"Wait and see" is never a good approach to claims management, or anything else, really

It sounds obvious, right?  “Wait and see” is the antithesis of “pro-active claims management.”

If you’ve spent any time skimming articles in the workers’ compensation blogosphere, you’re fully aware of the focus on being a proactive employer or carrier, leveraging predictive analytics, and applying all sorts of programs or steps to impact your company’s bottom line.  It goes without saying that having a plan in place prior to a loss or accident occurring is generally accepted as a best practice.

Glad we’re all on the same page.

It begs the question then, as to why employers take the “wait and see” approach when it comes to returning injured workers to modified duty.  Most people agree that proactive claims management is a good thing.  Getting people the right medical treatment and returning them to work as soon as it is safe is also a good thing.  So why is it, time and time again, employers receive a copy of work restrictions and say, we’d like to wait and see what the next appointment tells us. 

It’s like driving down a highway with your fuel light on, and having no certain way of knowing if the next gas station is 6 or 65 miles away.  Sure, the sign said fuel - 6 miles ahead, but it may be closed for service.  The doctor’s notes said that the injured worker would likely reach full duty status in 6 weeks.  In cases of a cut finger or even a clean fracture, maybe the prognostications are accurate.  These projections are based on many factors – most of which are subjective and can be difficult to quantify.  Does the injured worker smoke?  Have they had an injury like this before?  Are they considered obese?  How old are they?  Do they have other co-morbidities or conditions that may delay recovery?  Do they have a support system at home to help them get to their therapy appointments or change wound dressings?  Are they compliant with their home exercise program? 

It's a well-known joke that the best occupation in the world is to be a meteorologist because you can be wrong every day of the week and still have a job.  Well, predicting recovery times can sometimes be a lot like predicting the weather.  There is plenty of data that has been aggregated and put into a model to predict when we think this person will come back to work, but the factors that we cannot measure with great precision are those specific to that injured worker – the psychological and social factors.  How motivated is the injured worker? What’s going on in their personal lives that may impede or speed up recovery?

So, like predicting the weather or mentally calculating your vehicle’s MPG vs. distance to the next gas station, use the information that you know.  Base your next steps on the given work restrictions and find something the injured worker can do within those restrictions.  You don’t know what you’re going to get in the future, so make an informed decision rather than “hoping” or taking a “wait and see” approach.

Think about the last time someone told you that they would “wait and see how things go."  How did that make you feel?  Most likely, it made you feel pretty uneasy. 

We’ll wait and see how that tire holds up.  We’ll wait and see how this year goes for your first year freshman son or daughter.  We’ll wait and see how this prescription medication works for your cardiac problems or blood sugar.  We’ll wait and see if that health problem worsens before we decide to do anything about it.

Would you accept any of those things with ease?  Probably not.  You would likely ask the doctor if there was anything you could do to improve or influence the outcome.  Would diet and exercise help?  Are there tutors available to help my son rather than having to  “wait and see” if he passes or fails his mid-term?  Waiting and seeing is basically relinquishing all control and influence over a situation.  Sure, you cannot control everything but there’s always something you could be doing now to positively impact the outcome.

 

Eliminating uncertainty does wonders for peoples’ confidence in their future, as well as their workers’ compensation claims.

If you find yourself saying that you'll wait and see if the injured worker is released to full duty at their next appointment, you should probably not wait and see how that approach works out -- do something now.

Uncovering commonly overlooked RTW options by inspecting the way we view inspections

Sometimes it may seem as if there is a bureau or a department to regulate just about every business these days.  In all fairness, these regulations are for good reason and we're thankful that there's someone there to do it.  With regulation come rules.  With rules come inspections.  The good news is that these inspections can be a fantastic source for productive and meaningful return to work (modified duty) opportunities.

Restaurant Inspections

Hopefully your restaurant is not worthy of Chef Ramsey and his camera crew.  If it is, well, you’re dealing with more than just RTW problems and I’m afraid our blog can only address so many issues in 500 words or less.

