Dear Dr. X – I really don’t understand the note I received from your office, can the employee come back to work or not? What do you mean he has a five pound lifting restriction – he doesn’t lift anything all day!

This scenario plays out at countless companies on a daily basis, the frustration of getting treating physicians to join the return to work team. The key question for employers, did you explain your return to work goals to the physicians who treat your injured employees? Are we asking physicians to be mind readers? Or are we allowing our employees, who may have their own agenda, to determine their return to work options?

Workers Compensation is a team sport – everyone has to work for the same goal on the same team – unfortunately medical treatment often creates a disconnect between the goal of the employer – return to work; the goal of the employee – stay at home a little bit longer and the goal of the treating doctor – fill out volumes of paperwork so he or she can get paid and keep everyone happy in the process.

It is remarkable to review statistics that compare the length of time an employee is off work due to non-work–related injuries and the length of time they are off work due to a work-related injury. If you compare diagnosis, prognosis and treatment, the work-related disability statistics are significantly higher. If you remove the fact that the injury happened at work, most individuals would recover and resume their regular duties very quickly. Adding the workers’ compensation component creates a sudden extension of symptoms, treatment and a distinct delay in the amount of time required to return to an active lifestyle.

We all know that even when you are on a team, individuals play with their own self interest – this is no different in workers compensation. The significant difference between team sports and workers compensation – someone has to pay when treatment decisions delay the injured workers ability to access appropriate timely medical treatment or when the employer can not get appropriate information to get the injured worker back to work timely.

How do you get everyone to work on your return to work team?

The first step for employers – stop pretending that your goal is not getting the employee back to work as soon as possible – return to work is not a secret! Everyone who works for your company should understand your company’s return to work policy, the minute they start working for your organization. Keep the policy simple – “If you’re injured we will make every attempt to bring you back to work, until you are able to return to your pre-injury position.”

The second step – get the physicians who treat your employees to understand the same message. One of the realizations that most employers fail to acknowledge, they are not in the room when their employees seek medical treatment. Imagine yourself as the injured employee. What would you tell the doctor that would keep you off work? If you do not provide the treating doctor with adequate information to evaluate the employees ability to return to work – you’re giving the doctor a crystal ball, then complaining when he doesn’t see the same vision you do.

The third step – having a pre-determined injury management strategy that is consistent, cohesive and tactical. Everything starts on the ground floor; do your employees understand their role in the return to work process? Do you have a policy that you can follow every time an employee is injured? Or are you willing to cast blame on the treating doctor for your failure to plan for the inevitable injury that will occur at your company. Effective return to work programs start the day you hire your first employee not the day the file the Notice of Injury.

Forth step – understand your job site. If you don’t have clear job descriptions it is not the doctors’ fault that you don’t know what the employee did before the accident. Frankly, there is no excuse for not knowing the job demands and communicating that information to the treating physician. The job description dispels any myths or misinterpretations about the job requirements. A very specific job description is an essential part of the return to work process.

Every employee who sustains an injury with your company should take a copy of their pre-injury job description to the initial appointment. If the employee is referred to a specialist, a copy of the job description should be sent to that doctor. Provide an area on the Job Description Form that asks the doctor to confirm receipt and asks him or her to address the likelihood of the employee returning to this position immediately. If the employee can not return to the position immediately ask the treating physician to give you an estimated return date.  

Fifth Step – document and consistent follow through. Return to work should not be left up to your insurance carrier; it is the employers’ responsibility to make sure the employee returns to work or stays at work after the injury – not the adjuster, treating doctor or ancillary provider – it your job to make sure it happens. Use the restrictions given by treating physicians to as a tool to find the employee a job – focus on what the employee can do versus what the limitations are. Let’s not forget one other thing – human resources. Workers compensation does not mean employment rules go out the window your lack of HR polices is not the physicians fault. Follow through means that you get all the stakeholders on your return to work team to read the same playbook.

Finally, we have to stop accepting poor performance and rewarding the behavior with money. If you go into a department store and you get bad service, do you keep shopping there? Workers compensation is the only consumer based process that accepts mediocre service and rewards that type of service with a constant stream of business. What do I mean? For many years I worked as an adjuster and during those years I encountered numerous physicians who did not cooperate with my request for medical treatment status, refused to return my phone calls and admonish me to get the work status from the dictation attached to the bill. These physicians continued to stay on the approved provider list and year after year we sent them more patients or allowed the employee to select them, without doing anything to correct the disruptive relationship. Why did we do this? I guess we expected a different result – no we need to complain.

Employers have a responsibility to insure that their employees receive adequate timely medical treatment. Timely, is the key word – waiting weeks for treatment authorization can delay or eliminate the return to work options. Employers also have an expectation that treating physicians will make every attempt to work with the employer to safety bring the employee back to work.

Physicians we recognize that when you went to medical school they did not prepare you to handle the nuances of the workers compensation system, with a little effort we will educate you on the process, because we have to collectively work towards the same goal – getting the injured employees back to work successfully.

