Why bother with a job offer letter?

Time consuming, tedious, and seemingly unnecessary -- job offer letters for a worker's compensation claim are probably not an employer's favorite task.  As a RTW person, they're at the top of my reading list.  I realize this is not the case for most.

Why should employers offer a modified or full duty job in writing?

• It clearly communicates the expectations surrounding the return to work.
• What are the restrictions the employer is referring to base their offer on?
• What are the job duties?  Rate of pay?  Hours?  Start date?
• Where and who should the injured worker report to?
• How will other benefits be handled (accrued time, etc.)?
• Who should the injured worker contact if they have questions?
• It documents the offer
• So many times the employers state that they offered work or tried to offer work and the injured worker didn't show up.
• That may work in some states, but in many, employers need some type of documentation to demonstrate the offer.
• The letter is important in showing the amount of earnings the injured employee may be refusing as well as details that help a judge determine if the employee was unjustifiably refusing the work or if it was justified.
• This directly relates to whether the employer is entitled to relief under the WC laws or if the injured worker is entitled to ongoing benefits.
• IF an employer finds themselves in litigation over a job offered, they may need to testify.  This may not happen for months.  Are you going to be able to recall a conversation you had with any great level of confidence during a hearing?  Having everything written out will help ensure that you know what you offered months prior.
• It is a best practice
• Once an employer incorporates this practice into they disability management policies, it becomes routine and simple.
• It may be dictated by various laws other than workers' compensation (which is what this particular post pertains to).

Before issuing a modified or full duty job offer it's a good practice for the employer to contact the injured worker and let them know that modified work (or full duty work) is available.  This will allow them to ask questions in advance of receiving the letter and communicate things with a level of transparency that will hopefully make the process go smoother.

When the duties of a job change or the wages change, it may also be a good idea to send an updated job offer to document the changes.

Although they are sometimes time-consuming, job offer letters can be based upon a template that will pay for its initial investment time and time again.  If you have questions about what needs to go into a job offer letter, please contact your claim representative as each state has its own set of requirements (or lack thereof).

You've hear of Undercover Boss, what about Undercover Injured Worker?

Most of us are probably familiar with the concept behind the show, "Undercover Boss."  The removed CEO or owner of a large corporation changes their identity and goes "undercover" working as a new hire that needs to learn the ropes of the less than glamorous positions in the company.  They're stripped of the everyday luxuries and live in a motel room, etc. to experience what their lowest paid employees make -- all in an attempt to understand what it's like to work for their company.  The show is usually very emotionally charged, and ends with the CEO having a revelation that changes need to be implemented, improvements need to be made, and sometimes they even shell out thousands of dollars to help an employee pay for overwhelming medical bills or something of the sort. 

I propose that employers go to work as an undercover injured worker.

Before you diminish the value of a safety measure, process improvement, or a return to work (RTW) program -- put on a pair of the proverbial "someone else's shoes" or work boots and see what the experience is like to have a workers' compensation claim.

I guarantee the experience will be eye-opening.  It will open your eyes first hand to a system that is riddled with challenges, confusion, complexity and bureaucracy -- a system that was designed to be a no-fault system to promptly provide benefits to any person injured on the job.  What does your accident investigation feel like?  How well does your injury reporting process work?  How does it treat injured workers?  How do our employees treat injured workers?  How does RTW impact the injured worker?

You'll learn how coworkers and supervisors treat you -- maybe with respect, maybe with pity, or maybe with anger or suspicion.  You'll learn what it's like to receive confusing forms in the mail, feel the uncertainty of whether or not you'll get a check in time to pay your bills, and realize that life does not stop simply because you got injured.  You may be limited in returning to work but your supervisor determines that there's "no light duty" in your company.  You'll feel the isolation and detachment within a few weeks of being out of work.  The attorney commercials will get old quickly; the resentment may build between you and your employer because you want to come back to work, but aren't being offered work.  You'll feel that people don't believe that you're really injured.  You might even see a weird car parked outside of your house that you soon discover is a surveillance company hired to see if you're doing anything outside of your restrictions. 

Now, in this scenario, you're not truly injured -- as an undercover injured worker, you're lucky that you don't have to go through the physical pain that results from an injury.  You won't have to worry about how you're going to button your own shirt, make yourself dinner, find a position to sleep comfortably because you can't use your arm due to a shoulder injury.  Fortunately, you won't have to feel how tiring and exhausting constant, throbbing pain can be and how it takes a toll on your ability to cope with stress.  Luckily, you also won't have to experience the strain that it puts on your relationship with your spouse and/or children now that you can't fulfill all of the requests you used to, cooking a meal, doing the laundry, driving the manual transmission car-- you won't have to experience what it's like to give up a good bit of independence nor will you realize how much that impacts your psychological state.

