Return to Work (RTW) Interventions

According to OSHA, "Ergonomics is the science of fitting workplace conditions and job demands to the capabilities of the working population."  When the conditions and demands are properly matched with workforce, employers may benefit from increased productivity, reduction in injuries, and improved employee satisfaction. 

Workplace ergonomic interventions focus on workplace adaption, adaption in working hours, and adaptation of job tasks.¹

Workplace Adaptation
Workplace adaptation may involve altering or adjusting the work environment to best fit an employee's physical capabilities.  This may or may not involve changes in technical aids or equipment like desks, chairs, tools, keyboards, and workstation design.

Adaptation in Working Hours
Changing the number of hours or the pattern or hours that an employee works can include a "phased" return to work.  An example of a phased return to work is an employee who returns to work for 4 hours a day for two weeks, then advances to 6 hours per day for two weeks, and then 8 hours per day.  It could also include different shifts of work or changes in an employee's break schedule.

Adaptation of Job Tasks
Adapting an employee’s job tasks may focus on increasing variation in job tasks, such as job rotation, changing how much weight an employee is carrying.

In a multi-national study on the occurrence and effectiveness of ergonomic interventions on RTW for injured workers with low back pain (2004), researchers have found that workplace adaptation, change in working hours and job tasks were effective in improving RTW for injured workers who were given work restrictions for chronic low back pain.  The researchers focused on the median number of days off work, two years after the injured workers' first day of disability.  Employees who were offered workplace adaptation experienced 105 fewer days out of work than those with no intervention (p. 293).  Additionally, employees who were offered adapted working hours had 21 fewer days off work (p. 293).  

While we often think of ergonomics from an injury prevention standpoint, it is important that we apply the same principles when considering opportunities for modified duty and RTW after an injury.  For more information on job accommodations, check out JAN, the job accommodation network. 

1.        Anema, J. R., Cuelenaere, B., van der Beek, A. J., Knol, D. L., de Vet, H. C. W., & van Mechelen, W. (2004).  The effectiveness of ergonomic interventions on return-to-work after low back pain; a prospective two year cohort study in six countries on low back pain patients sicklisted for 3-4 months.  Occup Environ Med,61, 289-294.  doi:  10.1136/oem.2002.006460  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1740746/pdf/v061p00289.pdf

Ability to RTW: Is the glass half empty or half full and who is pouring the water?

 We've all heard the phrase "playing the victim" or have heard very different stories of two individuals with the same injury taking very different views on their ability to RTW.  Many employers tend to compare one injured employee to another, stating, "Well Tina had cervical fusion surgery and was back after three months, why is Sam still out after 8 months?"  Aside from physical limitations, we rarely consider the other elements that influence an injured worker's perception about their ability to RTW.

Why do some injured workers maintain a positive "can-do" attitude while others hold the "can't-do" attitude?

The way that we, as a society, as individuals, and as employers or coworkers react to those on disability may have something to do with it.  In a system where there is an increasing amount of fraud and stigma associated with being on workers' compensation or disability pay, individuals can react in one of two ways.  They can attempt to prove that they are not "one of them," that they are able to work with some assistance, able to carry on a fulfilling lifestyle and go to work every day with their pain.  On the other hand, if an injured worker doesn't believe that they are capable of performing work or their pre-injury activities, and they do not return to work they may feel that they have to justify their injury to others, or defend their inability to work -- not in an attempt to stay on disability benefits, but in an attempt at self-defense or self-preservation.  When you combine a strong social stigma with a perceived lack of control over a situation, it is human nature for an individual to look to examples of things they cannot do, or even catastrophize the situation. 

If you pay attention to earnings reports, there is a tendency to look to external factors, particularly those out of our perceived control, when the results are less than favorable.  However, when the results or outcome are desirable or exceed expectations, they are usually attributed to positive internal actions. 

Georgia WC Reform: RTW Amendments, among others signed by governor

The Georgia legislature has passed House Bill 154 which contains several workers' compensation amendments.  It was signed by the state's governor on May 6, 2013 and becomes effective July 1, 2013.

The major highlights as they relate to workers' compensation benefits include:

·         For non-catastrophic injuries, medical benefits are capped at 400 weeks. 

·         Mileage must be reimbursed to injured workers within 15 days of receipt of appropriate documentation

·         Trial RTW period:  If the injured worker attempts a trial RTW and attempts to work for the greater of 8 cumulative hours, or 1 schedule day and is unable to, the Employer must immediately reinstate the injured worker's benefits.  The employer then must demonstrate that the injured worker is not entitled to ongoing TTD benefits.

·         Trial RTW period:  If the injured worker attempts a trial RTW for less than 8 cumulative hours or 1 scheduled work day, or refuses to attempt to perform the job, the Employer may immediately suspend the injured worker's benefits.  The injured worker then has the burden of proof for continuing benefits.

