Who really holds the power in WC claims?

The injured worker?  The judges/commissioners?  The insurance carriers?  The employer?

Depending on which chair you're sitting in, you'll likely have a different answer.  Most times, your answer is someone other than yourself.  Stop putting the power into someone else's hands!  Whether intentionally or not, if you believe you have little or no control over the outcome of a claim (or any situation, for that matter) you relinquish your share of the “power-pie” to someone else. Stop!

Think about the ubiquitous day-time attorney commercials.  They are based upon the assumption that the insurance companies possess all of the power.  What about the employer's perception that the injured worker has all of the power?  Don't these two positions seem at odds with each other? 

Some additional thoughts on perception...

What have you got to lose?

Focusing only on what you have to gain in a situation only provides you with half of the picture.  It can be easier to consider what you will gain than to put a number on what you're going to lose.  Maybe it’s the uncertainty of the future that allows us to be more optimistic.  Maybe it's a self fulfilling prophecy.  Whatever it is, it's more pleasant to think about what we'll gain by making a decision than to think about what we'll lose.

Before you decide that you can't afford to offer modified duty, ask yourself what you're really losing...the answers may surprise you.

A chance to utilize work as therapy and assist in the injured worker's recovery.
Think about how quickly you lose any progress you've made on a diet once the holidays roll around, or after skipping the gym for a few weeks.  We quickly lose any gains (or gain back any weight losses).  The same holds true for someone who is away from work for an extended period of time.   This can extend the period of time it takes for them to return to their pre-injury job because.  When an injured worker is detached from the workplace, they also lose some of their skills, recollection of processes, and even simple everyday tasks can take longer until they are up and running again.

Experienced employees who possess valuable knowledge.
There is a lot that can be learned through books and higher education, but how do you put a price on work experience and skills that can only be gained by working.  I may be able to recite the Pythagorean Theorem, but I probably couldn't apply it to building a foundation.  Experienced employees provide an opportunity to shorten the learning curve for younger employees.  Envision an inexperienced workforce and how long it would take them to complete a project.  Without your most knowledgeable employees, the entire team suffers.

An opportunity to demonstrate what happens when a worker is injured.
Actions speak louder than words.  Co-workers will look to the treatment of the injured worker and envision themselves in that injured worker's shoes.  When an employer treats an injured worker with respect and provides them with a modified duty opportunity, it sends several key messages to their other workers.  "If I get injured, I know my employer will be bringing me back to work."  Some variations of this response may include "WC claims don't equate to paid time off" and "If I get hurt, at least I know I'll have a job to come back to."

So, ask yourself, what do I stand to gain?  But don't forget to also consider what you've got to lose?

Now, try and continue your day without humming "Judy Blue Eyes" by Crosby, Stills and Nash...

He's making a list, he's checking it twice...

His modified duty task list...that is. 

RTW planning is like holiday shopping.  Some of us get it done well in advance, as early as July, while others are in line the day before hoping that the gift they intend to buy is still in stock. 

So, really, when should an employer focus on RTW planning? It should be done proactively, re-evaluated after an injury occurs, and throughout the life of a claim.

Before an injury occurs
Do not wait until an injury happens to create a modified duty program.  Some employers have never experienced an injury involving time away from work, but it will remain a possibility as long as they are in business and have employees.  If an employer waits until after a loss occurs to develop their RTW program, needless days of disability may result. 

Create a list of job duties for the positions in your organization.  Start with the positions that you believe to be the most challenging to modify.  Categorize the tasks into sedentary, light, medium, one-handed work, seated work, etc.  Review your loss histories to determine the most frequent types of injuries (i.e., low back strain, rotator cuff tears, and carpal tunnel syndrome).

Make sure your employees know that you are willing to offer modified duty work. As previously noted, one of the number one reasons physicians do not release an injured worker to modified duty is because the injured worker reports there is no modified duty available.

After an injury occurs
Ask the nurse case manager to provide projected restrictions to start the RTW planning process before the doctor even releases the injured worker.  Review the injured worker's job duties and begin classifying them into categories of work (i.e., sedentary, can be done with one arm, doesn't require lifting above waist level). 

Call me...maybe?

In today's world of Twitter, blogs, Facebook, text messaging, and Face Time, staying in contact should not be a problem.  So why do many injured workers seem to fall off of the face of the earth after they're out of work for a month or so? 

Employers may feel that the claim is being handled by their insurance carrier so they needn't do much more.  However, there is more to a claim than just paying bills and wage payments.  Remember, this is your employee.  More importantly, remember that they are a person with life events that don't stop simply because a work injury occurred. 

Out of sight, out of mind.
One of the most important things an employer can do is to remain in contact with their injured employees while they are totally disabled and when they return to work modified duty.  Put yourself in their shoes.  An injured worker is going through a time of uncertainty.  They aren't quite sure about what their treatment will entail, their financial situation has changed, and they may be wondering if they will ever be able to return to their pre-injury job.  A weekly phone call to check in with your injured employees will go a long way.  Once they return to modified duty, check in with them regularly to make sure all is going well. 

It's a two-way street.
When communicating, it is never about what you meant to say, it's what the other person heard.  Think about a recent argument you have had over a misunderstanding and you'll probably see that it was because someone interpreted what you said in a way that you did not intend.  Just be sure that you put yourself in their shoes every now and again.

Useful tool! Job Description Writer

So, you've probably gleaned from our blog that job descriptions are very important (See our prior posts on such 04/16/12 and 03/12/12).  We've given you the forms to create a job description, advice on why you should have them on file for every job, and recommendations for using them to develop modified duty work.