When someone has an injury, it doesn't stop at the physical level.  It impacts the injured worker from a financial, social, psychological and physical level.  It impacts their relationships, their confidence in their ability to provide for themselves or their family, and their place in this world.

Thankfully, I've never experienced a work injury.  How do I know to write about all of this stuff?  It's called empathy.  I took the time to imagine what it must be like to go through this process.  We all like to say that "if it were me in that position I'd do X, Y, and Z" but you never know until you've experienced it firsthand.

I encourage all employers who are in the position to make decisions related to the safety and well-being of their employees to take 10 minutes out of their day, at least once a month, to consider the "other side of the coin" when making a decision, not just the coins associated with implementing a change or offering modified duty.

Injured Workers asking to RTW likely as a Blue Moon?

When an injured worker is out of work for a period of time, more often than not the reason is inaccurately attributed to the injured worker's motives.  They don't want to work.  It's easier to sit at home and "collect a check."  They could work, but they're not.  Please realize this is not always the case.  I've seen injured workers' calls to discuss return to work go unanswered by their employers.  The injured worker may call to update them on the work abilities, or just touch base with them regarding their recovery.

So, what happens when an injured worker doesn't get a call back?

It's no mystery...think about how you would feel.  You'd probably ask yourself some or all of these questions:  Do I have a job to return to?  Did I do something wrong?  Don't they believe that my injury is real?  What happens if I lose my job?  How am I going to pay my bills?  Why won't they even talk to me?

Do these questions sound familiar?

They should, thanks to the ubiquitous attorney commercials.  They promise to answer these questions (along with getting the injured worker the money THEY deserve, which may or may not include atypical financial results). 

This post isn't about how to prevent injured workers from getting attorneys...it's about helping employers understand that returning an injured worker's call (particularly one who is asking to return to work) is extremely important.  Do it not to avoid attorney involvement, but because it's the right thing to do.  Even if you don't have work available, having a discussion with the injured worker about their restrictions and what they think they can do could result in you identifying some options. 

Employers have reputations to maintain that directly impacts the quality and quantity of people who want to work for them.  I'm sure you could name a few places in town that don't treat their employees the greatest and you may have even silently sworn to never work there. 

When someone wants to return to work, the very least you can do is return the call.  You never know how much it may pay off in the end.

I'd be remiss if somehow I didn't tie this post to the New Year.  Make 2015 a year to implement the Golden Rule -- at the very least, when you have an injured worker who wants to return -- after all, lore has it that this only happens once in a blue moon.  (If you read this, you'll learn that blue moons, too, aren't all that rare).

Discharge planning begins upon admission

A very wise nurse once told me they had a saying in the hospital she worked at:  "Discharge planning begins upon admission."  The goal of any admission at a hospital is to discharge the patient, hopefully in a better, healthier state than they were when they arrived.

This same adage applies to workers' compensation claims.  The goal of any claim representative should be to ensure the injured worker receives appropriate medical treatment that will help them recovery, return to work, and hopefully a state of wellness.  This doesn't just miraculously happen!  A well-thought plan is needed to coordinate a successful return to work, but particularly if we're aiming to help the injured worker get better.

What can you do to help plan for success?

Start having the return to work conversation as soon as possible.  Employers should proclaim it to be their goal to return the injured worker to work whenever a claim is reported involving lost time.  That means having return to work discussion in the absence of a modified duty release.  You might be asking, how can we bring someone back to work if they don't have a work note allowing them to come back?  Generally we have an idea as to why type of restrictions correspond with the type and severity of injury.  For example, a rotator cuff strain/sprain may result in no overhead lifting, one handed restrictions, or lifting no greater than 2 lbs. over counter level.  How can you plan for RTW when there is such a variance in possible restrictions?  Plan for the worst, hope for the best.  Anticipate the most restrictive work note and go from there.  If they can lift 2 lbs. with their injured arm and you planned for, and found, one-handed work, then you have work available that fits restrictions!

When you have an injured worker with a note that totally disables them from working, it's never too early to try to identify a modified duty opportunity.  Sending this modified duty option to the treating physician may facilitate an earlier release to return to work, or it may not, but it's worth an attempt.

Communicate your intentions to the injured worker as well.  They are probably very concerned about their job, their income, and how they are going to pay their bills if they are taken out of work.  Letting an injured worker know, at the appropriate time, that you will try to find work available will be one of the best things you can do to reassure them that you value them as an employee.  Just be sure to do it in a sensitive manner at an appropriate time.