Restaurant inspections are conducted by various regulatory bodies at the state level to determine if a restaurant is operating within approved food-safety guidelines, has appropriately trained staff, among other requirements.  Many newspapers, as well as online sources, publish the health inspections of restaurants and other food service locations.  Copies of inspection reports are available by request from the agency responsible for completing the inspection.  The point is, this information is, for the most part, easily accessible and can have an incredibly positive or negative impact on your restaurant’s reputation (and subsequent sales).

Common injuries in the restaurant industry include cuts and lacerations, slips/trips/falls, and lifting injuries to the back.  The resulting work restrictions can include limited use of the involved body part such as:  no use of the right hand, no lifting greater than 10 pounds, must be able to sit most of the shift.  The old adage goes, “If there’s time to lean, there’s time to clean.”  Meaning, if you’ve got time to lean on the counter, you’ve got time to wipe said counter, polish said glasses on the counter, or refill said condiment containers under said counter – it’s like the military – there’s always something that needs to be polished, painted, or wiped down.

Restaurant inspections are based off of the codes in place.  Check with your local health department or state agency to see if they have any check list resources to help ensure your restaurant’s operations meet or exceed the standards.  Not only is it a good business practice, but it’s a great resource for modified duty.  A clipboard allows for ease of use.  Even if it is the injured worker’s dominant hand, they can probably check a box under “yes” or “no” with their non-dominant hand.  Most importantly, the work is meaningful, productive, and serves a legitimate business purpose.  This is the best kind of modified duty you can find!

Other types of inspections

 

Long term care facilities have many requirements to meet when it comes to Medicare compliance.  OSHA has numerous requirements related to various aspects of your business.  These include material safety sheets (are yours updated to meet the Globally Harmonized standards/hazardous communications documentation requirements).  Are your eyewash stations up to par?  (More importantly, does everyone know what the standards for an eyewash station are?)  When was the last time your fire extinguishers were inspected?  Are all of your crew members’ step ladders safe and free of cracks or damage?  Are your company vehicles properly maintained for safe operation?  Ask your Risk Management Consultant to help you identify some issues that OSHA may be concerned with and implement a checklist/maintenance system for compliance.  Use that checklist system as part of your modified duty options.  While it may not yield months of modified duty options, it will help you get an injured worker working and hopefully help prevent future injuries or citations.  The goal of course is to make your workplace safer, not just to avoid the citations.

I’m sure there are various other types of inspections that your business may face – be prepared and help return an injured worker to meaningful, productive modified duty.

Can we agree on one thing...? Variance between providers' RTW recommendations

In a 2010 study of healthcare providers’ agreement related to return to work (RTW) capabilities, researchers found some areas of consistency and some, well, not so consistent (Ikezawa, Battie, Beach & Gross, 2010).  The aim of the study was to determine if there are differences between providers as it relates to the information providers use to make RTW determinations, and what their RTW determinations were for three different case scenarios:  fracture, dislocation, and low back pain.  The survey focused on collecting three types of information.  Participants were asked to determine the following:  if the person was fit to return to work, assess the physical demands of their job, address any restrictions due to injury, determine the injured workers’ work capacity, and make any other recommendations if they were deemed unfit to work.  The second part of the survey focused on what type of information the participants used to make their decision, as well as commentary on what type of information would have improved their ability to make these determinations.  The final section of the survey focused on demographic information about the participants (specialty, gender, age, years of practice, etc.).

Inquiring minds want to know! 

The results indicate that 97% of the providers were in agreement with each other regarding the RTW readiness case of the fracture (p. 370).  This is likely due to fractures being of clear cut pathology.  Similarly, 94% of the providers agreed with each other related to RTW readiness for the dislocation scenario (p. 370).  For the low back pain case (a nurse who had back pain for eleven months), providers were basically split as to whether the injured worker should return to work or not – 55.6%.  Of note, however, with regards to the back pain case, 56% agreed that RTW with restrictions was appropriate; whereas 44% believed RTW full duty was appropriate. 

What did the providers rely upon to make these determinations?