A detailed job description is one of the most effective tools in returning injured workers to modified duty, not only for employers, but for physicians, physical therapists and injured workers.  Without an exact destination in sight, you can easily get lost, or end up taking the long way to get there. 

Provided by careeronestop, the aforementioned useful tool helps you build job descriptions, step by step.  Give it a try!

The Numbers of RTW

Decision-makers want facts.  They want numbers.  While numbers cannot tell us everything, they can certainly provide valuable information.

Here are some numbers to help put the costs and figures associated with RTW and WC claims into perspective. 

1,191,100 the number of non-fatal occupational injuries/illnesses in the U.S. in 2010

50% the likelihood of an injured worker returning to work after 8 weeks away from work

34%  the percentage of Waste Management employees who felt that they could have returned to work sooner than their full duty release (but didn't since their doctors kept them off work)

15% the likelihood of RTW after 6 months away from work

3 the number of years a claim will impact an employer's experience modification factor (impacting the premium calculation)

I've never seen (or counted) a million of anything, but I do know what a 50% probability looks like.  Simply flip a coin (repeatedly).  Most people are familiar with the duration of three years.  Take the following numbers and ask yourself how they are impacting workers, insurance costs and the future of your business.

WC: Trick or treat?

Until recently I hadn't given much thought as to why children go "trick or treating" for Halloween, other than the obvious aim of collecting as much candy as possible.  Since information is only a few short clicks away, I did a bit of research.

It turns out it's all about extortion.  Give me a treat or I'll play a trick on you.  So, here we have homeowners offering up a sweet treat to avoid being punished by a gang of guised kids.  Where am I going with this?

RTW, of course.

Employers may be able to ward off negative reactions of injured workers (tricks) by providing their workers with some treats.  In this case, prompt reporting of claims, open and frequent communication, and accommodating modified duty restrictions. 

Do you fear that an employee may be dressing up like an injured worker?  Implement a RTW program to provide them with modified duty work. Let your employees know that you care about their recovery and by using work as therapy, they can recover even faster.  There's no trick to that, it's pure logic.

For those of you who celebrate it, have a safe, trick-free, and happy Halloween!

Helping injured employees recover faster while helping your community!

We are pleased to announce our strategic partnership with two not-for-profit placement coordination firms.  Eastern has partnered with Re-EmployAbility, Inc. and Transitional Work Solutions to provide yet another innovative solution to RTW challenges. 

We realize that even when employers are on board with offering modified duty to their injured employees, locating suitable work can sometimes be a challenge.  We see this new tool as a temporary solution in cases where employers can accommodate medium duty (for example), but are unable to provide work that is within the proscribed sedentary restrictions.  This is where our strategic partners come in.  They help locate suitable work with a local not-for-profit organization where the recovering employee can volunteer their time, while being compensated by their pre-injury employer.  The employee receives the psycho-social and physical benefits of volunteer work, while the community benefits as well.  The injured employee recuperates while making the transition back to work with their pre-injury employer. While it is not a 'fix-all' solution, we're very excited to add this resource to our collection of RTW tools.

Interested in learning more about our not-for-profit partners?  You can learn more about Re-EmployAbility, Inc.'s Transition2Work program and Transitional Work Solutions by visiting their websites, or ask your Eastern Claim Representative about it today! 

Stay tuned for more information regarding this exciting new tool!

Why are so many lost time days occurring when they aren't medically neccessary?

The adage "every little bit helps" is extremely relevant in today's economy.  It reminds me of one particular bank who marketed the savings concept of "rounding up" your debit card purchase to the next dollar.  Those cents would be deposited directly into your savings account.  Think about how many times you swipe your debit card and enter your PIN, and then consider how quickly those small deposits add up.  It's the same idea as putting your pocket change into a piggy bank.  Here's another example – do you remember the movie Office Space?  The plot surrounds a group of disgruntled workers who devise a plan to embezzle money from their employer by installing an accounting software virus to divert fractions of pennies (repeatedly, over time) into a bank account.

Think about potential savings in terms of hours and days lost due to medically unnecessary disability.  Every little bit helps. 

When you consider most lost time cases, the IW is typically out of work until they can be evaluated by a doctor.  Not a big deal, as this usually happens on the same day.  But, what if the occupational health clinic states the IW is totally disabled until the IW can be seen by a specialist? 

Return to Wellness Perspectives from a WC Underwriter

As part of our ongoing Return to Wellness Perspectives series, we're continuing to interview Eastern team members from various departments regarding to get their take on RTW and WC.  This week, Anne Gennusa draws upon nearly a decade of underwriting experience to provide us with input on the importance of RTW to an underwriter.  Anne works in Eastern's Franklin, Tennessee office and writes business for our Custom underwriting unit.

Q:  For those blog followers who aren’t in the insurance industry, briefly tell us what the primary responsibilities of an underwriter are?

A:  Underwriters review accounts submitted by agents. We work to understand the operations of every potential client and analyze the possible insurance risks. At that point, underwriters determine if we can take on the risk profitably and at what terms and conditions.  

Q:  Why is an Eastern Alliance underwriter concerned with RTW?

The 7 (RTW) Habits of Highly Effective Employers (part 2)

Last week we covered the first 3 habits of highly effective people, and highlighted how these "habits" can be utilized by Employers seeking to return their injured employees to wellness through modified duty.  This week's post will cover the remaining 4 habits (be proactive, begin with the end in mind, and put first things first) and their application to Return to Wellness.
So, without further ado...here are habits 4 through 7.

