Work Hardening Frequently Asked Questions
What is work hardening?
"Work Hardening is a highly structured goal-oriented, individualized treatment program designed to return a person to work. Work Hardening programs, which are interdisciplinary in nature, use real or simulated work activities designed to restore physical, behavioral, and vocational functions. Work hardening addresses the issues of productivity, safety, physical tolerances, and worker behaviors."
American Physical Therapy Association, "Guidelines for Programs for Injured Workers" 1995.
- What is the criteria for admission?
- The worker is able to participate in a progressive rehabilitation program for a minimum of 4 hours a day, 3 to 5 days a week.
- A specific return to work goal is identified.
- Ability to benefit from the program based on a screening process.
- The injury is less than 2 years old.
- How does an injured worker enroll in a work hardening program?
The attending health care provider must provide a referral for work hardening.
The claim manager must authorize the program in advance.
- Who provides work hardening programs?
Approved providers who may be physical therapists, physical therapist assistants, occupational therapists, and certified occupational therapy assistants. Rehabilitation physicians, vocational counselors, psychologists, and dietitians, among others, may also provide services within a work hardening program.
See the list of Approved Providers for Work Hardening or obtain an alternate format by calling the Therapy Services Coordinator at 360‑902‑4480.
- Where can I get more information about work hardening?
See the Work Hardening Program Standards (19 KB PDF) for greater detail or contact the Therapy Services Coordinator at 360‑902‑4480.
Get Help Downloading Files (files open in a new window). - How does L&I pay for work hardening programs?
See the Work Hardening Fee Schedule. Approved providers are reimbursed for work hardening programs when authorized by the claim manager. Request alternate formats by contacting the Provider Hotline at 1‑800‑848‑0811.
- What is the difference between work hardening and work conditioning?
Unlike work hardening, L&I has not established standards or a reimbursement schedule unique to work conditioning programs. "Work conditioning" programs are reimbursed as outpatient occupational and physical therapy (OT/PT) under the daily fee cap.
"Work conditioning" programs may be used to bridge a gap between acute outpatient therapy and a structured work hardening program or return-to-work. Other key differences between the two programs are compared below.
Work Hardening OT/PT (work conditioning) Requires a specific return to work goal. No specific return to work goal required. Recognized as a specific treatment program by L&I — program standards have been established. Not recognized as a specific treatment program by L&I — specific standards have not been established. Reimbursed according to the work hardening fee schedule. Reimbursed according to the physical and occupational therapy WAC: - For PT, see
WAC 296‑23‑220 (www.leg.wa.gov). - For OT, see
WAC 296‑23‑230 (www.leg.wa.gov).
Addresses physical, functional, behavioral and vocational needs of the worker. Addresses physical and functional needs of the worker. Multi-disciplinary. May be provided by one discipline. Uses real or simulated work activities with some physical conditioning. Uses physical conditioning and functional activities related to work. Includes education (e.g., body mechanics, work pacing, safety, injury prevention). May or may not include an educational component. Begins at 4 hours/day and builds to 8 hours/day over the course of 4 weeks. 4 hours or less/day.
Note: Reimbursement for outpatient occupational and physical therapy do not typically cover 4 hours/day. - For PT, see
- Does the injured worker need to have a vocational counselor in order to enter a work hardening program?
This question has 2 answers:
- Yes. If there is no job available and a vocational determination is required. A vocational counselor would need to be assigned to the claim, as soon as possible, to obtain a job analysis and identify a job goal. The claim manager would authorize the referral for the vocational services.
- Maybe. Vocational services may not be necessary if:
- There is a job for the worker to return to, or
- The work hardening program incorporates a gradual return to work and the physical demands of the job are known.
- What is the vocational counselor's role in a work hardening program?
The vocational counselors may:
- Identify potential work hardening candidates.
- Facilitate referrals to a work hardening program, if approved by the physician and authorized by the claim manager.
- Provide a job analysis for the job goal.
- Explore return-to-work options with workers in order to identify a job goal.
- Assist in the development of job modifications, if appropriate.
They may also:
- Communicate with work hardening program staff.
- Attend conferences as needed.
- Work with the work hardening team to facilitate a transition to work if appropriate at the completion of the program.