Not surprisingly, experience and training will influence a provider’s recommendations.  In this study, researchers found the providers relying mostly upon physical examination, current functional status, and occupational status (pp. 370-371).  Providers stated that functional capacity exam (FCE) results, information on availability of modified duties, and patient participation in an occupational rehabilitation program would help improve their ability to accurately address RTW opportunities (p. 371).

Another interesting point made in this study is that only a small percentage of providers considered the sustainability of RTW, motivation to RTW, recovery expectations, and guarding movements.  Not until more recently are practitioners focusing on the biopsychosocial, or multi-dimensional, aspects of RTW.  These differences in approach will more than likely yield differing RTW recommendations and should be considered when evaluating a provider’s recommendations for RTW (p. 372).

 Regardless of their agreement, the majority of providers gave some type of RTW recommendation involving restrictions –so no matter their perspective (biomedical vs. biopsychosocial), we can expect some type of restrictions from an injury and prepare for them accordingly. 

 As noted above, the availability of modified duty was emphasized as being one of the factors providers are looking at when determining the injured worker’s release to RTW.  If you have modified duty, be sure that the providers are aware of it!  For those employers that utilized a panel of physicians or a providers list, send them copies of your modified duty jobs to keep on file in the event one of your employers visits there.  If that’s not the case, it would behoove you to provide the treating physician with a pre-injury job description and/or a modified duty job description to keep in the injured worker’s file.  The more informed provider will more than likely make a more accurate RTW recommendation.

References:

Ikezawa, Y., Battie, M. C., Beach, J., & Gross, D. (2010).  Do clinicians working within the same context make consistent return-to-work recommendations?.  Journal of Occupational Rehabilitation, 20, 367-377. doi:10.1007/s10926-010-9230-z

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.

New Year, new approach to RTW

Hopefully you found the holidays to be enjoyable, now it’s back to work!  If you’re one of the many resolution-ers out there, you may want to read this before going public with your resolution.  According to a study cited in a Forbes.com article, about 40% of Americans make resolutions and only 8% of them keep them. 

Resolve to improve your company’s workers’ compensation program.  Why? Because unlike a short stint at the gym or week or two on the South Beach Diet, improving your workers’ compensation program doesn’t require any special diets or new clothing.  Nope, you simply need some groundwork and a good team of people to support you.

The process of setting your goals has a direct impact on the likelihood of successfully attaining them.  Some simple considerations can go a long way.  Goals should be simple, attainable and measurable.

Simple

Stick to one or two goals for your RTW program.  A simple starting point for employers without a RTW program could be to identify 10 modified duty tasks for each department in your organization.  Creating a modified duty job bank is an essential step in achieving successful RTW outcomes.  Review your loss history to decide where to start if it seems overwhelming.  Try not to reinvent the wheel – use existing job descriptions for ideas. 

Attainable

Sure, every organization would like to eliminate all injuries or all lost time days, but that might not be very realistic.  You can’t prevent everything, so make sure you have a plan to deal with an accident when it occurs.  Review your past loss histories to identify trends and to set reasonable goals.  You can also look to the Bureau of Labor Statistics (BLS) for comparison data.  Periodically re-assess the goals to determine where you are and if they need to be adjusted.

Measurable

As the old adage goes, you manage what you measure.  Once you’ve determined your simple, attainable goal, you must be able to measure it.  Some examples include:  reducing lost time days by 20%, reducing the number of lost time claims by 80%, getting every injured worker who has restrictions back to work within 7 days of their release to return to work.  If part of your goal focuses on providing training for supervisory and management staff on the importance and benefits of modified duty, consider setting a goal to require each staff member to attend training.  You could go the extra step and require them to score a 95% or higher on a post-training quiz.

Other considerations

Announce your goal to the organization.  Divulge your plans and then demonstrate the progress you make toward those goals.   Make it extremely clear how each employee contributes to this goal as well as how your workers’ compensation premiums impact the financial results of the company.  If your company has quarterly meetings, add this to the agenda.  Regularly post your progress in a visible area such as your mandatory postings board or break room.  If you don’t reach your goal, determine an objective reason why.  Use this information to realign your goals for the following year. 