·         Interest owed to injured workers for lump sum payments is decreased from 7% to 5%.

·         The maximum TPD rate is increased from $334 to $350 and capped at 350 weeks from the date of injury.  The maximum TTD rate is increased from $500 to $525 and capped at 400 weeks from the date of injury.

These amendments are beneficial for employers who are offering modified duty to their injured workers as they provide a period of time for which the injured worker must attempt modified duty.  The Georgia 240 process for offering work to an injured worker has not changed.  To read a copy of the bill, click here.

What does an injured worker have to do with the US economy?

In an article written by the American College of Occupational and Environmental Medicine (ACOEM) entitled "Healthy Workforce/Healthy Economy:  The Role of Health, Productivity, and Disability Management in Addressing the Nation's Health Care Crisis" the authors highlight the importance of a healthy workforce, and more importantly, the role that RTW can have on the economy, federal programs and the United States' workforce.

Between an aging workforce, increased chronic illnesses among all age groups and people relying on federal programs like Social Security and Medicaid at earlier ages, the future of federal entitlement programs are at a severe risk of bankruptcy.  These programs rely heavily upon the workforce that is contributing to the programs and maintaining what the authors refer to as "a critical balance of net contributors versus net dependents." 

What does an injured worker have to do with the US economy?

Well, if we're doing the right things such as getting the injured worker the appropriate medical treatment, assisting them in their recovery through modified duty work, and returning them to a state of wellness, we are moving in the right direction.  As a result of these efforts, we are returning an otherwise disabled person as a productive, wage-earning, tax-paying contributor to the economy.

Integrating preventative wellness programs, providing modified duty to utilize work as therapy, and assisting employees who are precluded from returning to their pre-injury jobs with alternative employment options or vocational counseling serves an incredibly important role in making sure that our economy continues to grow and that otherwise capable individuals are not becoming dependents.

This is a (very) big-picture approach, but it highlights the importance of modified duty in an injured worker's recovery, as well as the impact it has on society and the economy.

Struggling with WC costs? -- Focus on what you CAN control!

It's easy to focus on what you can't control.  Sometimes we do this to avoid accepting responsibility for our own situations or simply because we've never stepped back and taken an objective look at the situation.

As an employer there are many things that we can't control -- the weather, the laws the govern how you must conduct business, as well as the restrictions that a physician places on an injured worker as a result of a work related injury. 

So, let's take a look at what we can do to influence the outcome of a workers' compensation claim.

Offer modified duty
As written in our last post -- there's no condition so disabling that there's not someone in the US with that condition working full time today.  If you say that you don't have modified duty, you're likely not going to look for it.  Keep an open mind and use the resources available to help you identify modified duty options.

Modified duty wages
The rate at which you pay an injured worker for modified duty impacts the amount of any temporary partial disability benefits (TPD) the injured worker may be entitled to.  Obviously, the more they are paid for modified duty, the less they receive under their workers' compensation claim.  In most states, the TPD rates are 66 2/3 of the difference between the injured worker's pre-injury wages and their modified duty wages.

Safety and Injury Prevention
While injuries may occur that are out of your control, there is much that you can do to prevent injuries from occurring, and to reduce the severity of the injuries if they do occur.  Providing a safe work environment is one element of injury prevention, enforcing safety rules, providing appropriate personal protective equipment (PPE), and appropriate training for new hires are just a few suggestions.  Injuries can still occur if we're being safe drivers, but if the employee is wearing their seatbelt at the time of injury, this safety measure can greatly reduce the severity of the injury.  Also, having employees properly trained to administer first aid can help minor injuries from developing into something worse.

Organizational Culture that Supports Safety and RTW
While this may be the most challenging aspect of safety and RTW, creating buy-in at all levels of the organization is paramount in influencing your workers' compensation program before an injury even happens.  If employees know that they will be offered modified duty, they may be less likely to file a false injury claim.  It also communicates that employers care about the wellbeing of their most valuable assets -- their employees.

Appropriate Medical Treatment
Providing prompt and appropriate medical treatment can have a significant impact on the injured worker's recovery.  If your state allows direction of medical care, having a physician panel that complies with state regulations is an important step towards helping the injured worker recover and RTW.

Maintain Contact with the Injured Worker
Too often an employer files a claim and assumes that they should let the insurance carrier maintain all contact with the injured worker -- this is incorrect (unless of course the employee retains an attorney who prohibits contact with the injured worker).  One of the best ways to keep an injured worker focused on returning to wellness is to stay in contact with them.  Send a get well card, give them a call once a week or every other week to check in, invite them in for employee meetings, and keep them in the loop so that they feel connected with the workplace.

This turned into a lengthy post, but the length (and content) hopefully communicate just how much an employer can influence the outcome of their WC claims.