A version of this article appeared in Risk & Insurance Magazine

In May, 2003 a 51-year-old New Hampshire male mason fell 20 feet from construction staging. Emergency room doctors found a fractured pelvis, fractured rib, contusion to his left knee, and extensive bone fragments in one forearm. By Thanksgiving, he was back at work–a successful recovery. And by any measure a relatively rare recovery given the worker's age, nature of work, and extent of injury. This could have ended as a permanent disability. Why did it not?

Consider what contributed to this happy ending. As reported by Lynne Heller, a therapist involved in this case, the mason, his clinical team and his employer had seven ways to botch it up. None of them happened.

He underwent surgery on the same day by a hand surgeon, who put back together the bones in one forearm, inserting a pin, and decompressed the median nerve at the wrist. He was then placed in a thumb cast for 8 weeks.

The clinical team led by the surgeon was unfailingly optimistic in talking with the worker. Thus they avoided the negative scenarios which many clinicians are tempted to convey, such as "You'll never work as a mason again." This is the first of seven possible ways to frustrate the worker's recovery.

He began physical therapy with his thumb cast on. If therapy had not begun while he was still in the cast, finger stiffness may have thrown a monkey wrench into rehab, derailing progress by several months. The team thus avoided a second pothole–lack of urgency in rehabilitation. “Chronicity” sets in fast and hard. I have estimated that the probability of long term disability for a recoverable injury increases at a compound rate of about 25% for the first ix months after the traumatic event.

Often a serious hand or wrist injury precipitates shoulder problems which can be overlooked or put off until the primary emerges from the acute phase. In this case the clinicians tackled the shoulder issues immediately, treating it as a separate diagnosis. The hand surgeon also worked on the patient's lower extremity problems, knee and hip pain. In short, the clinical team addressed all problems at the same time. Unfortunately, treatment of multiple conditions is often done sequentially, requiring less effort at team coordination, but at the cost of more prolonged recovery. This was a third avoided barrier to recovery.

The cast was removed mid-July, but before then the mason began to suffer from shoulder pain. Hip bursitis and knee pain settled in. The pin was removed in August. The next day he entered a more intensive physical therapy program while receiving limited doses of a pain drug. The clinical team avoided a fourth opportunity for failure: over-prescription of medication. A disturbing large share of disabled workers become psychologically if not chemically dependent on pain drugs.

After only a month of treatment, the clinicians – working always as a team -- introduced work simulations. The side-stepped a fifth risk of failed recovery, delay in job-focused reconditioning. After another month the clinical team discharged the worker to 12 three-hour reconditioning sessions.

According to Heller, the mason was exceptionally motivated to return to masonry, his profession for 19 years. He was not enervated by psychological trauma, a sixth barrier recovery failure. The employer was also motivated to bring him back. Thus a seventh possible complication, employer recalcitrance or indifference, was avoided.

I have a lingering question about this eventful story: Would the claims payer become aware of it, and be adept to use it as a teaching tool for its claims team?