Rethinking Return to Work

With the New Year comes a chance to look at doing something different, however, we’ve all heard the phrase, “If it ain’t broke, don’t fix it.” If something is working reasonably well, leave it alone. And with the daily pressures of running a business, it’s easy to be complacent about things that appear to be running well.

Employers with return to work programs often assume they’ve done their part by putting the process in place. There’s little analysis or evaluation until a claim starts to spiral out of control and then it’s assumed that employees understand how the program works and why it exists, and the program chugs along as it did five, ten years ago. Yet, return to work is the cornerstone of workers’ compensation cost containment. According to the BLS, the overall incidence rate of nonfatal occupational injury and illness cases requiring days away from work to recuperate was 104.0 cases per 10,000 full-time workers in 2015. In 2015, there were 1,153,490 days-away-from-work cases in private industry, state government, and local government-essentially unchanged from the number of cases reported in 2014. The median days away from work to recuperate-a key measure of severity of injuries and illnesses-was 8 days in 2015.

For the first time in its four years of surveys, The Workers’ Compensation Benchmarking Study identified precisely which claims best practices are generating better outcomes. Getting injured employees back to work tops the list and employers can do better.

Here are six points to consider:

  1. Rethink the nameIn most cases, when an employee is injured, it is the first time they’ve dealt with workers’ compensation. Depending upon the individual and the culture of the company, they can be worried, even scared. Am I going to get in trouble? Will the company help me out? What are other employees thinking?

    Ray Gage, a Master Work Comp Advisor from Indiana recently gave a compelling presentation at the Institute of WorkComp Professionals’ Symposium, urging members to change the conversation about return to work. The place to start is with the name. Return to work implies that injured employees have to leave compounding their fears about feeling expendable and what is going to happen. Consider the difference, if it were named Recovery at Work, or Stay at Work. Suddenly the employee feels valued, protected, and knows appropriate work will be available.

  2. Take control from the insurance company“Insanity is doing the same thing over and over and expecting a different result,” as Gage noted, most employers follow the same steps when an injury occurs. They begin with the First Report of Injury. Then they wait two or three days for a call from the adjuster. Then wait for the employee to go to the doctor and wait again to receive the work restrictions, which may or may not be clear or reflect an understanding of the job. Insurance adjustors can have 75 – 150 cases on their desk at one time so the employer and the injured employee are at the mercy of the insurance company. And the same thing happens when another employee is injured.

    Gage urges employers to flip the process and become the center of the spoke by immediately engaging the other most important players – the medical providers and the injured employee.

  3. Manage the Experience Modification Rate (EMR)Following a claim, employers exercise effective cost control when they can minimize the impact on the Experience Mod, reduce lost time or days away from work, and implement successful transitional duty. Paying wages has a dual advantage: it can cost less than the increase in premium resulting from a lost time injury and boost morale. In many states, medical only claims are reduced by 70% before they are entered into the Mod formula.
  4. Make it mandatoryRequiring mandatory participation keeps the process in control of the employer and establishes the ground rules with employees. While employees cannot be required to accept transitional assignments when on FMLA leave, in most cases, the Workers’ Compensation indemnity payments may discontinue with the refusal to return to work.
  5. Ban the “No Work” restrictionWhile physicians are medical experts, many are not trained in the treatment of occupational injuries, nor do they have essential information about workplace policies, job demands, and the availability of transitional work. Some still have the attitude that “no work” is an appropriate restriction. Therefore, it makes little sense to grant them the role of “gatekeeper.”

    Begin by encouraging a visit to the worksite and providing information on the transitional work program. There needs to be an on-going three-way conversation – employer, employee, and medical provider throughout the process. If an injured employee is facing surgery, it’s not enough to plan the transition jobs once the employee returned. Conversations should take place with the doctor before the surgery to understand what can be done in the time immediately following surgery when the employee cannot do too much.

  6. Raise the bar: almost no restriction is too limitingDisability guidelines can help guide the types of work that can be done and how the recovery should progress. But each case has to be managed individually and at times it will take creativity and commitment to get the employee back to work. Gage told the story of a Transmission Shop employee who suffered a serious shoulder injury and could not lift his arms above his head. His restriction: must sit in a La-Z-Boy for six weeks. The shop moved a La-Z-Boy into the work bay and the employee directed others on how to rebuild engines.

Employees are often called “assets;” yet, assets and people are quite different. A Recovery at Work program has both an economic and a human element. There are many economic reasons to strengthen a Recovery at Work program, but the bottom line is it simply is the right thing to do for all your employees.


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