Clearly we have a lot of work to do to make this relationship productive.  Everyone has a vested interest in making sure injured employees receive exceptional medical treatment – that results in their rehabilitation from the injury and their speedy return to gainful productive employment. Treating physicians are the most important factor in the return to work process. The relationship that you develop with your authorized treating doctors will often determine if your employees return to work or remain off work. We have to make every effort to create a team that works towards the same goal.

Press Release: National Return to Work Week is an opportunity for everyone involved in the workers compensation and disability management process to demonstrate their commitment to helping injured, disabled or ill employees stay-at-work or return-to-work. This week highlights the importance of employee retention and employee ability. What can the employee do? Verses what they can not do – Disability does not mean no ability.

“The stakes have never been higher” said Margaret Spence, founder of National Return to Work Week. “Every day we hear disturbing information about layoffs and downsizing – when company’s layoff employees, what happens to employees who are injured on the job or have illness that prevent them from find new employment. What do we do with these individuals? Are they just forgotten?”

Annually, 4.1 million employees sustain occupational injury or illness – 1.2 million have lost work days directly related to their injury or illness. Employees who are off work for more than sixteen weeks seldom return to the workforce. Employees with permanent work related disabilities are more likely to become unemployable. The unemployment rate for people with disabilities is 14.0 percent according to the Office of Disability Employment Policy. These statistics prompted, Margaret Spence to submit National Return to Work Week to Chase’s Calendar of Events last April, to her surprise it was accepted and added to the 2009 Calendar.

From a Workers Compensation standpoint – when employees are injured in the workforce there is a monetary reward mindset, a feeling that money is better than a job.  This is the only system that rewards employees to stop working – even when they are capable of returning to some employment. “We allow people to join the ranks of the unemployed for the price of a pick up truck” says Spence.

While most employees who are injured immediately return to work and continue their regular job – there are far too many who we settle out of the system. These employees either move on to a new employer, sometimes repeating the cycle, or they move to the ranks of the unemployed. There is also another subset that move into the Social Security System and become permanently disabled – adding a new burden to an already over taxed system.

From a non-work related disability standpoint – once an employee becomes eligible for long term disability, there may be few options to help the employee return to gainful employment or to encourage the employer to explore job or task modifications that would allow the employee to return to work in some capacity.

“Are there other options? says Spence. “Why can’t we make an effort to implement return to work programs that retain injured or ill employees rather than discarding them from the workforce?” she added “even in a challenging economic environment return to work programs are vital. Employers are not conducting a thorough evaluation of the long-term cost of workers compensation and disability coverage in their termination or retention decisions. Many companies may emerge from the economic downturn is dire financial situations because of the decisions they are making about ill, injured or disabled employees today.”

National Return to Work Week 2009 will bring together employers, employees, treating physicians, vocational experts, insurance, legal professionals and disability providers from around the country to share best practices and exchange information to increase return to work opportunities for ill, injured and disabled employees. Together we can highlight the importance of Return to Work, Stay at Work or Transitional Duty Programs.

The NRTWW Motto – Disability does not mean no ability – injured, ill and disabled employees should not be discarded from the workforce. Nor should we create a system that rewards and allows them to discard themselves from the workforce.

For details and more information about National Return to Work Week, becoming a partner, or participating in a our virtual conference, please visit www.nationalreturntoworkweek.org

About National Return to Work Week – This week highlights the impact of not implementing proactive stay-at-work or return to work programs for ill, injured or disabled employees. It is a full week of national educational and best practices presentations aimed at bringing disability management to the forefront of the national employment retention discussion. National Return to Work will be celebrated annually during the second week of May. Visit our website: www.nationalreturntoworkweek.org for more information and to get involved.

About Margaret Spence, CWC, RMPE – Margaret is the author of From Workers Comp Claimant to Valued Employee – and the founder of National Return to Work Week. She is an injury management expert on a mission to help employers understand the importance of implementing proactive return to work or stay at work programs. Learn more about Margaret Spence, visit her website at www.margaretspence.com

Chase’s Calendar of Events – Brothers William D. Chase, a journalist and publisher from Michigan, and Harrison V. Chase, a university social scientist from Florida, founded Chase’s Calendar of Events in 1957. Chase’s Calendar of Events today is the most comprehensive and authoritative reference available on special events, holidays, federal and state observances, historic anniversaries and more. Each spring, thousands of new entries are submitted to join the more than 12,000 items that make up each year’s book. Each event listing (where applicable) contains contact and mailing information. There is no charge to be listed in Chase’s. Each new edition appears in late September preceding the year in question. Visit their website – www.chases.com

The key component that is often missing from a company’s Injury Management Program is a written Return-to-Work Policy. Many injured employees have been released by their treating doctors to return to work but their employers are reluctant to allow them back into the work environment. In these instances, the insurance carrier has to pay benefits to an employee who has approval to work but is sitting at home with nowhere to go. The major factor that contributes to this reluctance is a lack of a clear policy with specific procedures that can be applied immediately after an accident that will result a positive return-to-work experience.

Lost Work Days – is a billion dollar crisis hidden in the American workforce! The National Safety Council estimates that there are more than 80,000,000 lost work days due to occupational injuries or illness. The Bureau of Labor and Statistics indicated that, 1.2 million employees lost an average of seven days due to their injury or illness.