4.  Think win-win
It's self-explanatory.  You win.  I win.  We win.  It's not only about providing a solution that saves you, the employer, money on your WC insurance premiums.  It's about returning injured employees to a state of wellness after their injury.  It's about getting your business back on track after a loss.  You gain productivity while your injured worker gains the physical benefits of working.  You approach the challenge of RTW with integrity and with the end result in mind.  You do it because it's the right thing to do, not because you have to do it. 

5.  Seek first to understand, then to be understood

Have you ever had a conversation with someone who, while you were talking, was formulating their next thought, completely ignoring what you were saying?  Sometimes people do this without even thinking, particularly when the topic of discussion is something we feel very strongly about.  Before you say, "We don't have any modified duty work for Larry, he can only come back if he's 100%," listen to the options and solutions that your Eastern team can provide.  Understand the statutory provisions and the hurdles that must be overcome in any claim.  Learn what the true costs (direct and indirect) are associated with this particular claim.  Understand the potential repercussions of your decision before shutting down any options. 

It's a two-way street.  We need to listen and understand your circumstances before trying to apply a solution.  This is why we have more than one approach to resolving RTW challenges...we have a whole toolbox full!

6.  Synergize
Sounds like a pop-psychology buzz word, right?  Please refer to the old adage "two heads are better than one."  Synergy occurs when two or more people use their experience and skills to build off of each other's ideas to attain results greater than what they could've acheived alone.  This is where your Eastern team comes into play.  You have an entire team of people committed to helping you resolve your RTW issues.  Maybe the Risk Management Consultant was out for a visit last week and saw some RTW ideas that the Claim Representative didn't think of, or maybe you have some ideas but aren't quite sure if they would solve the RTW problem.  By using our combined knowledge, the possibilities are exponentially greater than leaving it to one person.

7.  Sharpen the saw
While Dr. Covey has a new book out, The 8th Habit, we're going to stop at seven.  By all means, you can keep going.  This last habit focuses on the physical, emotional/social, mental and spiritual realms of life.  How does this relate to RTW?  Well if you haven't noticed, we take a similar, holistic, approach to RTW.  Returning to wellness is about restoring physical and psychological wellness to injured employees.  Injured employees who are given modified work maintain their mental sharpness and skills required for their jobs, too.  The seventh habit is about self-renewal and keeping yourself fresh and ready to approach future challenges.  Keeping a fresh outlook will also produce a better outcome.  So, take some time to recharge your batteries and stare down your RTW challenges. 

Oh, and please be sure that all sharp saws have a proper guard in place.

While you may not embrace all of these habits, they are an excellent framework for how you approach RTW challenges. 

Please check out the author/publisher website for more information.

The 7 (RTW) Habits of Highly Effective Employers (part 1)

It's human nature for us to like it when things are broken down into an easy three step program or some other numerical collection of steps until success is reached!  For example, there's the "5 minute ab workout" or the "10 minute transformation plan" or, my personal favorite, the ubiquitous "lose 50 lbs in three days" crash diets displayed on the covers of virtually every magazine in the grocery store checkout line.

I'm guilty of it too.  We've created our 10 step guide to building your own RTW program.  In hindsight, maybe it could have been 11 steps, but as humans, we like nice round numbers.  It's easy to mock these "n-step" programs, but sometimes there's something to them.  One of the more popular "quantified characteristics" publications is Dr. Stephen R. Covey's The 7 Habits of Highly Effective People.  If you're unfamiliar, you can read a concise summary of the book on the publisher's website or the reviews on Amazon.  While Dr. Covey didn't intend to write a book about RTW programs, some important parallels can be drawn between his 7 habits of effective people, and qualities of effective RTW programs. 
.
This week we'll cover the first 3 habits...

What if the one who treats you is the one who is injured? Returning healthcare workers to wellness

Nurses are usually thought of as playing a role in helping injured or ill people get better, however from a workers' compensation standpoint, members of the nursing profession face unique challenges and opportunities when returning to work after a work-related injury.

Challenges

Physical
Often nurses (as well as CNAs, home health aides and other care staff) may be required to lift a great deal of weight, potentially deal with combative patients, and be on their feet for long periods of time.  The shifts they work may be long, and require them to walk great distances. From a WC perspective, the physical requirements of jobs in the healthcare field can present an obstacle for early return to work opportunities.

RTW Perspectives from a WC Claim Representative

She’s not just any ordinary claim representative.  We've interviewed Senior Claim Representative II, Mary Roudebush who has handled claims for the jurisdictions of Indiana, Illinois, Kentucky and Missouri.  As a claims professional, Mary has earned the Associate in Claims (AIC) designation as well as the Associate in Insurance Services (AIS) designation.  In her 12 years of being a claim representative, Mary has seen it all.  That's one of the many reasons we chose to interview her as part of our Return to Wellness Perspectives series.

Q:  What is the most creative solution to a RTW challenge that you, as a claim representative, have experienced?

  A:  A staffing agency's clients would not accommodate light duty.  We were able to partner the agency with local non-profit organizations to accommodate restricted activities.  Most of the injured workers who were provided this opportunity, to help people in their communities who are less fortunate than themselves, have reported feeling a sense of well-being.

I now know why Employers don't often have written RTW programs...

As the Return to Wellness Specialist, I am bound by professional, moral and ethical obligation to promote RTW and encourage employers to create their own RTW programs.  And then one day I took a walk in an Employer's shoes.  I sat down to create a general RTW program for employers to implement, or at the very least, use as a reference when creating their own.  This was the inspiration for the title of this post; as these were the first words out of my mouth when I sat down to write the program.

So you're probably not a Return to Wellness Specialist...