The Importance of an Ordinary Day at Work

In a recent meeting, I was encouraged, as I'm sure many others were, by a very simple, poignant observation.

We often wish away the ordinary days -- we pine to be on vacation, experiencing something exciting or adventurous, but when something happens to us or one of our loved ones, someone gets sick or injured, the one thing that we all long for are the ordinary days. We'd give nearly anything to have an ordinary day.

I've always believed that every day is a gift, and your health is a gift -- both of which we shouldn't take for granted.  It's unrealistic to spend every minute of every day focusing on how lucky we are to be alive and well, but as soon as something impedes our health or normal lives, we realize how fortunate we were.

I believe this is the case for most of us.  I also believe that is the case for most injured workers and employers of injured workers -- we all want the same thing.  We want to get back to the way things were.  We want things to be "normal" again.  Yesterday (Tuesday after Labor Day) was probably tough for most people -- getting back to work after a long weekend can be challenging.  Many people probably thought, why can't I win the lottery and get to stay home forever?! 

Work plays such an important role in our lives -- how we define ourselves, it is from what we derive our value, it shows what we can contribute to the world.  Think about the last time you met someone new.  After introducing yourself, the next thing you probably moved on to discuss was where you worked or what you did for a living.

Our job as workers' compensation professionals is to do what we can to restore injured workers to wellness.  To provide the appropriate medical treatment, guidance, and assistance to help achieve that sense of normalcy.  While it is true that not everyone will return to that old "normal," getting back to a state of wellness and productivity is our aim. 

We are creatures of habit.  We crave consistency.  We like routine and predictability.  Any disruption can cause us a great deal of strain and stress.  Think about the last unanticipated road construction detour you were faced with on your way to an appointment? 

Think about your morning routine.  You wake up, maybe you stop at the usual place to grab your coffee on your way to work, exchange some daily banter with the cashier, and continue on your way to work.  The average person spends 90,000 hours at work during their lifetime.  That's over 10 years, 24 hours per day.

Sure we all have our days we wish we'd win the lottery -- some more than others.  Those things that we'd rather be doing than working are probably also the same reasons we go to work.  There are probably aspects of everyone's job that would rather not have to do-- but that's why it's called work, right? 

When the ability to participate in work every day is taken from someone due to an injury or illness I'm confident in saying that what that person would like most is an ordinary day at work.  Employers have an opportunity to give the gift of ordinary days. 

You've heard of early RTW, but what about late RTW?

So much of what we hear about return to work focuses on early return to work. The majority of injured workers receive medical care, return to modified duty and then eventually their pre-injury jobs. But there's also a group of injured workers who receive medical care, and are given restrictions that are ultimately deemed permanent.  The injuries are typically more severe, or require more than conservative treatment.  Eventually, disability persists so long that we lose focus on return to work as a treatment goal. As Sullivan and Hyman (p. 1, 2014) put it,

     "Evidence-based clinical guidelines emphasize early return-to-work as a critical          
     treatment objective in the management of recent onset pain conditions.  However, 
     something changes when a pain condition becomes chronic.  For chronic pain        
     conditions, return-to-work is rarely put forward as a primary treatment objective.  
     Consequently, successful return to work is rarely an outcome in the treatment of chronic 
     pain conditions."

In their editorial, the authors emphasize the importance of remaining active in ALL phases of recovery, even after an individual's pain becomes "chronic."  If all the treatment that is provided (primarily prescription pain medications) does nothing to improve the individual's level of function, then they aren't really working, are they?  One can argue that pain medication alleviates the individual's pain, but if that doesn't result in an increase in function, is it worth it?  Why aren't we focusing on function?

There's also an assumption that individuals with chronic pain cannot work.  The authors cite a study in which 40% of chronic pain patients who underwent a return-to-work intervention program were successful in their return to work.  If you don't think it is an option, you will never look for information to prove yourself wrong.  Employers who adamantly proclaim that they don't have modified duty will not then go look for modified duty options.  Injured workers who believe that they will never return to work will most likely not look for opportunities to go back to work. 

"Beliefs are the roadmaps of behavior" (p. 2, 2014).  We must keep return to work on the table.  When I say "we," I mean insurance professionals, case managers, medical providers, employers, and injured workers.  The return to work may not be a pre-injury position, but there is work out there for those who want it.  Take workers' compensation, or any other type of benefits, out of the equation, and focus on the individual.  This is their life, for the rest of their life, not just until their benefits expire or their claims settle.  What are "we" doing to provide the best outcome and what are we doing to return them to wellness via return to work?  Can we really expect an injured worker to stay motivated if their physician has thrown in the RTW towel?

