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Five fallacies that trip up Return-to-Work (RTW) programs

It's well documented that getting injured workers out of their homes and back to work will reduce Workers' Compensation costs. According to studies by the Workers' Compensation Research Institute and others, employees who are out of work for longer than six months have less than a 50% chance of ever returning to their job. Also, those who get back to work enjoy faster recovery times and the employer benefits from improved productivity and employee morale, reduced litigation and lower costs.

Yet, even employers who have well established RTW plans can take too much for granted and find claims unexpectedly escalating into costly lost-time cases. Here are five fallacies that can derail RTW:

  1. Assuming a RTW assignment is all that is needed for an employee with a minor injury

    Employees with minor injuries that require limited medical attention are sometimes immediately offered transitional duty in RTW programs and then fall off the radar screen. Since the greatest cost savings comes when an offer of transitional duty averts a lost time claim, the employer believes when the employee returns to work, the goal is accomplished.

    Such claims tend to be "processed" rather than "managed." The accepted protocol for a more serious injury (immediately contacting the injured employee, proper investigation, communication with treating physicians, etc.) is bypassed as the time and energy required is seen as excessive for the type of injury. There's an attitude that in a few days the injured employee will be back at his regular job.

    Yet, these are often the claims that morph into costly indemnity claims. Employers, supervisors and claims handlers fail to properly investigate, don't share information about co-morbidity issues or are lax in enforcing medical restrictions. Injured employees may feel they are expected to be as productive as pre-injury, overextend themselves and exacerbate their injury. Or they may not understand how Workers' Comp works, feel the employer is not concerned about their recovery, and fear for their job.

    There really is no such thing as a routine claim. All offers of modified duty should be in writing and include a copy of the Work Status Report from the treating physician; the location at which the employee will be working; the work schedule; the wages that will be paid; a description of the physical requirements of the position; and a statement that the employer will assign tasks consistent with the employee's physical abilities, knowledge and skills and will provide training if necessary. Be sure the employee signs a statement that they understand the restrictions.

    Let injured workers know how pleased you are they are back at work and ask often how they are feeling. Staying in contact with the injured employee, focusing on what they can do rather than can't do and providing the structure to support the transition to full duty is key.

  2. Assuming that medical-only claims will be resolved quickly

    When an employee has seemingly minor injuries, all stakeholders generally expect a quick, smooth resolution. As a result, minor injuries may not be properly monitored. Supervisors and injured employees may be less diligent in following work restrictions, claims handlers may be more lax on follow through or the claim can be assigned to inexperienced adjusters who are handling heavy caseloads.

    An article in the August 13, 2012, Business Insurance, "Even seemingly minor injuries require informed follow-up," noted that Hilton Worldwide Inc. conducted an audit of its claims and found that mismanagement of medical-only claims caused them to mushroom into "monstrous claims." Many of these involved workers who were receiving medical treatment while in a RTW program. Because these presumably simple claims were often assigned to less experienced claims handlers or even administrative clerks, unnecessary medical treatment was authorized or employees were not returned to full duty when released by the physician.

    Hilton now has a dedicated medical-only claims unit. While many employers cannot afford or do not need such a solution, it clearly points to the need to monitor all claims. Assuming such claims will be properly handled and quickly resolved is cited by Workers' Compensational professionals as a major reason why otherwise routine cases spiral into difficult-to-resolve legacy claims.

  3. Assuming the physician will guide the RTW process

    While physicians are medical experts, they need employers' involvement to make well-informed return-to-work assessments since employers know about specific workplace policies and job demands. Employers must take the lead role in coordinating the return to work, communicating with both the injured employee and physician about transitional opportunities and the company's RTW program.

    Equally important, the employer must work with the physician and injured employee to set benchmarks consistent with evidenced-based guidelines so the employee's progress to regular full-time work can be regularly monitored. Time is money in the Workers' Compensation system, so it is very costly to be waiting for medical information. Lag times to initial doctor visits, lag times in receipt of doctors reports and in getting releases to progressively demanding tasks all have negative effects on the effectiveness of RTW efforts.

  4. Assume supervisors are on board

    For many companies, it is the supervisor who implements and monitors RTW programs. While employers may have educated them as to the value of RTW, often times, supervisors are not provided with the tools or information they need to be effective. It's not easy; in the short-term, they have the added responsibility of managing work restrictions, with the continued expectation of meeting production requirements. Moreover, they need to understand work restrictions, but they should not receive information about the conditions that led to the restrictions.

    They may have concerns about their ability to accommodate the injured worker or to handle complaints that the injured worker is getting equal pay for much less demanding work. There may be conflict between the supervisor and the injured employee about what can be done. Once the worker returns to the workplace, there should be ongoing dialogue and periodic follow-up with the worker to discuss any difficulties with the return to work, and perhaps to make any adjustments, but supervisors may feel this is outside the realm of their expertise. Duties of the frontline supervisor and HR are seemingly blurred.

    Supervisors often get frustrated when transitional assignments are prolonged and when there is a lack of incoming information from the worker or health care practitioner and their attitude toward RTW begins to sour. While supervisor training, including managing job restrictions and proper communications, is essential for a successful RTW program, ongoing support to resolve conflicts or how to escalate them within the organization is also crucial.

  5. Assume that as long as employee is working, the claim is processing

    Employers often depend on the adjustor to keep the claim moving. Yet, adjustors typically do not aggressively follow claims if the employee is working. So the adjustor will continue to pay bills awaiting revised status reports from the physician that can take a month or two, if the employer is not proactive.

    As time passes, the transitional assignment becomes open-ended and the injured worker remains in the reduced-productivity position too long, and in some cases, indefinitely. RTW assignments are transitional work assignments, not jobs, which are intended to facilitate the transition from temporary medical restrictions to full duty.

    Regardless of the nature of the injury, a timeline of expected outcomes is necessary to guide the process. By definition, the duration must be limited; often set as a maximum of 90 days, after which injured employees who haven't made substantial improvement towards return to full capacity cannot continue. At that point, it should be recognized that the transitional duty no longer benefits the employer nor the employee and alternatives pursued.