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Return-to-Work - An Investment Worth Making
Everyone’s goal should be to have an injury free work environment, but even the safest workplace will experience a work injury sooner or later. Although attitudes have changed dramatically in the last several years, returning an injured worker to the workplace can still represent a real challenge for many employers. Fiscal constraints can discourage some employers from bringing an injured worker back to any job duties other than those they were hired to do. In some cases, union rules or employment contracts may limit the employer's ability to bring an injured worker back to modified duty or modified hours. There is also the concern that bringing an injured worker back into the workplace too soon could lead to an exacerbation of their injury resulting in a longer recovery.
Because of such obstacles, it is often easier to simply wait until the injured worker is fully recovered before bringing them back to work. While this is easier and might be justifiable on many levels, at what cost to the employer?
Department of Labor statistics show that in 2008 3.5% of American workers experienced a work related injury. And of those workers, who experience work related injuries, 30% had two or more lost work days. When an employee misses a day of work, the employer always loses their contribution to the products or services that company delivers to make a profit. The employer also often bears the expense of paying wages and/or benefits while that worker is off work. When the absence is due to a work injury, they will also experience the indirect costs of lower morale among coworkers and increased operational costs associated with making up for the lost productivity of the injured worker (i.e. temporary workers, overtime, training, retraining, etc.).
So what is the cost to an employer when a worker is injured on the job? According to the Workers Compensation Research Institute, the average direct costs of a work related injury that results lost work days is ~$ 27,000*. Direct costs are defined as medical costs associated with treating the injury, indemnity costs associated with statutory wage replacement, and settlement costs associated with any permanent impairment caused by the work injury. According to OSHA, the indirect costs for a work related injury average 4.5 times the direct costs. This means the average work related injury can cost an employer over 150,000 dollars. The companies on the S&P 500 have an average net profit margin of 8.5%. To make up for the average $ 150,000 lost time work injury, a S&P 500 employer would have to increase sales by $ 1,764,000.
Other than the obvious pain and suffering, does the injured worker experience any additional costs when they are off work with a work injury? Several statistical studies have shown that when an injured worker is away from the workplace for just 4 weeks, there is a 20% chance they will never return to work. At 8 weeks, the likelihood that they will never return to work increases to 30%. At 12 weeks off work, the injured worker has only a 50% chance of ever returning to work. When an injured worker does return to work after 12 weeks, studies show that they will experience a loss of earnings of up to 27%.
So, it should be obvious that the significant costs associated with lost time injuries warrant special attention to ways such costs can be mitigated and/or eliminated. While many employers realize that something needs to be done and while most make some sort of return-to-work "effort" to minimize lost work days, few have a well thought out plan to deal with the many issues that need to be addressed to effectively provide a safe and timely reintegration of the injured worker back into the workplace as they transition back to the job duties they were hired to complete.
Because every company has a different "culture", there cannot be one cookie cutter plan to meet all companies' needs. There are, however, certain principles that will hold true regardless of company size, geography, union involvement, workforce age or education, or any other factors that makes any company somewhat unique.
Principle #1 – Examine your current situation relative to work related injuries and how they are handled.
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Do you have employees report and record all incidents of injury even if they are minor?
If so, how many incidents are reported each year?
How many were recordable?
How many resulted in at least 2 lost work days?
What was the estimated cost of your work injuries…
In medical and indemnity expenses?
In increased insurance premiums?
Lost production?
Hiring of temporary workers or overtime for existing employees?
Where did the injured workers go for injury evaluation and treatment?
Were any standards utilized to track progress toward injury resolution and return-to-work?
Were modified job duties, alternative job duties, and/or modified hours made available to any/all of the injured workers?
Were medical/functional outcomes benchmarked and optimal?
Were vocational outcomes benchmarked and optimal?
Was a site coordinator appointed to retrieve investigative information and report the results along with the injury to the insurance company/TPA?
Who conducted the investigations?
What was done with the investigative reports?
Principle #2 – Set goals and objectives regarding what you would like the outcomes of your injury management and return-to-work efforts to be. Each employer will necessarily have different specific goals and objectives, but “big picture” goals will generally be…
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Fewer lost work days
Lower costs associated with workers’ compensation claims
Secondary goals might be…
Improved employee morale
Improved community relations
Lower costs associated with the use of temporary employees
Improved employee productivity
Goals and objectives should be clearly articulated and should be measurable so that progress toward attaining them can be evaluated.
Principle #3 – How to you plan on reaching your goals and objectives?
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The first step in this process should be to establish someone in the company that will be responsible and accountable for the company's workers' compensation program. This can not be delegated or abandoned to a claims professional at your insurance company or TPA. No matter how professional or well intentioned an insurance/TPA adjuster is, your company is not their company. There will be many issues in the return-to-work process that can only be addressed by you, the employer. Having one person that acts as the point of contact and primary decision maker on issues related to the management of work injuries will make this process more efficient for all parties involved. When dealing with workers' compensation injuries, efficiency is often the key to better outcomes and lower costs.