To read the editorial, click here.

References:
Sullivan, M. J. L., Hyman, M. H. (2014).  Return to work as a treatment objective for patients with chronic pain?  Journal of Pain Relief, 3(1).  doi:  10.4172/2167-0846.1000130 







Industrial athletes: Dip your toe in the pool before diving in to RTW

In his blog post, Dr. James Butler of Orthopedic Associates of Evansville, Indiana, writes: 

“30 years ago, as a young physician I was taught, as many of our parents were, that if you have an injury you must have complete rest.  We have discovered over the years that that is a fallacy and leads to other problems.  I often joke with patients that as a young doc we used to hospitalize patients with back pain and put them in bed for a week or two at a time, and many of them are still there.  The sports medicine specialists were in the forefront of changing that idea.  They began treating their athletes by resting only the injured part while continuing to actively use the rest of the body.  They found that people healed quicker, and were back in the game sooner.  Well, we have finally realized that workers are just a different type of athlete, an “Industrial Athlete” and they also need to be kept with their team while healing so they can get back up to bat again sooner.” 

Work must be a component of any injured worker’s recovery. 

Maybe you are an employer who wants a healthy, productive employee back to work or you're the spouse of an injured worker who wants things at home to return to the way things used to be. Maybe you’re a physician who wants to help your patient recover and achieve the best possible outcome.  Graded work exposure may help you attain these goals by making work a part of the recovery process.

What is graded work exposure?

It’s a predetermined plan agreed upon by an injured worker’s occupational therapist and the injured worker’s supervisor that returns injured workers to job duties in which the hours and duties are gradually increased until the injured worker can return to their pre-injury duties. 

An example is when an injured worker returns to work four hours per day, five days per week for two weeks.  After two weeks, the injured worker’s hours are increased to 6 hours per day for two weeks, and then eventually eight hours per day.  Graded work exposure may involve the injured worker only performing certain aspects of their job that are more physically challenging for just a portion of their day.  Graded work exposure can be particularly helpful for injured workers who question their ability to return to their pre-injury job, or are fearful of getting injured again.  Making progress toward goals through graded work exposure can help both employers and injured workers restore their confidence in the injured worker’s physical abilities. 

In a 2000 study conducted on therapeutic return to work (TRTW), researchers found that work rehabilitation programs that linked graded work exposure with traditional physical therapy for chronic low back pain resulted in 93% of participants working at two-year follow up.  More telling of the success of this program is that none of the participants reported back pain recurrence from working during the period of the study (p. 59, 2000). Of those participants who underwent traditional functional restorative therapy, 73% of participants were working at two-year follow up.  Participants in the TRTW group also indicated lower average disability scores, lower average pain intensity scores, and lower scores on fear avoidance beliefs measures (p. 60, 2000).

Speaking of industrial athletes…

Do you remember the first time you jumped off the diving board?  Your thoughts preceding that jump probably focused on every time you nearly drowned before that.  You’re teetering at the edge of the fiberglass board hoping that you won’t sink like a rock, hoping that someone will come to your aid if you suddenly swallow half the contents of the pool, and hoping that it will all be worth it.  The people on the side of the pool are telling you to just do it already, to trust them -- they’ve done it a hundred times before and it will be great.  Something tells you to linger on the board just a little longer, inch a little closer to the edge, and that you’ll decide when you’re ready.

Returning injured workers to modified duty requires trust.  Employers and injured workers are concerned about re-injury.  There may be doubts in either party’s minds about whether or not the return to work will, well, work.  These feelings of anxiety, uncertainty and doubt are also experienced by employers and injured workers who are contemplating a return to work after a work injury.  No matter how many times a doctor tells an injured worker or an employer they can do x, y and z, they haven’t seen it done yet and they aren’t really sure of the outcome. Without an attempt no one will ever know. 

When planning the return of an injured worker, focus on setting it up for success and consider graded work exposure as an option. 

References:

Durand, M. J., & Loisel, P. (2001). Therapeutic return to work:  Rehabilitation in the workplace. Work, (17), 57-63.

Complimentary Webinar: Using Not-for-Profit Organizations as a RTW option

Are you or your clients interested in learning about a new and innovative RTW solution?  Sign up for a complimentary webinar being offered by Eastern Alliance Insurance Group's Return to Wellness Specialist, Sarah Tayts. 

