The distinction between sickness absence referral and case management referral relates to the timing, purpose, and ongoing nature of occupational health involvement:
Sickness Absence Referral
This is typically a one-off, reactive referral made when an employee is absent from work due to illness or injury. The key characteristics are:
- Timing: Usually made during or following a period of absence, often triggered by absence thresholds (e.g., four weeks off, frequent short absences)
- Purpose: To obtain advice on fitness to return to work, likely duration of absence, whether the condition might be a disability, and any adjustments needed for return
- Single point assessment: Generally results in one report addressing the current situation
- Questions focus on: When can they return? What can they do? What can’t they do? Is this related to work? Is further absence likely?
- Outcome: Employee either returns to work (with or without adjustments) or remains absent with clearer prognosis
Case Management Referral
This involves ongoing occupational health involvement in managing a more complex or long-term situation. Key features include:
- Timing: Can be made while someone is working (with difficulties), during absence, or at return to work
- Purpose: Active, coordinated management of the health issue and its workplace impact over time
- Ongoing relationship: Multiple contacts, reviews, and reports over weeks or months
- Complex situations: Typically used for serious injuries, long-term conditions, phased returns, mental health issues requiring graduated support, or cases where there’s uncertainty about prognosis
- Collaborative approach: OH works alongside the employee, manager, and HR to adjust the plan as the situation evolves
- Regular reviews: Scheduled follow-ups to monitor progress, adjust recommendations, and prevent relapse
Practical Differences
A sickness absence referral might ask: “John has been off for six weeks with back pain. When can he return and does he need adjustments?”
A case management referral might say: “John has complex back pain and anxiety. We need ongoing OH support to manage his phased return over 12 weeks, monitor his coping with adjustments, liaise with his physiotherapist, and review his fitness as we gradually increase his duties.”
When Case Management is Appropriate
- Long-term conditions requiring workplace modifications over time (diabetes, epilepsy, mental health conditions)
- Serious injuries with prolonged rehabilitation
- Phased returns to work requiring monitoring and adjustment
- Cancer treatment and recovery
- Complex situations involving multiple health issues
- When there’s significant risk of relapse or deterioration
- Cases approaching ill-health capability proceedings where ongoing documentation is needed
Resource Implications
Case management is more resource-intensive for both OH services and the employer. It requires more OH time, closer coordination between parties, and active manager involvement. However, for complex cases, it can prevent prolonged absence, reduce risk of relapse, and provide better outcomes than one-off assessments.
Legal Considerations
From a legal perspective, case management demonstrates that the employer is taking reasonable steps to support the employee and fulfill duties under the Equality Act (if the condition is a disability). It provides documented evidence of a structured, supportive approach, which is valuable if the case progresses to capability procedures or tribunal.
Many organizations start with a standard sickness absence referral, then convert to case management if it becomes clear the situation is more complex or prolonged than initially expected. The OH professional might recommend case management in their initial report if they identify the need for ongoing involvement.