Light duty immediately invokes negative feelings for most employers. I have heard countless stories from employers recanting the horrible experiences they have had as they attempted to bring injured employees back to work. I have witnessed the frustration and the surrender that occurs when injured employees manipulate the system and I have been involved in countless cases as a consultant that made me wonder, “Why are we even doing this?” Some of the cases that come to mind include:

l        A client who assigned all of their injured employees to the same work area for light duty. The employees immediately developed a friendship that resulted in symptom exaggeration, defiance and litigation.

l        An insurance agent who asked me to review the claim file of an employee who was on light duty and managed to file three additional claims within seven days of returning to work.

l        A file that resulted in an employee filing an Equal Employment Opportunity Commission (EEOC) complaint after being terminated for not showing up for a light-duty job.

l        Several injured employees who became extremely comfortable in their assigned light-duty positions and refused to return to their pre-injury jobs.

l        A claim for an employee who found a new excuse every time we asked him to return to work—every time he showed up for work, his symptoms of constant pain kept him from doing any work. Finally, he got his attorney to find him a doctor that took him off work permanently.

These cases highlight the challenges faced by employers when they attempt to get injured employees back to work. Despite all the negative commutations about injured employees they can return to work successfully, if your return to work program is not an after thought but an integral part of your retention strategy.

Historically, the workers compensation system and laws have not adequately supported the return-to-work process—it is much easier to offer an injured employee a settlement than it is to give them the opportunity to return to gainful employment. The only problem with this scenario the next employee you hire might be someone else’s settlement.

The Challenge—Your Role as the Employer?

The critical steps for any employer, understanding the system, learning the pitfalls and establish appropriate procedures for returning injured employees to work as soon as possible. Return-to-work programs are only effective if they are implemented with the support of upper, middle and lower management. Return-to-work programs are successful when you allow frontline employees to contribute to developing the overall plan—remember, they are the ones doing the job, their input and recommendations will be critical if you have to modify a position to accommodate an injured worker. You can not expect employees to know your return to work policy if it is a secret. You can not continue to blame the system, the insurance carrier, the treating physician for the employee’s lack of cooperation – that is an HR issue. Like any other policy within your organization, your return to work program must be in writing and is should have clear, specific procedures that can be applied immediately to insure that the employee returns to work immediately.

Don’t forget the definition of a return to work or stay at work program?

Over the years, the workers’ compensation system has given the return-to-work process many names: Modified Duty, Light Duty, Limited Duty, Alternative Duty, Restricted Duty, Transitional Duty or Transitional Work. These terms all mean the same thing—returning an injured employee to a meaningful job until they are able to return to their regular position.

Don’t loose sight of the definition – A return-to-work program is designed to facilitate the return of an injured employee to work as soon as he or she is able to perform meaningful, productive work within the restrictions imposed by the treating physician. “Modified Duty” refers to changing or removing some tasks from the employee’s normal duties so they can continue working in the regular work area. “Alternate Position,” or “Alternative Duty,” refers to a temporary position that can be used to accommodate most injuries within your work environment. 

Employees generally do not want to be at home. And, even if they want to be there, it is your job to remind them that they are still gainfully employed and that watching TV is not an acceptable benefit from the injury.

Remember, to be effective a comprehensive return-to-work or stay-at-work program has to be implemented as a key component of a broader injury prevention and injury management program. Imagine if you could return every injured employee to work as productive members of your team, how significant would that be to your company’s productivity and profitability?

So the challenge for National Return to Work Week – what can we do collectively to help ill, injured or disabled employees stay in the workforce?

All too often, an injured worker is not put back into the workforce for one of three reasons. First, employers do not feel that they can offer the employee a limited but meaningful job. Or second, you worry that the recovering employee, who is not up to “full speed”, many re-injure themselves and create additional injury claims. Third, you may not have the resources to systematically implement a proactive injury management program. And there’s also, the negative side of Injury Management.  Most employers do not want to deal with the attitude problems, productivity issues and the morale drain that can occur when injured employees do not want to be at work.

                                              Read the full story

Background:

Joan has been employed for twelve years as an administrative assistant at  AXZ Company. On December 3, 2007,  Joan notice a pain in both of her hands, initially she dismisses the pain and continues working. One week later the pain is now radiating up to her elbow. She stops at the pharmacy and purchases a bottle of over the counter pain medication, her symptoms seem to go away. On January 4th, she experiences pain in her elbow, neck and shoulder, again she dismisses the pain and continues working. By the end of the day Joan is in a lot of pain, she is having a difficult time doing her work. She tells her supervisor about the pain and he suggest that she make an appointment to see her doctor.

