to focus on what you need to do emotionally and physically to return to work. This might include doing tasks around the house to build your strength and stamina, participating in an exercise program, or wearing work boots around the house to get comfortable in them again, particularly if you had a burn to the foot or leg.
• Meet with someone who has returned to work after an injury to get support and guidance.
• Build a supportive network to help you role-play such things as interviews and educating employers and co-workers about your situation.
• Getting prepared may also include counseling to help you cope with psychological and emotional issues you have about returning to work.
  • You may feel uncomfortable about your change in appearance due to your burn injury, especially if your burns are highly visible such as on your face or hands.
  • You may want to learn how to handle questions from your coworkers or employer about your injury and how it happened, or about the way the burn has changed the way that parts of your body look (e.g., scars, pigmentation).
  • If you were injured on the job, treatment for Post-traumatic Stress Disorder (PTSD) symptoms will be important. Treatment might focus on being prepared to return to the place and activities where you were working and other reminders of your accident, such as coworkers who were there when you were injured. It will also include managing nightmares, flashbacks and other symptoms of PTSD.
  • Some people have found it helpful to get in touch with some coworkers they are looking forward to working with again.
• Stay in touch with your employer and express your interest in getting back to work. Keep your employer informed about your recovery to ensure your job will be waiting for you when you are ready to return.
• Ask your health care provider to clearly evaluate your current work restrictions and a time frame for when you may be able to return to work.
• Ask him or her to write a note to your employer with a timeframe and list of supports (workplace accommodations) you may need so that your employer can plan accordingly.
• If you are not able to return to your job for a while, talk to your employer about jobs that you may be able to do during your recovery.
• See your health care provider regularly and follow through with treatment. Success with getting back to work requires active participation on your part.
• If you are not able to return to your regular job for a while, talk to your employer about jobs that you may be able to do during your recovery.

Work Conditioning Programs

If your medical team determines that you are ready to return to work but you and they feel you lack the stamina needed to do your work, you may participate in a return to work program that will gradually build your stamina for work, or be encouraged to do fitness training.

If your injury happened at work, you might also be referred to participate in a work conditioning (work hardening) program. These are specialized programs run by occupational and physical therapists that aim to improve your strength and endurance to perform your job tasks.

Discuss options for improving your endurance for work with your health care providers since there are advantages and disadvantages to various approaches.

Workplace Changes to Help You Return to Work

Your medical team may ask your employer for a job description when you are ready to return to work. This job description is usually provided by the human resources department at your place of employment. The job description helps your medical team determine if you are physically capable of meeting the demands of your job, or if you need changes made at your workplace to accommodate your disability (accommodations).

It is OK to ask your employer for accommodations to help you return to work. The Department of Human Resources at your place of work is a good place to start this dialogue. Whether you were burned on the job or not, employers are legally obligated under the Americans with Disabilities Act and many state laws, to provide you with reasonable accommodations as long as it will not cause the business any undue hardship.

• Under the law, it is your responsibility to make the request for accommodations.
• Be prepared to advocate for yourself or find someone to advocate for you because your employer may not be familiar with the laws that require job accommodations.
• Your medical team may provide you with guidance and supporting paperwork to help you receive job accommodations.
• You have the right to refuse a job assignment that violates your doctor's stated restrictions.

Typical Workplace Accommodations Include:

• A modified work schedule (4 hours per day in the beginning, with a gradual increase to full time).
• Working in a clean and dry environment.
• Limits on how much you can lift.
• Limited exposure to extreme temperatures (avoiding extreme heat or prolonged periods of cold).
• Altering work schedules to accommodate outpatient physical therapy and other medical appointments.
• Special software and hardware so a person with limited or no hand function can work on a computer.
• Adaptive equipment to help you perform your job tasks.
• Consider having your first day at work be in the middle of the week, rather than on a Monday. This short week will be less physically demanding for you. You may also need more recovery time when you get home at the end of the workday.

These accommodations can make the initial transition back to work less demanding on you, and over the long haul, make it possible for you to succeed in your job. It may be helpful to educate your employer and co-workers about burn injuries so they are more understanding to your needs and have realistic expectations of your performance.

On-the-Job Injury

If you were injured at work, you are likely covered by your state’s workers’ compensation insurance. Your case manager is responsible for making sure you get the benefits you are entitled to because of your on-the-job injury. Your case manager can help you get the treatment you need and make the transition back to work go more smoothly. He or she can also be a great resource in helping you to navigate the complex workers’ compensation system.