WHO:     This presentation is open to all EAIG agency partners and EAIG clients.  Please feel free to forward this post via email to anyone you believe would benefit from attending this presentation.  You can do this by clicking on the envelope icon located at the bottom of this post, or simply copy/paste the URL to this post into a separate email.


WHAT:     The presentation will highlight how to strategically use NFPs to solve even your most challenging RTW situations, as well as address the most common questions regarding the process. 

WHEN:     Wednesday, December 4, 2013 @ 10 am EST

HOW:     Register for the webinar by clicking here and completing a basic registration form.  For more information on how to get the most out of the GoTo Webinar session, you can click here to view a brief PowerPoint tutorial.               

In the past, this presentation has been very well attended, so be sure to register now to reserve your spot!

Modified duty job offer letters communicate more than just RTW details

Return to work date, restrictions, hours, wages…

These are important elements of a modified duty job offer letter.  A modified duty job offer represents much more than a letter – it sends long lasting messages about an employer’s relationship with their employees, particularly in a time of stress or uncertainty.

If I get hurt, my employer will work with me to bring me back to work.

When employers offer modified duty, it demonstrates that they are willing to make some accommodations for someone who wants to work.  Involving the injured worker in the return to work (RTW) conversation is an important step – after all, they are the ones who are doing the work.  Listen to the injured worker’s complaints.  Consider altering their assignments or scaling back their hours if indicated.  Not every RTW will be a success the first time around.  Instead of throwing in the towel, talk to the claim representative, nurse case manager, and ask them to address this with the treating physician. 

My employer offers modified duty, so getting injured at work does not equate to sitting at home.

This is an incredibly important message.  Employees learn from what they see happen with other injured workers.  While the overwhelming majority of claims are legitimate, there are a sometimes people who wish to file an illegitimate claim or “build” their legitimate claim.  Having a strong RTW program that consistently gets injured workers back to work can help eliminate the motivation for filing illegitimate claims or exaggeration of existing claims.  Modified duty job offers shorten the time and injured worker will be out of work.

What happens after RTW?

If you’ve been following this blog, you’ll realize many of our posts focus on the process of identifying modified duty, the benefits of RTW, and developing RTW programs.  Getting someone back to work is important, but it doesn’t stop at the RTW date.  It’s a phase of the return to wellness process that must be managed.

What happens after an injured worker returns to work?
I’m sure one could find bits and pieces of answers to this question in books, and there are plenty of scholarly journal articles on this topic, trust me.  Personal experience will teach employers the most in this regard.  Not the answer you were looking for?  What follows is an attempt to summarize the most frequently learned lessons.

Communicate the return to work date to your claim representative immediately!
There simply aren’t enough font embellishments with which one can emphasize this point!  Prompt communication of the injured worker’s return to work will prevent plenty a problem:  over payments, taking credits against future benefits, getting the appropriate forms filed with the state’s workers’ compensation authority…  It’s also a great feeling for the claim representative to know that we’re returning someone to modified duty.  So it not for any other reason, notify your claim representative to provide them with the good news.

Medical treatment
Just because an injured worker returns to modified duty, doesn’t mean that they are no longer entitled to medical benefits.  This is a concern of injured workers when they contemplate RTW.  Returning to modified duty is part of an injured worker’s recovery.  As one person put it, you don’t get better and go back to work, you go back to work to get better.  It is common for an injured worker to continue physical therapy or use of prescription medications after RTW.

Employers should encourage injured workers to schedule their physical therapy and doctor’s appointments outside of the work day.  Check with your claim representative, as it depends on the state and the type of appointment (IME, etc.).  It may also be a good idea to locate a physical therapy location that is on the injured worker’s way home.

Wages
What happens if the injured worker receives less in wages than they previously earned?  As with all answers to WC claim questions…it depends.  In most states, there are temporary partial disability benefits.  These are paid as a percentage of the difference, or gap, in post-injury wages compared to pre-injury wages (calculated as the average weekly wage – AWW).  These percentages range from 50% to 90%. 

Employers process their payroll as usual and if the injured worker’s weekly earnings are less than the pre-injury average weekly wage, they should submit the payroll records to their claim representative who will review and process any TPD benefits due to the injured worker.  So, the injured worker will receive a paycheck for hours worked, and a TPD check for a percentage of the gap. 

What if the injured worker is disruptive or violates company policies?