Creating a RTW program can be a daunting task, even if your job title is "Return to Wellness Specialist."  Let's face it, it probably doesn't fall on the top of your list of things to do...but it should be there somewhere!  I understand.  It took me quite a few hours to develop the general RTW program that is available as part of our ecovery library.  I vowed from that day forward that if you're an Eastern client, implementing a RTW program should not be difficult!  We want to help our clients easily implement a program that is efficient and effective.

Video: Injured Worker & Employer Interview

As you know, RTW can benefit injured workers and employers alike.  The psychological and physical benefits of proper RTW planning are highlighted in this interview of a childcare worker who sustained a serious shoulder injury and her employer's RTW Coordinator.  To view the interview, click here.

While viewing this video, take note of the positive attitudes of the employer and injured worker.  The structure of the employer's RTW program as well as their efforts to maintain contact with the injured worker undoubtedly had a positive impact on the outcome of this claim. 

Issues with RTW form long before a claim even occurs.  If you are interested in learning more about how an employer's actions can influence a claim, check out "Employer Do's and Don'ts" in the ecovery library under the For Employers section of our website.

EAIG neither controls nor is responsible for the content located on the sites provided above. EAIG does not guarantee the accuracy or applicability of the information provided on the site. Parties are advised that EAIG is providing the link for information purposes only, and that each party using the site is responsible for verifying the accuracy and applicability of any information contained therein.

We're pleased to announce our ecovery newsletter for Employers!

If you're an employer who is insured by Eastern, you now have access to another great RTW resource!  Written with employers in mind, we've developed a monthly ecovery newsletter that focuses on a variety of topics including:  RTW tools and resources, a recap of the month's blog postings, "how-to" section, helpful tips, news, and reminders. 

You can access the newsletter by visiting http://www.eains.com/work/employers/additional-resources.aspx and logging in.  Upon logging in, you will see a link to access the ecovery newsletter.

If you would like to receive the newsletter via email once a month, please send an email to ecovery@eains.com and include your name, your account/policy number and the email address to send the newsletter to.

We hope you find this resource beneficial to your organization!

Study: Physician panels reduce duration of lost time claims

Frequently, the first question after a work injury is reported is, where do I go for treatment?  Each state has its own provisions regarding physician panels, including whether they are permitted, what types of providers must be on the panel, and rules governing the change to a new provider.

The treating physician plays a very important role in the direction and duration of a WC claim.  Physicians influence the injured worker's return to work, permanency rating, frequency and cost of care, as well as their eligibility for WC benefits by giving an opinion as to whether the injury is work-related or not.

Neumark, Barth and Victor (2007) utilized data collected from 750 interviews with employers and injured workers in California, Massachusetts, Pennsylvania and Texas, as well as data from the WCRI database of over 16 million workers' compensation claims.  They focused on the impact of provider choice.  In this study, provider choice is defined as by the employer or employee.  More specifically, it looks at outcomes when an employee chose to treat with someone they've previously treated with, or when they choose a new provider.

So, how do you think that an employee's choice of a new provider or a provider that they have previously treated with impacts the following issues? Take a minute to jot down your answers.  I gave you a freebie with the title of this post.  The results may or may not surprise you.

To push oneself or self-protect oneself, that is the question...

...asked by many older workers.  Many of us have asked ourselves the same question, whether it's a choice between taking the stairs or the elevator, doing that extra set of reps at the gym, or getting out of bed after pulling a back muscle.  It is also likely that the decision you would have made at age 20 is not the same decision that you would make at age 45. 

What factors go into making these decisions?  More importantly, how can employers and insurers use their understanding of this decision making process to improve the outcomes of WC claims for their older employers?

Video: An introduction to ecovery

Learn how ecovery, an exclusive, value-added program from Eastern Alliance Insurance Group, helps return injured workers back to wellness and productivity by using work as a therapeutic tool.

Return to Wellness Perspectives: Juanita Snyder

Welcome to our first blog interview!  Since ecovery is a holistic, proactive approach to returning injured workers to wellness and productivity, the entire Eastern service team works together to support our Return to Wellness philosophy.  Over the next few weeks, we’ll take a look at ecovery from a variety of team perspectives.  First up, Juanita Snyder, Eastern’s Regional Supervisor of Risk Management for the Southeast Region, provides her thoughts on ecovery and why it is a Best Practice for every employer!

Q: From your risk management perspective and experience, what is the biggest challenge for an employer in offering modified duty?

A: The biggest challenges I see is not understanding what modified duty is, what modified duty can be and how to do implement modified duty.  The other issue that is significant to overcome is past experience.  For some reason, employers feel they cannot manage an injured employee.  Once they realize they still have the ability to manage the employee and hold them accountable to doing productive work, they are often more willing to move forward with a modified duty position.  

Permanent Restrictions - the ultimate challenge

Cartoon Source:  Safety.BLR.com

SCENARIO:  As an employer, you've been cooperating with providing modified duty within the injured employee's work restrictions.  Despite the challenges, you've made it work.  And then you receive notice that the injured employee's work restrictions are permanent.  What is a mason who cannot lift cinder blocks all day going to do?  What could a dietary aide worker do who cannot feed patients possibly do?  How about the delivery truck driver who has never done anything but deliver auto parts?

Consider the following ideas as options to resolving your most challenging RTW opportunities:

OSHA's $afety Pays Program

OSHA's website provides a fantastic tool to demonstrate the estimated costs of occupational injuries and illnesses and the estimated impact on an organization's profitability.  Check out the $afety Pays Program Calculator.


Here's how it works:
The user manually inputs some basic workers' compensation claims data including profit margin, type of injury/illness, and number of injuries.  The calculator has been programmed with data from the National Council on Compensation Insurance, Inc. (NCCI) which details the average cost of lost time workers' compensation claims from 2006-2008.

