Document wqkLVJVVo0pJN7yo4qpeN1gxQ

jured worker for a new occupation or for ways of continuing in his old one Usually, voca tional rehabilitation is assigned when medical treatment fails to restore the worker to the job he held when injured The worker's in jury may be so severe or his work require ments such that residual impairment prohibits effective performance Workers with such impairment must be trained to surmount or by-pass the residual limitations Many will enter new occupations In practice, the more effective the medical rehabilitation, the less the need for vocational rehabilitation This definition of vocational rehabilitation distinguishes it from medical rehabilitation more than it should. While the difference in kind of treatment seems clear enough--re training as opposed to medical care--the cate gories overlap In the public vocational re habilitation programs in each state, services include medical diagnosis and evaluation, sur gery, psychological support, the fitting of prostheses, and other health services along with education, vocational training, on-the-job training, and job placement The two programs blend also on the record Recordkeeping by workmen's compensation in surers does not separate claimants who receive medical rehabilitation from those who receive vocational rehabilitation, although some dis tinguish between medical rehabilitation and acute medical care In contrast, records kept by workmen's compensation agencies usually separate vocational rehabilitation from other benefits The delivery system. The relatively few injured workers who need vocational rehabili tation are served by several means An em ployer or insurer may channel the worker to whatever sources he thinks will provide satis factory service Some workers are referred to the public vocational rehabilitation program where services may be financed by taxes, al though insurers may reimburse the public agency Other insurers direct workers into private facilities where vocational training is conducted by technical schools or on the job For such services, insurers always pay the costs As with medical rehabilitation, some work men's compensation agencies support voca tional rehabilitation so that, if the insurer does not direct the worker into a program, the agency often will Several jurisdictions select candidates either in conjunction with screen ing for medical rehabilitation or separately Workers with serious injuries, permanent dis abilities, or those who receive extended com pensation payments are reviewed by the agency for referral to the state's public voca tional rehabilitation agency or to the insurer Some workers obtain vocational rehabili tation through their own efforts If no one refers them, they may go directly to the public vocational rehabilitation office Since 1920, the federal government and the states have cooperated financially in supporting a voca tional rehabilitation program, 80 percent fed eral and 20 percent state, which can be uti lized by anyone with a vocational handicap Rehabilitation counselors, who usually de termine a referral's acceptability, simply look for a vocational handicap without regard to the source and consider the possibilities of overcoming the handicap If the candidate shows relatively good prospects, a plan is de signed for his restoration For those who cannot return to a paying job, the objective of vocational restoration may be to enable clients to care for themselves and to free other members of the family to earn wages The worker may be referred also by his physician, a friend, or a member of his family Once a worker is established in a vocational rehabilitation program, he is aided by what ever sources the counselors think best fit his needs Generally, the sources are not owned and operated by the vocational rehabilitation agency but are private vendors or other public agencies A worker may be sent to a private rehabilitation center or school or a sheltered workshop such as those run by Goodwill In dustries of America, or he may be enrolled in a public institution Degree of Disability Determination of the extent of disability is perhaps responsible for more litigation than any other single issue in workmen's compensa tion It requires not only correct application of legal principles but also evaluation of facts, subjective complaints and opinions, and at tempts to predict the future As a general proposition (some jurisdictions 189