Joan contacts her primary physician and schedules an appointment. During the examination, Joan describes her symptoms and relays that it is worse when she is at work. She tells the doctor that she does a lot of typing and she is using a manual hole punch to make training manuals for her boss. The primary physician examines Joan and advised her that she may have tendonitis or carpal tunnel syndrome – he tells her to file a workers’ compensation claim with her employer because her symptoms appear to be work related.

The next day Joan tells her manager that she may have carpal tunnel syndrome based on the evaluation completed by her primary doctor. The manager reviews the paperwork from Joan’s primary doctor and completes the Notice of Injury.

The manager contacts the workers’ compensation insurance carrier and reports the claim to them. Joan is told to make an appointment with the occupational clinic that treats the employees who work for AXZ Company.

Joan Enters the Workers’ Comp System:

Joan has her first appointment at the walk-in clinic on January 23, 2008. The physician evaluates her and concurs with the primary doctor that Joan may have tendonitis or possible carpal tunnel syndrome. He prescribes a conservative treatment plan – brace for both wrist, physical therapy two times per week for 2 weeks and a prescription for anti-inflammatory medication. Joan is schedule for a follow up appointment in 3 weeks.

Three weeks later Joan return to the walk-in clinic, she relays that she is feeling a little better but her hands are still a bit stiff. Her employer has reduced the amount of typing she has to do and they have reassigned the hole punching job to someone else. The doctor orders two more weeks of physical therapy and advises Joan to continue using her brace. She is schedule to return to the clinic in three weeks.

Joan returns to the walk in clinic on March 11, 2008 – she tells the doctor that she is feeling much better, in fact she is almost back to normal. The doctor discontinues her therapy and advises her to wear the brace if she has any symptoms. She is discharged – Full Duty  with a 0% permanent impairment rating.

You Know This is Not Over – Right?

Joan returns to work – she is back to her regular job and she is back to making training manuals for her manager. Gradually her symptoms return, again Joan ignores the warning signs and continues to type and hole punch. Two months after her last appointment at the walk-in clinic, Joan is back with significant deterioration in both arms, tenderness and pain radiating from her shoulder to her wrist.

Joan is immediately referred to an orthopedic hand specialist for an evaluation. The hand specialist orders a nerve conduction study and confirms that Joan has carpal tunnel and ulnar neuropathy. She is schedule for surgery.

Was there a delay in her diagnosis?

Yes, based on her original symptoms the nerve conduction study could have been order earlier to rule out the carpal tunnel syndrome or confirm her diagnosis.

What did the employer do wrong?

This employee reported an injury that is repetitive, reporting the claim to the insurance carrier is only half of the process. It is imperative that the employer evaluate the employees job tasks to determine the root cause of the employees problem.

70% of all claims are related to productivity and workplace conditions. The Notice of Injury does not capture the daily routines that can be contributing to the employees symptoms.

Carpal tunnel claims are 34% more likely to transition from medical only to lost time increasing the cost by 300%.

When the employee received the Full Duty release the employer assumed that she was totally better, this was a false assumption.

Best Practices:

• Repetitive injuries require additional evaluation – employers should evaluate the job tasks to determine if they are contributing to the employees symptoms. For example – the manual hole punch machine could have been replace with an electric automatic machine. A simple solution that is cost less than carpal tunnel surgery.
• Based on Joan symptoms, some diagnostic testing should have been ordered to thoroughly evaluate her symptoms and provide a definitive diagnosis. Everyone focuses on reducing claims cost – if the carpal tunnel diagnosis was made earlier and the employer made adequate adjustments to the job tasks – Joan’s condition may have improved, avoiding her subsequent surgery.
• When the employee was released to return to work full duty the employer should have continued to monitor her symptoms to make sure she was transitioning back into her regular routine successfully.

Sometimes, we rush to get the Full Duty Release and forget that the employees symptoms were not thoroughly evaluated.

Tags: carpal tunnel, workers compensation claims cost, medical treatment and workers comp

WorkCompSeminars.com will be hosting a Four Part Teleseminar on Implementing a Proactive Return to Work Program. Workshop dates: April 23, April 30, May 7 and May 14, 2008 – 2:00 to 3:30 Eastern-time.

This is an interactive workshop that will allow you to exchange ideas with other participants, receive best practices coaching, design and develop your program, receive templates and sample policies.

By the end of the workshop you will be able to implement a comprehensive Workers Compensation Return to Work Program.

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