Table 3.

Four models describing aspects of employer-level decision-making regarding disability management practices

Model	Core rationale or motivation	Decision-making criteria	Primary responsibility for RTW	Intended consequences	Unintended consequences
Biomedical model	Disability of workers is a private, medical concern	Provider judgments of suitability for work	Health care providers	DM programs and decisions are left to experienced and knowledgeable professionals	Providers may lack workplace details; workers feel ignored or forgotten; minimal workplace problem solving and support
Financial management model	Disability of workers consumes valuable company assets	Lost-time costs; Cost of services and vendors	Health care providers	DM programs and decisions are streamlined and designed to reduce short-term costs	Contribute to poor labor-management relations; Higher long-term disability and health care costs
Personnel management model	Disability of workers requires attention to legal requirements	Adherence to laws, regulations, and insurance and benefit plans	Human resources and benefits departments	DM programs and decisions are fair and consistent, with good documentation to defend against legal challenges	Inability to solve complex cases or establish trust and rapport with affected workers
Organizational development model	Disability of workers can be mitigated or prevented by workplace support and communication	Conformance with corporate health and wellness culture	Distributed responsibility between workers, supervisors, managers, and Human Resources staff.	DM programs are more proactive and integrate individual preferences and characteristics of working groups	Higher short-term cost; Greater need for organizational commitment and investment in internal DM resources

DM disability management