It is also important that you know your rights and be prepared to advocate for yourself. State workers’ compensation insurance differs by state. Your case manager may not provide you with all the information about what workers’ compensation benefits you are entitled to such as mileage compensation for doctor appointments.

Here are some things you can do to make this process run smoothly:

• Be sure to keep all your paperwork.
• It is important for you to know your claim number and to be in touch with your case manager regarding your treatment and your plan to return to work.
• Always keep your medical appointments to ensure your claim remains open.
• Remind your health care provider to send in the required worker's compensation paperwork so your claim is not closed before you are ready to return to work.
• Do not ignore calls, mail or other forms of communication from your workers' compensation program. Some of these communications may require you to take action.
• Make sure your case manager knows the name and address of your health care provider. Good communication between your health care provider, you, and your claims manager is essential to the smooth delivery of benefits.

Independent Medical Evaluation

The worker's compensation case manager or your health care provider may request an Independent Medical Evaluation (IME). These are often done when the health care provider feels that you have recovered as much as you are likely to recover.

If you receive an IME, you would be referred to an outside health care provider who would independently assess if your condition is stable and no further treatment is appropriate. In that case, your claim is ready for closure.

Permanent Partial Disability Award

If your injury caused permanent loss of physical or cognitive function or a chronic psychiatric illness you will receive something called a “permanent partial disability award.” Any permanent partial disability award you receive is based on the degree of physical or mental impairment on activities of daily living, not on whether you can work.

Vocational Rehabilitation

Whether you were injured on the job or not, you may need vocational rehabilitation to help you return to work.

How does vocational rehabilitation work?

If you are treated at an inpatient rehabilitation setting, vocational rehabilitation usually starts the first day you are admitted and continues after discharge, as the rehabilitation team and counselor continue to follow your employment status and provide help as necessary.

Vocational rehabilitation can also take place at any time an individual with a disability needs help finding employment. If your burn injury makes it difficult for you to get or keep a job, you may try to seek assistance from a vocational rehabilitation counselor.

Your vocational rehabilitation counselor may provide the following support to help you find a job:

• Assessing your skills, limitations, health needs, work and education histories, interests and even personality style.
• Helping you develop a plan that includes specific employment-related goals and how to achieve them.
• Setting up a "trial" work situation for you with a potential employer for a specified period of time to see if you are able to do the job, if you like the job, and what accommodations you might need.
• Helping you determine whether a potential job would be a good match for you. He or she can conduct a job analysis to determine the actual kinds of tasks done in that particular job, the cognitive (mental or thinking), social and physical demands of the job, and the need for accommodations.

How you can find a vocational rehabilitation counselor

• Ask your health care provider or burn center for a referral to a vocational counselor.
• The State Department of Vocational Rehabilitation agency (DVR) can be found in almost every state (see Resources). The DVR may also be able to help you train for a new career if you are unable to return to the job you had before your injury.
• Vocational rehabilitation services vary by state. State DVRs are permitted to enter what is called an “order of selection” during difficult budget times, which means people with more severe disabilities will be given priority to receive services.

Long Term Disability

Due to the severity of the injury, some people may not be able to return to any type of employment.

A person is eligible to receive disability payments from the Social Security Administration (SSA) if he or she is unable to perform any kind or work at a level of “substantial and gainful” activity and the disability is expected to last at least a year. The SSA pays disability benefits under two programs:

• Social Security Disability Insurance (SSDI) is a long-term disability insurance program funded by payroll taxes. In addition to disability, eligibility is based on your past work history and income. After a waiting period, SSDI recipients are eligible for Medicare.
• Supplementary Security Income (SSI) is a federal welfare program for people with disabilities who are unable to work and are poor. SSI recipients are eligible for Medicaid after one month.

If it seems unlikely that you will return to work within a year, we recommended that you apply for SSA benefits as soon as possible. If you have purchased a long term disability policy, you may also be eligible for benefits from that policy provider.

What will happen to your long term disability benefits if you return to work?