5 Tips for identifying modified duty RTW options

1.  Review job descriptions of other positions. 
If you don't have job descriptions (tisk! tisk!) then think about the less physically demanding elements of each position within your company.  Make a list of these tasks.  Ask other managers or supervisors if they have any "extra" work that needs to be done.  Most people have a name for this type of list...we'll call it the never-ending, ever-expanding to-do list.  Sure, re-organizing the toolboxes on the trucks would help, but who has the time?  Answer:  Your injured employee!  Yes, having well-stocked first aid kits in every vehicle would be a nicety, but who has the time?  Answer:  Your injured employee!  Bonus tip:  Keep this list in the same place you keep your WC insurance information -- there's no need to reinvent the wheel the next time you experience a lost time claim.

2.  Ask the injured worker
It is astonishing how many employers don't involve the injured worker in the RTW conversation.  I bet there are at least 10 things that you do, weekly, if not daily, that fall into the "other duties as assigned" category of your job description.  Most likely, your boss doesn't even realize they're being done, but would sure notice if they weren't.  The point is, the injured worker knows their job better than anyone else and if asked, they could probably identify at least a handful of things they could do.  Offer a bit of cross-training and voila!  That brings us to our next tip...

3.  Offer a few hours of cross-training
The payoff for this tip can be extensive.  There's nothing more frustrating than having one of your team members taken out of work when you need them.  Consider any type of cross-training opportunities.  Could they learn to answer the phones?  Make follow up customer satisfaction calls?  Could the injured worker learn to write estimates or coordinate deliveries?  Even if it takes 10 hours to train someone, it could yield weeks of valuable, meaningful, productive modified duty.  This could also free up some of your other team members to get to more pressing issues.

4.  Add value to your organization with RTW
What if you could use a challenging situation (such as a WC claim) to increase sales or customer satisfaction?  An example of this involves an appliance retailer.  The injured worker couldn't deliver appliances, but knew how to operate them.  Today's appliances involve many technological advances, buttons, self-cleaning, filters, etc.  I, up until a few months ago, didn't know my microwave had a "potato" button.  Apparently my mother-in-law didn't either.  I was so excited to discover this feature, but wished that someone had shown me sooner!  So, why not have the injured worker do a new customer orientation, demonstrating all of the functions of the appliance, best practices for maintaining and cleaning that tricky flat top stove... You get my point.  I'm pretty sure the big box stores aren't doing something like that...

5.  Use a work injury as an opportunity to improve safety
 Consider having an injured worker review safety materials, watch safety videos for your industry, or even conduct a "tool box talk" that will help prevent future injuries.  When the message is coming from an injured worker, it carries greater weight.  This shouldn't be punitive, but it should be viewed as an opportunity to increase safety culture, to learn from a negative event, and to accommodate restrictions.

What employers need to know about DE House Bill 175

On June 27, 2013, DE Governor Jack Markell signed House Bill 175 into law, amending Titles 18 and 19 of the DE code.

Employers and insurance carriers have an increased responsibility to ensure they are communicating available modified duties to the injured worker's physician.  While the Employer's Report of Available Modified duty is not a new form, the recent changes now provide an incentive for employers to make sure these forms are being sent for each claim where temporary total disability (TTD) benefits are being paid under an Agreement As To Compensation-- an employer's eligibility for a Safety Credit requires that the they are compliant with these "back to work" procedures.  According to the bill, as of September 1, 2013, safety inspections will now include a review of the employer's compliance with these procedures, dating back to July 1, 2013.  Please review 2379(4) regarding the workplace safety credit changes.

According to 2322E.(d) of the Delaware Code, employers should provide their injured workers' physician with a completed Employer's Modified Duty Availability Report within 14 days in addition to their insurance carrier.  So, send a completed copy of this form to the doctor and to your claim representative, and do so timely. 

Having a modified duty job bank may assist employers in identifying modified duty options for their injured workers.  Utilizing our modified duty task lists forms (found at eains.com/ecovery under the ecovery Library) may be a good first step in coming up with modified duty ideas. 

Place a completed copy of the Employer's Modified Duty Availability Report form in the injured worker's WC claim file for your safety credit inspection.  Consider dating when it was sent and to whom, or include a copy of a cover letter if you use one.  According to the code, the workplace safety credit inspections will review up to three years' worth of history. 

Nothing in this post is to be construed as legal advice or risk management advice.  If you have specific questions regarding these changes, please contact your counsel or the Office of Workers' Compensation, or the Insurance Department's Consumer Services agency at 302-674-7300.

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.

RTW and Seasonal Workers: Bring them back or risk paying them all year long

It's that time of the year again...your neighbor is fertilizing and seeding their lawn to ensure that their lawn invokes feelings of grass envy throughout your neighborhood, you're waking up to the sound of birds chirping in the trees as opposed to snow plows scraping the streets, isn't Spring a wonderful time of the year?