Recently, I met with a client who wanted to reduce the number of injuries at their job site. Instead of totally focusing on the number of injuries, I asked him to bring the company’s Occupational Safety and Health Administration – OSHA 300 log to the meeting so we could calculate their Return to Work Ratios—the number of lost days, the number of restricted days, the number of injuries, and the number of employees who never returned after an injury.

For calendar year 2006, this employer had 61 injuries that resulted in 1769 lost days, 255 restricted days. Yes, the frequency of injuries was huge, but it was staggering to look at the lost days—more than four years of productivity had been lost by employees who did not return to work after an accident.

We then randomly selected 5 of the employees who had been off work for more than 21 days. We reviewed the medical documentation associated with each worker to determine if these employees had a valid reason for being off work beyond the first seven days. The review showed that on average all 5 employees had been released by their treating physician to return to work—with limitations—by the second week after their injury. The review highlighted the fact that the employer had not entertained the idea of identifying a job that would accommodate these employees. These employees were allowed to remain off work until the physician released them to return to full-duty work.

I find that employers seldom attempt to quantify the impact of allowing an employee who could return to work to stay at home. If employers ask one simple question—What is the cost of leaving this employee at home?—they might not be so quick to say, “We have nothing available.”

What contributes to this off work crisis?

Well, there is a long list: insurance carriers, medical providers, insurance agents, ancillary insurance providers, injured employees, attorneys and employers.

Before we can address implementing a proactive return to work program we have to evaluate the system that created this crisis. The workers’ compensation system was intended to be self executing, easy to navigate and easy to administer – instead it is riddled with loopholes, litigation, layers of rules and regulations and it does not provide employers with adequate guidelines or resources to understand the importance of implementing return to work policies.

When companies purchase workers’ compensation insurance coverage they are given a large packet that tells them how to file a claim. Stacks of Notice of Injury Forms and great resources to call the claim in – generally there is limited or no information about implementing a return to work program. For most employers the first time they hear return to work is from the adjuster managing their claim files. Why does the return to work process start at the adjuster’s desk and not during the underwriting process?

If you evaluate workers’ compensation from a pure financial standpoint, there is no real incentive to educate employers so they effectively manage their injuries. If employers opt to keep the employee out of work, the insurance carrier pays the lost wages or indemnity benefits until the employee is released to full duty or the employee exhausts the state-mandated benefits or until they settle the claim. Indemnity payments impact the experience modification, which increases the workers’ compensation premiums, ultimately driving up the employers cost of doing business.

Everyone benefits in this system except the employer – unfortunately most employers still don’t grasp this concept.

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.

Learn More

Employers do not realize the amount of control that they have over the direct and indirect costs of workers’ compensation. The workers’ compensation system was built to benefit employers who implement injury prevention programs by allowing them to pay lower premiums. Most employers do not effectively control their costs, and some employers put their entire businesses at risk by not implementing programs that reduce or eliminate injuries and reduce lost work days.

Several years ago, when I first stared my consulting practice, I received a panicked phone call from an insurance agent who advised me that his client received a Notice of Cancellation and that he had sixty days to find them new coverage. Apparently, the company had numerous accidents, large settlements and they had made no corrections after several visits from the insurance company’s loss control representatives.

The agent advised me that he had already called several underwriters to find out if they would be interested in issuing a quote for this client. After he relayed the fact that the company’s paid-in premium amount was $280,000 and the claims paid-out total was $850,000 the underwriters broke into hysterical laughter. No one was interested in providing workers’ compensation coverage for this company. The client faced the real issue of closing his business because he could not secure coverage.

After meeting with this employer, I quickly realized that their injury management program was a cycle: injury, terminate, settle—the revolving door that had earned them their Notice of Cancellation.

Most companies focus their efforts on implementing safety procedures and they hope that their employees will follow directions and not have any injuries. In reality, employees are injured every day, so the key issue is how to eliminate or lower workplace injuries while simultaneously reducing the number of lost work days for injured employees. The solution is having a plan that addresses total injury management by reducing or eliminating injuries, reducing or eliminating lost work days and reducing or eliminating the readiness to litigate and settle workers’ compensation claims. It is a total package.

Reducing or eliminating lost work days is a critical piece of any injury management program. Employers are not in a win-win situation when it comes to workplace injuries. If you leave the employee at home, the insurance carrier pays them to be there. This, in turn, affects the amount of money you pay for premiums. If you refuse to bring the employee back to work you may be in violation of the Americans with Disabilities Act – ADA. If you bring the employee back to work in a nonproductive light-duty position that has them counting paperclips, you are paying state and federal taxes as well as benefits for an employee who is not contributing anything to your bottom line. The solution – implementing policies and procedures that facilitate injured employees returning to work as productive members of your team.

An effective injury management or return to work program starts before an injury happens, not on the day the employee files the First Report of Injury or Illness. When treating physicians issue light duty restrictions, employers must have a well defined plan in place to bring the employee back to work immediately. Reality, most employers do not have effective return to work policies or procedures.