If you do not already have a standard procedure for managing work injuries, develop one. You may want to consider…
A flow sheet that outlines responsibilities of all employees associated with such an incident, including the injured worker
An “injury packet” that includes…
All forms necessary to record and report the work injury/incident
“What to do” instructions for the supervisor, the injured worker, and the initial caregiver
A form for the injured worker that explains workers compensation benefits and the employer’s policies/procedures for handling work injuries, including the return-to-work process
Contact information for the injured worker’s -
Emloyer contact
Insurance/TPA adjuster
Occupational clinic
Medical case manager
A point of contact if any of these other contacts do not respond to the injured worker’s inquiries
An affirmation notice to all employees, especially supervisors, that the employer is fully committed to facilitating an early return-to-work for injured employees and that this will be provided by the most appropriate of the following…
Modified duties
Modified hours
Alternative duties
Transitional duties
Identification, in advance, of work activities that can be performed by injured workers with various temporary impairments
Other considerations might include training of management regarding the escalating cost of workers compensation. A general education of employees about how the workers compensation system works so they know what to expect should an injury occur is also beneficial.
One of the biggest challenges with managing work related injuries is that they don't happen that often. An operation employing 250 people, for example, will only experience about 8 injuries per year. Only 2 to 3 of those injuries will experience 2 or more lost work days. Unless an employer has someone dedicated to staying on top of statutes, insurance/company policies, injury management procedures, and progress in the treatment/rehabilitation progress, there will be too many opportunities for issues that need immediate attention to fall through the cracks. Without someone from the employer being responsible for keeping things on track, there will be too many situations where the injured worker may begin to feel alienated from their employer. While it may seem far fetched, one work injury that is allowed to "go bad" can result in a price tag of several hundred thousand dollars.
Principle #4 – Determine what you need to do to meet the noted goals and objectives. What tools or what assistance will you need to help you work your plan and reach your goals?
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Put together a team of professionals you can work with to help you you’re your plan. It will be important to develop a list of providers that are willing to learn about your workplace, the type of injuries that are typical to your work environment, and the availability of return-to-work activities that can assist in transitioning the injured worker back to their regular job duties. Providers to include could be…
Occupational health or urgent care clinics
Physical therapy clinics
Orthopedic specializing in most frequent WC injuries identified
If you have an occupational health department, determine how they can best help in the injury management/return-to-work process. Sometimes an occupational nurse can assist in screening injuries and identifying those that will need closer attention. Sometimes the occupational nurse may have a workload that will allow them to directly provide some medical case management for the injured worker.
Partner with a medical case management company that has the expertise and the proven ability to manage work injuries proactively, securing optimal medical and vocational outcomes. Studies have shown that medical case management can significantly shorten the length of a disability, can enhance the injured worker’s satisfaction with their employer’s injury management/return-to-work process, and will reduce the overall costs of work related injuries.
Utilize standards to promote appropriate transitional goals in the rehabilitation/return-to-work progress. Standards such as the Medical Disability Advisor and the Official Disability Guidelines are available and will outline appropriate lengths of disability for various diagnoses and procedures, as well as suggest appropriate modified work activities that can be considered. Many medical case management companies utilize such standards as they develop a case management rehabilitation/return-to-work plan and incorporate it into their management of the work injury.
Find a defense attorney that knows your workplace and the statutes as they are applied in your jurisdiction. Good legal advice given before an issue develops can mean the difference in a $ 50,000 claim and a $ 250,000 claim. Sometimes a decision that would be a sound human resources move otherwise can be very costly when a workers compensation claim is added to the mix.
Explore ways to keep records and statistics so that you can evaluate your success or lack thereof. Modern software or web-based programs can give you access to reports and/or data securely, making sure you won’t have to worry about unauthorized access of private medical information by coworkers that may have access to your desk.
Ultimately, if you feel you need help evaluating your current process for managing injuries and returning injured workers to the workplace, do not hesitate to get help from professionals that work in this arena every day. Many insurance companies or TPA’s have loss control departments to assist their clients. Many medical management and/or risk management companies have expertise and experience in putting such programs together. Getting help in this important area of concern will be money well spent.
Summary
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A workers compensation claim represents an employer’s statutory obligation to resolve a worker’s medical condition that is the result of an accident/incident experienced while performing work duties. The key to the successful resolution of the claim is the successful resolution of the underlying medical condition. Anything an employer can do to facilitate this process will improve both medical and vocational outcomes.
Utilizing the best available medical services is vital to an optimal medical outcome. Employing a medical case manager to facilitate and expedite medical treatment and progress toward an early return to the workplace can be just as important. No less important in this process is the employer’s willingness to provide work opportunities that accommodate any medical restrictions and that prove therapeutic in the injured worker’s rehabilitation/return-to-work endeavor.
A survey of over 3000 occupational health physicians asked a basic question, “Based on your clinical experience, what fraction of workers with work-related injuries and illnesses who seek medical care really need to be off work for more than a couple of days for strictly medical reasons?” Greater than 90% of the physicians surveyed said that less than 10% of the work injuries they see require two or more days away from work for purely medical reasons. In actuality ~30% of work injuries result in 2 or more days of lost time. This means that almost 750,000 American workers will miss days of work due to non-medical issues that can be rectified at the discretion of the employer, the provider, and/or the injured worker. The potential savings for all parties – fiscal, physical, and emotional – are too significant to ignore. Doing what it takes to minimize unnecessary lost time truly is an investment worth making.
Additional Resources
Constructing Return to Work Programs: Building for Better Returns
by Dennis L. Chandler, President Day-1 Systems, Chandler Consulting Inc.
Developing and maintaining a successful Return to Work Program
by State Compensation Insurance Fund