Soon we will start to see the landscaping trucks on the streets at the crack of dawn and workers spreading shovelfuls of recycled and dyed pieces of wooden pallets, known to the consumer as mulch.  What did you think I was going to say?  College students will be returning home to look for summertime employment, hoping to secure that sought-after summertime gig that pays more than minimum wage in an attempt to offset the rising prices of bee---I mean...books.  Everywhere you look, people are starting their spring projects, building patios, planting gardens and getting those home repairs they've put off until warmer weather.

But, if you're a seasonal employer you're probably not thinking of gladiolas and grilling, you're thinking about starting up business again and getting back to work! 

Why worry about WC at a time like this?  There are several reasons.

The Dollars and Sense of RTW Programs

According to one study on worker absenteeism, the costs of a worker who is out of work for 2 weeks costs their employer 133% of his/her wages.  So, if an employee earns $500 per week, it will cost the employer $665 per week, or an extra $330 over a two week period. 

Various studies have been conducted on the cost-benefit and ROI of RTW programs.  In an article from the American Society of Safety Engineers, RTW programs can return $8 to $10 dollars for every $1 invested in a RTW program. 

In the same article, the authors cite another study which found that the direct costs associated with a WC claim (wage benefit payments, medical payments, and legal expenses) make up only 28% of the costs associated with WC claims.  The other 72% is comprised of indirect costs such as lost productivity, training, replacement worker costs, and other costs not covered by insurance.

A RTW program doesn’t have to cost you big bucks.  Many things can be done by making small changes.  When creating or identifying modified duty job opportunities, employers should look at the job tasks that other employees already perform.  This will help to ensure that the modified duty work is productive and serves a legitimate purpose, thereby helping reduce any costs associated with RTW.

Vocational Rehabilitation, RTW and WC: What every employer should know

What is vocational rehabilitation (VR)?

According to IRMI:

"One aspect of the overall rehabilitation process that focuses on restoring an injured person's physical and mental capacity to perform work in a safe and productive manner. This process is normally geared to individuals whose disabilities permanently prevent them from returning to their prior positions without job modification and is normally overseen by a vocational counselor or therapist. For instances involving work-related injuries, the state workers compensation act establishes the type and range of services that must be provided the injured employee."

 

When is VR utilized?

The use of VR is typically triggered by an employer's inability or unwillingness to accommodate the IW's permanent restrictions.   

As with everything in WC, it is jurisdictionally specific.  Some states, like Minnesota, have regulations that require a vocational rehabilitation consultation if there's a reasonable expectation an IW will be totally disabled for more than 13 weeks.  Other states don't require vocational rehabilitation benefits but allow for them if an injured worker meets specified criteria, such as permanent disability.  

VR is sometimes used to rebut an opinion that an injured worker is permanently, totally disabled.  In other words, a VR specialist would identify jobs that the IW is capable of performing within his/her physical abilities and vocational skill set to disprove an opinion that the IW is incapable of earning any wages as a result of their injury.  The type of disability benefits an IW is receiving, as well as the duration for which they can receive them (total # of weeks) is governed by the state's WC law.  In some cases, converting an IW's benefits to a different status (temporary total to temporary partial) triggers a statutory cap, thereby limiting the amount/duration of benefits an IW is entitled to.

RTW and the Injured Worker -- It's all in their head!

Research demonstrates why we should be concerned about what the injured worker believes to be true regarding the outcome of their recovery.  When an injured worker is told, and believes, that they are going to return to their pre-injury duties, it is more likely that it will happen.  This obviously has to do with how accurate the doctor’s prognosis is, but also with how the injured worker aligns their behaviors with what they believe to be true.

Social psychology can help explain some of this.  The social psychological theory of confirmation bias posits that as humans, we will likely seek out information that supports our beliefs, and we will reject information that contradicts them.  If you hold a particular political view, you're likely going to be drawn to people, publications, and sources that support your views.  You will naturally reject ideas or points that are dissonant with your beliefs.  I, for one, will likely not search for articles that do not support RTW.

Another example is smoking.  Everyone seems to agree that it is not good for your health, but why do some highly intelligent, self-aware individuals continue to smoke?  They justify it in various ways, or reject information in an attempt to ease the dissonance between their actions and what they know.