Results:
The calculator provides the user with estimated direct costs (actual costs associated with claims which may be insured under WC policy) and indirect costs (loss of production, overtime, hiring costs, etc. -- always paid by employer).  The calculator then bases the amount of sales the employer would have to make to cover the indirect and direct costs of the claims.

The user can use this for an individual claim, or they can input their loss runs data to demonstrate just how much their WC claims costs them above and beyond premium dollars.

Considerations:
The NCCI data is based on an average including a number of states.  Numbers are only an estimate, but can serve as an eye-opener to employers who assume that "this is what I have WC insurance for."  While partly true, every employer has more at stake than just a WC premium increase.

Being out of work is bad for your health!

For many of us Memorial Day signifies the start of the summer vacation season.  Each year many of us anxiously await the opportunity for a week or so off from work, vacationing or "stay-cationing."  We relish the time that we get to spend with friends and family, relaxing and trying not to think about work.  While it is said that vacation time is linked to many aspects of mental and physical well-being, too much of a good thing is never a good thing.

Did you know that being out of work may actually be bad for your health?  That's right, I said it.  Let me clarify -- I'm not stating that being out of work for a work related injury is equivalent to taking PTO or vacation, nor am I stating that we shouldn't be taking a well-deserved vacation...trust me. 

The evidence
In a literature review conducted by Waddell & Burton (2006) regarding the impact of unemployment, re-employment, and work for sick and disabled people demonstrates the following findings:

Job Offer Letters: Who, What, Where, When ,Why, and How?

Who is involved in the job offer letter process?

Your Eastern claim representative can provide you with a template and guidance for a job offer letter.  The physician is involved, as they provide the restrictions and may have already approved the job being offered. The injured worker receives a copy of the letter via regular and certified mail.  If there are attorneys involved, they should receive a copy of the letter.  Your insurance agent may also want a copy of the letter.  A company HR representative may be involved in writing the letter.  The injured worker's supervisor should also receive a copy of the letter.

What goes into a job offer letter?

The letter should introduce the date of the most current restrictions and the name of the doctor releasing the injured worker to modified duty.  A copy of the restrictions should be attached to the letter.  The name of the job being offered should be included if it has a different job title.  The duties of the job should be clearly detailed in the body of the letter.  Wages and number of hours, including start date and shift/hours to be worked should also be contained in the letter.  Please be sure to include the person who the IW should report to upon returning to work.  If the job is in a different department or location, notify the employee in the letter of this.  Finally, a response date should be set about 7 days out from the date of the letter.  This will ensure that there is enough time for the letter to reach the IW prior to their expected RTW date.

Disciplinary problems after RTW

The majority of injured employees who return to modified duty do so with motivation and a good attitude.  They don't cause problems, they work within their restrictions, and eventually transition to their pre-injury full duty jobs.  There are exceptions to every rule.  Typically these exceptions are those employees that may "ruin it" for the rest of the group, or those who may give their employers a bad taste in their mouths regarding modified duty work.  We've highlighted some of the more common concerns below, answering them with suggestions for handling difficult RTW challenges.

The first step in addressing these issues proactively is to send a written job offer letter that outlines the details of the position, the hours and wages to be paid, the start date and supervisor who the injured employee should report to.  You should also check our our post on 03/12/12 regarding job analysis forms.

Employee fails to show up for modified duty job assignment, or shows up late/leaves early.  Employee is disruptive.  Employee was found sleeping on the job.  Employee states they can't do the work assigned to them.

Eastern Alliance Insurance Group Introduces ecovery Program and Return to Wellness Specialist

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LANCASTER, Pa., May 21, 2012 /PRNewswire via COMTEX/ -- Eastern Alliance Insurance Group (EAIG), a subsidiary of Eastern Insurance Holdings, Inc., announced today the launch of ecovery, a new EAIG program that returns injured workers to wellness and productivity by using work as a therapeutic tool. EAIG is a domestic casualty insurance group specializing in workers' compensation insurance products and services.
In conjunction with the launch of the ecovery program, Sarah Tayts has been appointed as EAIG's Return to Wellness Specialist, responsible for developing ecovery tools, resources and technology initiatives to assist EAIG's agency partners and policyholders with implementing modified duty programs.
"Sarah brings a unique combination of experience in the workers' compensation industry and education in industrial and organizational psychology," said Michael Boguski, President and Chief Executive Officer of EIHI. "She has already become a tremendous asset to our organization through her role in launching our ecovery program."

EAIG has a strong philosophical commitment to modified duty. EAIG's ecovery program was developed after market research indicated a need in the workers' compensation marketplace for next generation approach to modified duty featuring comprehensive, practical information and proactive education. Instead of "Return to Work," EAIG uses the phrase 'Return to Wellness' to describe its unique, holistic approach.
"We selected the name 'ecovery' to link the Eastern brand with the goal of recovery for both the injured worker and the employer," said Suzanne Emmet, Senior Vice President of Claims and Corporate Compliance for EIHI. "The phrase 'Return to Wellness' captures the intrinsic, positive spirit of ecovery, and reflects the broader scope of the program, which promotes faster healing, increased productivity, improved employee retention and workplace culture, and reduced insurance costs."

The ecovery program features an extensive online library of turnkey and customizable materials targeting employers, injured workers, agents and medical providers. In her role as EAIG's Return to Wellness Specialist, Tayts uses webinars, newsletters, blogs and social media to communicate to EAIG agents and policyholders on a wide variety of topics related to workers' compensation and modified duty.
Prior to joining EAIG, Tayts served as a Workers' Compensation Claims Team Leader for Donegal Insurance Group. She graduated from Millersville University in Millersville, Pennsylvania with a Bachelor of Arts degree in Psychology and from the Chicago School of Professional Psychology with a Master of Arts degree in Industrial/Organizational Psychology with a concentration in Organizational Effectiveness. She has also earned the Associates in Claims designation.