Sometimes people are reluctant to start working because they don’t want to lose their medical benefits under SSDI or SSI, or because of the extra costs of getting to or staying at work. Several federal programs have been created to help avoid this situation. Federal work incentive programs under SSDI or SSI allow people with disabilities to receive benefits and federal health care (Medicare and/or Medicaid) while still keeping some of their earnings from employment.

Two federal work incentive programs that help people with disabilities secure a variety of supports such as job coaches, transportation, equipment, and work-site accommodations, include:

• PASS (Plan to Achieve Self Support) – This program (3 year max) allows funds used in achieving employment goals such as paying tuition for training courses to be excluded in calculating your monthly SSI benefits. Contact your local SSA office or for more information, go to http://www.socialsecurity.gov/pubs/11017.html
• IRWE (Impairment-Related Work Expenses) – IRWE benefits can be claimed for your entire working life. In this program, work-related expenses such as adaptive equipment or personal care costs can be deducted from your income so you can retain more of your SSI benefits.

The Law Protects You

The federal Americans with Disabilities Act (ADA) prohibits employers from discriminating against qualified individuals with disabilities who are able to perform the essential functions of the job with or without accommodations.

To be protected under this law, you must have a disability that limits major life activities.

• An employer must make “reasonable accommodation” to your disability if it would not impose an undue hardship on the business.
• Whether an accommodation is considered a hardship depends on the business size, financial resources, nature of operation and other factors.
• When you apply for a job, an employer cannot ask you about the existence, nature or severity of your disability, but can ask you about your ability to perform certain job functions, although some elements of your disability may be visible to others.
• An employer can require you to pass a medical examination only after a conditional offer of employment are made and if it is job-related and required of all employees in similar jobs.

If you feel an employer has discriminated against you, contact the U.S. Equal Employment Opportunity Commission (EEOC). Call 1-800-669-4000 to find the office nearest you, or go to www.eeoc.gov. Many states have powerful disability rights laws as well.

Resources

Benefits for People with Disabilities, Social Security Administration. 1-800-772-1213 www.ssa.gov/disability

Find your local Vocational Rehabilitation Agency and other federal and state resources, contact the Job Accommodation Network, U.S. Department of Labor. 1-800-526-7234 https://askjan.org/organizations/

Equal Opportunity Employment Commission (ADA) 1-800-669-3362 www.eeoc.gov

The Phoenix Society for Burn Survivors. 1-800-888-2876 www.phoenix-society.org

References

Esselman PC, Askay SW, Carrougher GJ, Lezotte DC, Holavanahalli RK, Magyar-Russell G, Fauerbach JA, Engrav LH. (2007). Barriers to return to work after burn injuries. Archives of Physical Medicine and Rehabilitation, Dec:88(12sup). S50-6.

Brych SB, Engrav LH, Rivara FP, Ptacek JT, Lezotte DC, Esselman PC, Kowalske KJ, Gibran NS. (2001). Time off work and return to work rates after burns: systematic review of the literature and a large two-center series. Journal of Burn Care Research, 22(6):401-5.

Mason, S. T., Esselman, P., Fraser, R., Schomer, K., Truitt, A., & Johnson, K. (2012). Return to work after burn injury: a systematic review. Journal of Burn Care & Research, 33(1):101-109.

Authorship

Employment after Burn Injury was developed by Shelley A. Wiechman, Ph.D., and Sabina Brych, B.S., in collaboration with the University of Washington Model Systems Knowledge Translation Center.

Factsheet Update

This factsheet was reviewed and updated by Lynne Friedlander, MED, Spaulding Rehabilitation Hospital, in collaboration with Oswald Mondejar, Sr. VP Spaulding Rehabilitation Network; Joan Phillips, Assistant Commissioner of Vocational Rehabilitation, Commonwealth of Mass; Peter Esselman, MD, MPT, University of Washington, and James Fauerbach, PhD, Johns Hopkins. The review and update is supported by the American Institutes for Research Model Systems Knowledge Translation Center.

Source: Our information is based on research evidence whenever available and represents the consensus of expert opinion of the Burn Model System directors.

Disclaimer: This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment. This publication was produced by the Burn Model Systems in collaboration with the University of Washington Model Systems Knowledge Translation Center with funding from the National Institute on Disability and Rehabilitation Research in the U.S. Department of Education, grant no. H133A060070. It was updated under the American Institutes for Research Model Systems Knowledge Translation Center, with funding from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DP0012). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS).

Copyright © 2016 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.