In a 2002 study of 1566 injured workers who were receiving temporary total disability benefits, researchers found that workers' expectations about their recovery had a statistically significant impact on the duration of their disability.¹

When controlling for other suspected factors that could influence the injured workers' RTW, it was found that injured workers who felt their recovery would be slow or reported higher levels of uncertainty about the length of their disability were consistently associated with longer disability durations.  Conversely, workers who reported more positive expectations returned to work sooner. 

When measuring injured workers' recovery expectations, researchers found that 4 variables were able to explain 15.5% of the variance in the duration of receiving benefits. To put it another way, when a physician determines that an injured worker will recovery in x number of weeks, there is typically some variation between the prognosis (x) and the actual duration of disability.  If x is 10 weeks, and the injured worker actually returns in 13 weeks, 15.5% (or 1.5 days) of the 3 week variance can be attributed to the injured worker’s expectations about their ability to RTW.

So why is this study important?

·    Medical providers play an integral part of managing an injured worker's expectations about their ability to RTW.

·    Employers who offer modified duty can increase injured workers' self-efficacy by allowing them to prove that they are capable of doing more than what they initially thought.

·    Employers and medical providers must set realistic recovery expectations early in the recovery process. 

1. Cole, D. C., Mondloch, M. V., & Hogg-Johnson, S. (2002). Listening to injured workers:  How recovery expectations predict outcomes -- a prospective study. Canadian Medical Association Journal 166(6).

What The Rolling Stones' "Gimme Shelter", the theme song from Cheers, and RTW have in common, Part I

Welcome to Psychology 101.  Today’s lecture will be on human motivation. 

If you’re still reading by this point, that’s a good sign.

The basis of Abraham Maslow’s hierarchy of needs theory is founded upon the notion that we are motivated by unmet needs.  In simple terms, humans strive for improvement, but cannot move forward until the lower level needs are satisfied.  While much of this theory is best exemplified by human behavior in extreme situations (starvation, in the wake of a natural disaster, or a cast-away on a deserted island) the theory is still applicable to returning injured workers to a state of wellness after work-related injury. To return an injured worker to wellness, there are certain needs that must be addressed in order to smoothly and effectively transition an injured worker back to wellness.

 

Biological Needs

Before putting effort into relationships or gaining prestige, humans must first take care of their very basic needs – to eat, to breathe, etc.  At this point we’re not concerned with enjoying life – we’re concerned about extending or even maintaining it. 

How can an employer help satisfy this need?

An employer can make sure the injured worker receives prompt and appropriate medical attention.  Before we can discuss RTW, the injured worker needs to be treated for his injuries and cleared to do some type of work, safely.

Safety Needs

Similarly to the biological needs, we’re still scrambling to make sure that we’re going to physically survive.  Safety needs are a level higher than biological needs.  Think of it as surviving, but in an improved environment. 

The need for stability and order, as well as protection from the elements, is evidenced by an injured worker’s initial concerns after an accident– when will I get paid, how will I keep food on the table, or pay my rent to keep a roof over my head?  How frequently will I receive a check and for how much?  Will I still have a job to return to? 

Sometimes injured workers are scrutinized for asking questions about pay and benefits right away, but what would your top concern be if you were disabled from working?

How can an employer help satisfy this need?

Models, dining out and RTW

One of the most common responses we hear from employers regarding their ability to offer modified duty is:  "This is [insert industry here], we don't have modified duty!"  You fill in the blank -- we've heard it from all types of employers-- construction, home health, temporary staffing, etc.

I then refer to my ever-growing list of employers in their particular industry who accommodate restrictions, And do so with great success, might I add.

There's a common thread among employers that offer modified duty -- it doesn't have to do with their size, industry, or annual sales.  It has to do with their commitment to modified duty.  Those organizations that fully understand and embrace the concept and the power of modified duty find a way to accommodate even the most challenging restrictions.

As humans, we learn through modeling behavior.  No, I don't mean strutting around like you're on the catwalk; I mean observing and emulating the behaviors of others.  Remember the time your child repeated an action (or worse, a phrase) that you weren't so proud in front of an audience?  Guess where they learned it? 

We're still pretty fresh into 2013 and some of you are likely still sticking to your New Year's resolutions.  When trying to eat better but faced with temptations at a restaurant, experts recommend that you ask yourself, "What would a healthy person order?" 

The same goes for RTW.  Ask yourself, what do other successful companies do?  While what works for them may not always be plausible for your organization, I'm sure you could pick up a few good ideas.  Talk to your peers in the industry.  Find out what they do in difficult RTW situations.  Ask us!  Ask your agent!  Ask your risk management consultant or claim representative who have had the experience of resolving issues with organizations who face the same challenges that you do.

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...