The vocational rehabilitation process in the American public and insurance sectors may be differentiated according to: (1) case finding and referral processing, (2) evaluation and assessment procedures, (3) vocational rehabilitation plan development, (4) service delivery and coordination, (5) job placement, and (6) follow-up. The insurance sector is largely industrial or workers' compensation rehabilitation, but services are sometimes provided under other insurance lines if the carrier has an obligation for medical or income replacement benefits.

The state-federal rehabilitation program (public sector) has an obligation to identify and serve consumers meeting its eligibility criteria. They cannot simply wait for them to find their way to the agency's door. Finding individuals in need of services requires outreach efforts, often in the form of liaison relationships with institutions, organizations and agencies having regular contact with handicapped individuals (e.g., schools, hospitals). A caseload carrying counselor is frequently the liaison representative for one or more facilities.

In the private sector, providers also seek to identify clients needing their services, but this activity is typically called marketing. It is directed toward third parties (usually insurance companies) that have contractual obligations or economic incentives to provide rehabilitation services to claimants covered by one of their policies, usually workers' compensation. Services are sometimes provided under other insurance lines such as general or auto liability, malpractice, or long-term disability.

The evaluation and assessment process of the public sector must first answer the question of whether the individual is eligible for state-federal program services. This decision must normally be made within 60 days. Individuals are eligible if they have a medical disability (which includes psychiatric and mental conditions) constituting a handicap to employment, and if agency services can reasonably be expected to result in vocational rehabilitation.

Beyond eligibility, the evaluation process must identify medical (physical restoration) and other needed services, and a realistic vocational rehabilitation goal or objective. Depending on client circumstances, the agency will sometimes refer the client to a facility, such as a sheltered workshop, for a work (vocational) evaluation. A work evaluation will typically identify realistic placement and retraining options.

In insurance rehabilitation, the provider does not worry about eligibility criteria. Providers work with any referred claimant in close collaboration with the insurance claims representative and/or state workers' compensation agency. The goal is often reemployment, but not necessarily so. Some claimants may be referred for only an evaluation or for medical management services. The latter are designed to avoid medical complications, unnecessary procedures, and to identify and coordinate services necessary to bring the injured claimant to maximum medical improvement at the earliest possible date.

The vocational assessment process in insurance rehabilitation emphasizes the identification of transferable skills that can lead to reemployment. Workers' compensation claimants can frequently be returned to less physically demanding positions with their former or a new employer using this method. Transferable skills are any qualities or characteristics of the individual, unaffected by disability, that may have reemployment relevance. They may be classified as adaptability skills (temperaments), physical and mental skills, and job content knowledge.

In the public sector the first step is to determine eligibility and this is normally accomplished within 60 days. Subsequently an Individual Employment Plan (formerly Individualized Written Rehabilitation Program) is developed with the Consumer. The plan must identify: (a) a vocational objective, (b) all services necessary to accomplish the objective, (c) the party responsible for each service, and (d) the projected date for plan completion. The plan may call for placement in the competitive labor market, supported employment, self-employment, or placement as a homemaker (if another party is able to work as a result). Consumers are subsequently tracked through the rehabilitation process so be sure you understand the case management system.

Private sector plan development varies by state, carrier, and rehabilitation company. Workers' Compensation is by far the largest area of insurance rehabilitation, and the plan normally needs to be approved by the state Workers' Compensation agency and insurance carrier. In other lines of insurance only the carrier would oversee the plan. Unlike the public sector, a claimant may be referred to a rehabilitation service provider for only one specific service (such as job placement) or for medical management ... long before it is possible to develop an employability plan.

Written employability plans in the private sector will identify a vocational objective and the services needed to meet the objective. Because private sector claimants have previous work experience, and because the carriers obligation is restoration of work potential, private sector plans usually first emphasize a return to work on the basis of transferable skills, preferably with the former employer. When this is not possible other options are considered.

After the plan is developed the next step is to coordinate and deliver all the services called for by the plan. This process is essentially the same in both sectors. The basic difference is that third parties are involved in the private sector. The insurance carrier and/or State Workers' Compensation Agency will oversee the process, and there may also be a private attorney representing the claimant entitled to all records.

With more than two parties (i.e., counselor and consumer) timely and effective communication with all parties is especially important in the insurance sector. The rehabilitation provider in the insurance sector will need to make periodic reports and submit service charges for hours worked on each case. Purchased services are paid for by the insurance company or State Workers' Compensation Agency.

In the insurance sector job placement based on transferable skills is a high priority. Claimants in Workers' Compensation all have previous work experience, and transferable skills are frequently sufficient for reemployment. Welch (1979) noted that private sector placement priorities were sequentially: (1) the same job with the same employer, (2) a different job with the same employer, and (3) a new job with a new employer. Retraining is considered when direct placement is not possible. Severely disabled individuals will receive the cash benefits for total disability written into the Workers' Compensation law or insurance policy. Disability related medical expenses are covered for life.

The public sector emphasizes training around the limitations of the disability, and is interested in maximizing consumer employability potentials. Unlike the insurance sector, many consumers do not have previous work experience (e.g., as in developmental disabilities) or have disabilities not typically seen in the insurance sector (e.g., chronic psychiatric disabilities). Prevocational services that help a consumer become job ready are provided, and for individuals with severe disabilities placements may be in noncompetitive employment situations (i.e. supported employment).

After 90 days of successful placement a consumer may be closed as "rehabilitated" in the public sector. Post employment services may be provided, as necessary, to maintain the placement.

Folow-up provisions in the private sector are highly variable. In Workers' Compensation they vary by state. Insurance carriers frequently want to "close their books" on a case, and a lump sum settlement may be negotiated with the claimant or the claimant's attorney. This normally releases the insurance company from any future expenses other than medical expenses directly related to the disability.

Both the public and private sectors have the common objective of vocational rehabilitation, but they typically serve different clientele. The state-federal rehabilitation program serves everyone meeting its eligibility requirements with the first priority for services going to those with the most severe disabilities. The private sector primarily serves Workers' Compensation and other insurance claimants. The public sector seeks to maximize the vocational potentials of consumers through training, and is often involved in vocational habilitation (serving individuals who have never before worked). In the private sector claimants are returned to suitable employment as quickly as possible, with placement on the basis of transferable skills emphasized. The public sector is a federally mandated program that is run by each state and territory, but overseen by the Rehabilitation Services Administration. The insurance sector is principally Workers' Compensation, and with the exception of a few special federal programs, rehabilitation services are managed by each state.