Employers can visit www.eains.com/ecovery to learn more about the ecovery program and find an independent insurance agent representing EAIG. Founded in 1997, EAIG specializes in providing workers' compensation products and services to businesses and self-insured clients. EAIG is a member of the publicly-held Eastern Insurance Holdings, Inc. family of companies, with offices in Lancaster and Wexford, Pennsylvania, Charlotte, North Carolina, Carmel, Indiana, Franklin, Tennessee, and Richmond, Virginia. EAIG's Web address is http://www.eains.com/.

Jumping Hurdles in the RTW Race

It's that time of the year where schools everywhere are holding their annual "field days."  For those of you who are unfamiliar with field days, they are a competitive event held by schools where students compete against each other in various events and physical challenges. Where am I going with this...?  It got me thinking about overcoming obstacles, challenges and hurdles in the WC system.

There are specific hurdles that must be overcome prior to becoming entitled to a suspension of wage benefits, and each set of hurdles depends on the jurisdiction (state) in which an injured worker is receiving benefits.  Each state has its own WC laws and regulations that govern the duration, frequency, calculation and amount of workers' compensation benefits an injured employee is entitled to.  Eastern provides some fantastic resources regarding what ecovery looks like in your state on our website, so we won't go into the details in this forum.  In general, each state has its own set of hurdles to suspend or terminate benefits.  Your Eastern claim representative is well-versed in your state's requirements, so feel free to contact them with any particular questions.

Maximum Medical Improvement (MMI)
MMI is the point in recovery from an injury at which an injured employee will no longer benefit from any future medical treatment or intervention. Basically, they are as recovered as they will ever be.  In some states, employers/carriers may unilaterally stop benefits once MMI is attained.

Full Duty
Full duty is when a physician releases the injured worker to return to their pre-injury job without restrictions.

Small Businesses Yield Big Opportunities for RTW

Initially, one may think that developing modified duty jobs for small businesses is extremely challenging, if not impossible.  It's not as daunting as you may think.  We've seen many small businesses successfully implement modified duty jobs to reduce and help control their claims costs.

That is not to say that small businesses do not have their challenges.  Often times it is the owner who has to play multiple roles in the organization, wearing the Human Resources hat one hour and the Accounts Payable hat the next.  Typically, smaller companies have less experience with losses or work accidents.  Just like many other businesses, small business owners are faced with budget constraints, creating the perception that they cannot "afford" to offer modified duty work.  From a WC cost savings perspective, employers cannot "afford" to not offer modified duty work.  Pardon the double negative.

Research has shown that smaller companies have many unique attributes that they can leverage to achieve successful return to wellness outcomes (Andersen, Kines & Hasle, 2007):

· Employees are often responsible for multiple tasks that may be outside of their "normal" job description.  They pick up and fill in as needed to ensure that things get done.  Maybe there isn't a designated person to clean the break room, but one person naturally takes care of it.  These "extra" duties are often a trove for modified duty opportunities.  Make a list of these duties and start your modified duty tasks bank.

Developing Return-to-Work Programs in Unionized Companies

If you are an employer seeking to implement a RTW program, check out the following link to a 2009 article found in the July 2009 issue of Risk Management  entitled:  Developing Return-to-Work Programs in Unionized Companies.

The link to the above article provides insight for employers who strive to implement RTW programs, however have concerns about labor contract requirements.

The author, Rebecca A. Shafer,  provides 7 considerations for implementing a RTW program in a unionized company:

1.  Check for Management Rights - Know what your company's rights are in your collective bargaining agreement regarding your ability to promote, layoff, or transfer employees due to lack of work.

2.  Review Contractual Provisions - Certain provisions in your contract may also impair the ability for your to utilize a RTW program.  Consider these as negotiation points in future collective bargaining agreements.

An HVAC installer and a customer service representative both sprain their ankle...

(no this is not the start of a bad joke)...which one will return to modified duty sooner?

A.  The customer service representative

B.  The HVAC installer

C.  Neither because their employers only bring Injured Workers (IWs) back to work when they are "100%"

D.  Both have equal chances of returning to modified duty at the same time

The correct answer is D.  That is, if their employers have an effective modified duty program such as an ecovery Return to Wellness program.  Full duty releases may vary, but we're talking about modified duty.

Why don't the physical demands of the job make a difference?

You may think it is impossible for both of these IW's to return to modified duty at the same time based on what they are required to do in their occupations.  Wrong! The only true determining factors of when an IW will RTW are:

Biopsychosocial vs. Biomedical Models -- yes we're still talking about RTW

 Do you remember the movie Patch Adams, in which Robin Williams plays a doctor who treats ill children with humor and laughter?  Well, that's sort of what we're talking about.  His famous line in the movie was, "You treat a disease, you win, you lose. You treat a person, I guarantee you, you'll win, no matter what the outcome."

Up until the late 1970s, the biomedical model for the treatment of injuries and illnesses was the primary approach of many medical providers.   A change in the way medical providers approach the treatment of injury and illness has taken place since then, thanks to the biopsychosocial model.

Let's break it down:

Bio - meaning biological (study of life, functioning of living organisms)
Psycho - meaning psychological (thoughts, behaviors, emotions)
Social - relating to sociology (how we relate to society and groups)

vs.

Bio - study of life, functioning of living organisms
Medical - treatment of illness or injury

How does this relate to returning injured workers to work?

Top Reasons Physicians Keep Injured Workers Out of Work

In a 2000 survey of occupational health physicians, the folllowing list of reasons why physicians keep injured workers (IWs) out of work was provided:

• Physician does not want to force an unwilling patient back to work (most often cited reason)
• Solution:  If able to direct care, refer to objective physician
• Unequipped to determine the apporpriate restrictions on work activity
• Solution:  Ensure the IW is seen by the appropriate specialist for the injury (ex: orthopedic physician or podiatrist)
• Employer has a policy that prohibits light duty work
• Solution:  Employer should remove this policy and implement an ecovery Return to Wellness program
• No light duty available
• Solution:  Utlilze your Eastern Alliance Insurance service team to assist with developing modified duty and notify the treating physician that you offer light duty!
• Different versions of events (between employer and injured worker)
• Solution:  Have a Nurse Case Manager clarify that the RTW issue is what the IW can do as opposed to "he said" "she said" issues.
• There is too little information about what the pre-injury job to provide a release
• Solution:  Provide a pre-injury job analysis and/or a modified duty job analysis
• Conflicts of opinions between two physicians
• Solution:  The physician should take all medical records and objective medical evidence into consideration when determining an IW's ability to work.  Their opinion regarding work ability should be well-founded and objective!

Sources:

Article:  Christian, J. (2000) Reducing disability days:  healing more than the injury. Journal of Workers Compensation 9(30), 30-55.

Cited in:  Talmage, J. B., & Melhorn, J. M. (2005).  How to negotiate return to work in Talmage, J. B., & Melhorn, J. M. (Eds.),  A Physician's Guide to Return to Work (pp. 19-38). Chicago, IL:  American Medical Association

Upcoming Webinars for PA CE Credit

We are pleased to offer 2 FREE Webinars for CE credit

To register for the webinars, please review the flyer and complete the registration form.

April 18th:  Controlling Workers' Compensation Insurance Costs (1 CE credit)
10:00 a.m. - 11:00 a.m.
Presented by Matt Sinosky, Marketing Representative and Rob Reale, Director of Underwriting



April 19th:  Workers' Compensation and Return-to-Work: What, Why and How (1 CE credit)
10:00 a.m. - 11:00 a.m.
Presented by Sarah Tayts, Return to Work Specialist

We look forward to your participation!

Why offer RTW in a "Permanency" state?

A permanency state is a jurisdiction (state) that awards monetary compensation which reflects a functional loss of a particular body part (or parts).  Each state has a pre-determined method for calculating the amount (typically in weeks) of which a particular body part is valued.  In most instances, permanency evaluation is based on a percentage, or a number of degrees, of impairment.  Permanency is not valued until an injured worker is at maximum medical improvement (MMI). This is determined by a physician, who opines that the injured worker (IW) will no longer improve with additional medical intervention.

In permanency states, it is often assumed that the goal is to get the injured worker to MMI, get their rating, and get it resolved.  This is not always the best way to go.

The benefits of offering work as a therapeutic tool are illustrated by the following scenario:

IW sustains a shoulder injury requiring surgery.  MMI is projected 3-6 months from the surgery date.  The employer wants to hurry the claim along and get the IW's rating to close the claim.  The claim representative realizes that the IW's rating after 12 weeks post-op will be significantly impacted by the IW's inability to lift more than 25 lbs. overhead. The employer states they cannot permanently accommodate these restrictions. The claim representative has a discussion with the employer about bringing the IW back to work modified duty.  The IW returns to modified duty and receives the benefits of being physically active at work (within the prescribed restrictions).  As the IW continues to work, their restrictions become less stringent.

After working for another 3 months, the IW is deemed at MMI and receives their permanency rating, which is now based on the IW's ability to lift 50 lbs. overhead.  The increased lifting ability significantly reduces the amount of the IW's permanency rating.  This also reduces the Employer's claim costs, provides a productive employee, and increases morale around the workplace.  The IW improves physically, returns to earning their pre-injury wages, is motivated by their increased physical abilities and feels like a valued member of the workplace.

How is this not a win-win for everyone involved? 

Need to start a Return to Wellness program in your workplace?  Visit Eastern Alliance Insurance Group's website to download a RTW program or a guide to build your own.

Check out the newly revised ecovery website!

After months of planning and development, we are proud to unveil the newly updated ecovery Return to Wellness section of our website. 




Highlights of the site include:
- Audience specific site pages for Employers, Injured Workers, Agents and Medical Providers
- Expanded ecovery library (must be logged in to access)
- Jurisdictionally relevant materials for your location
- Pages of useful, relevant, and up-to-date information

If you are already an Eastern policy holder or agency partner, you will have immediate access to these valuable tools, simply by utilizing your login for the eains.com site.

We would love to hear your feedback on the site.  We are very pleased to offer these innovative resources to our partners and thank them for their commitment to Return to Wellness.

Attributes of Successful RTW Programs

Some have it, others don't, but everyone wants it.  No, I'm not talking about the latest gadget from Apple.  I'm talking about a successful RTW program. Many of the criteria that make a RTW program effective are what also make any other company initiative successful.

Awareness
If employees don't know about their company's RTW program, it will make implementation much more difficult when an injury occurs.  Conversely, if I am an employee of a company that has a well advertised RTW program, I know that if I sustain a work-related injury, my employer is going to work with me to bring me back to work. This serves two very important purposes.  It sends the message that being injured on the job does not = staying home.  It also sends reassurance that my job is more secure.

Support from the Top
If the head of the company does not take RTW seriously, neither will senior management.  If senior management doesn’t make it a priority, neither will middle management. This trickle-down effect can have the same impact if the CEO and management teams take RTW very seriously.  The culture of the company is dictated by the C-suite.  RTW programs should be viewed not as something we have to do, but something that the company believes is the right thing to do.

Accountability
A RTW program requires clearly defined roles and individuals to be held accountable.  Who is doing what is important in making sure that each task gets done and that nothing “falls between the cracks.”  This goes for injured workers, supervisors, HR and claim representatives.  If you don’t know your role and its importance, ask.

Preparedness
Unless you can predict the future, you will never know when a work injury will occur.  Having a list of modified duty tasks for each department will enable you to transition injured employees back to work faster.  If you are in a state the does not permit “make-work,” identify other jobs that exist in your company that are less physically demanding.  If you wait until a work injury happens to try and come up with modified duty, it can take weeks.  In the meantime, the injured worker is at home not receiving the physical benefits of RTW, while they could be at work doing some type of productive activity.  Save time, money and production by being prepared.

If you are just starting a RTW program, or looking to improve your current program, and would like further assistance or information, feel free to contact your Eastern Claim Representative, Risk Management Consultant, or Return to Work Specialist.  You can also visit Eastern Alliance Insurance Groups' website for additional resources and information.

Why following RTW restrictions is Imperative

A recent article in Business Insurance highlights the importance of adhering to and respecting the restrictions placed upon an injured worker by their treating physician. In an article entitled "Metro-North violated saftey act in forcing injuredy employee back to work:  OSHA", the employer allegedly ordered an injured worker to return to work at his regular job, despite an initial medical opinion that the injured worker was totally disabled.  Per the article, the OSHA report filed against the employer also alleges that the employer allegedly "forced" the treating provider (an on-site occupational health facility) to release the injured worker back to work regular duty. 

From a RTW perspective, this article demonstrates three very important lessons for employers (and insurance carriers) who are seeking to reduce insurance costs by offering modified duty to injured workers.

1.  At all times, all parties involved must adhere to and respect a medical provider's restrictions.  This means that the injured worker should follow these restrictions at work and at home.  Employers must also acknowlege the restrictions and not ask the injured worker to perform any duties outside of the prescribed limitations.  Restrictions are in place for a reason.  Although we may not always agree with them, they are typically in the interest of the injured worker's (and employer's) best interest.  If you are concerned with a total disability opinion rendered by a doctor, send them a copy of your proposed modified duty job and see if they will allow the injured worker to work modified duty.  In many cases, if doctors do not have a clear idea of what modified duty options are available, they cannot make an informed decision to release them to modified duty work.

2.  In most (if not all) jurisdictions, it is illegal for employers to retaliate against employees who file for workers' compensation benefits.  In this article, OSHA states that the employer's actions constituted retalitation, which resulted in fines and attorney fees close to $20,000.  Employers cannot force, or threaten employees, to get them the return to work.  If an injured worker fails to RTW after being offered a job, the employer should notify their claim representative who will advise of the appropriate avenues provided by their state's workers' compensation Act and/or regulations.

3.  This article does not mean that employers should avoid offering modified duty.  It does, however, illustrate the importance of employers acting in good faith when making modified duty job offers, obtaining the appropriate documentation, and discussing any concerns with their insurance carrier prior to acting upon emotion or initial instinct.  A well-documented, good faith job offer will serve employers much better.

The Importance of Job Analysis Forms

One of the often overlooked tools for facilitating return to wellness (RTW) is the Job Analysis (JA) form.  A JA is a list of the physical requirements and environmental conditions for a specific job, including the amount and frequency of types of activities the job requires.  There are two types of JAs to consider when effectively navigating RTW:  pre-injury JAs and modified duty JAs.  Some jurisdictions already have state forms used for these, many do not.  Your Eastern Claim Representative can provide you with copies of each form.

Why have pre-injury JAs on file for each job at your company?

When an injured worker (IW) goes to the doctor to discuss their restrictions, a pre-injury JA helps the doctor have a better understanding of the physical and environmental demands of the IW's job.  Maybe the IW is required to occasionally lift 50 lbs., but the majority of their job involves sedentary type work.  Instead of totally disabling the IW, the doctor could approve a portion of the job, thereby creating a modified duty opportunity for the IW and Employer.  It also gives the treating providers an idea of what level of physical ability the IW should work toward in physical therapy or work hardening.

What is the purpose of modified duty JAs?

When an IW or a Nurse Case Manager (NCM) asks the doctor if the IW can return to modified duty work, it helps to have a clear explanation of what activities the IW will be required to perform and the frequency/duration of these activities.  It also creates an understanding as to what the IW can and cannot do at work, as to prevent re-injury.  Supervisors or Line Managers who overseeing the IW's transition back to work will also benefit from this.

Modified duty JAs enable IWs to make an informed decision in response to a job offer.  They know what is expected of them if they return to modified duty.  In other words, they aren't just deciding whether they can return to modified duty based on a vaguely described position in the job offer letter.

Employers should keep current JAs on file for each position, and create a bank of modified duty JAs in the event of a lost time work injury.  These small steps will expedite the successful transition of returning the IW (and the Employer's business) to wellness.  Your Eastern Risk Management Consultants and Claims team can assist you with this investment.   These documents will also be available on our website in the coming weeks.

Welcome!

Welcome to the ecovery Return to Wellness blog!  The purpose of this blog is to provide up to date, relevant information to our ecovery partners, and to empower them to acheive success with their return to wellness endeavors.

Posts will be updated weekly, so sign up to receive notifcations of new postings.  If you have a particular topic you would like to learn more about regarding return to wellness, or ecovery in general, please email us at ecovery@eains.com.

We are glad that you stopped by and hope that you find this to be a useful tool and source of information.

Thank you and check back soon!