We’re here to help you successfully implement a return to wellness program.  Check out our resources on www.eains.com/ecovery or contact us directly.

Best of luck in whatever resolution you take on this year, and if you’re one of the nearly 60% of Americans who don’t make New Year’s resolutions, we still wish you all the best for 2014.

Why you should care about RTW for direct-care workers

According to US News and World Report, it is estimated that in 2013, roughly 3.3 million Americans called a nursing home their place of residence.  For these millions of residents, there must also be millions of people to care for them. 

Productive modified duty for nursing staff

Nursing homes are rated on various aspects of their operations by Medicare.  Nursing homes are rated on health inspections, staffing, and other quality measures.  One element of staffing criteria that is measured is the number of staffing hours per resident.  A facility reports the number of hours of care on average provided to each resident, each day, by its nursing staff.  It is important that RNs and LPNs, for example, are providing care to residents as opposed to “non-care” hours.  This is important when considering modified duty opportunities for long and short term care facilities.

When considering modified duty options for health care staff, a great place to start is their job descriptions.  What aspects of their jobs fit, or can be modified to fit, within their work abilities?  Consider other areas or departments for opportunities.  While there may be some initial resistance, some of the duties that other health care employees perform may also yield modified duty opportunities.  An example of this would include having an RN perform duties that an LPN could do.  Another great source of modified duty suggestions is to ask the injured worker what they believe they could do.  This will provide suggestions, but also foster support of the return to work process.

Keeping injured workers at work doesn’t just help your workers’ compensation insurance costs

When an employee is injured, the repercussions are felt throughout an organization and the community.  Maintaining a staff of qualified and skilled employees is a challenge in any industry, but is particular evident in the health care field.  According to one study, the cost of turnover in the direct-care industry was found to be 25% of an employee’s total annual compensation.¹ The Bureau of Labor Statistics estimates in 2003 that costs associated with turnover in this industry ranged between $4,200-5,200.

            Direct costs:

·          separation

·         vacancy, replacement, training and injuries

Indirect costs:

·         lost productivity

·         reduced service quality

·         lost clients revenues due to lost existing and potential clients

·         impact on the culture, morale, facility reputation and service quality

Service delivery level costs:

·         Consumers/Clients

o   quality of care

o   quality of life

o   care hours not provided

·         Employees

o   increased work injuries (doing more with less)

o   increased physical and emotional stress

o   reduced working conditions may lead to higher turnover

Suggested resources

There are many resources available to employers who wish to offer modified duty to one of their injured workers.  The Job Accommodation Network (JAN) is a great resource for ideas and modification suggestions.  We previously wrote about it in this post.   Our website also has a variety of tools to help, in addition to lists of suggestions for health care employees who are given restrictions as the result of a work injury.

You can also check out the studies and resources referenced in this post by clicking here.

1.  Seavey, D. (Oct., 2004).  The cost of frontline turnover in long-term care. Washington, D.C.:  Better Jobs Better Care.

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!

RTW: It takes a village

Recently, someone brought up an excellent point about human behavior and accountability.  It’s easy to point the finger at the person who’s not in the room.  Who’s ultimately responsible for returning an injured worker to modified duty?  The injured worker’s physician?  The employer?  The claim representative?  Based upon the contextual clue in the title of this post, you’ve more than likely determined that it isn’t just one person’s responsibility.    

Employers have a responsibility to provide a safe work environment for your employees, report claims, and stay in contact with injured workers.  Too many times the claim starts out and the injured worker is a “great employee” and then 6 months later when they are still recovering from their work injury, they’re now referred to as someone who is “milking the system.”  How does that happen?  Think about a relationship that has dwindled to the point of “acquaintance” as opposed to close friend.  If you haven’t talked to someone in a few months, it’s easy to draw conclusions about the reason for the lack of communication.  I’d be willing to bet you aren’t looking introspectively or taking accountability for losing contact.  It’s only human to attribute a negative outcome to the actions or someone else. 

Injured workers have a responsibility to report injuries to their employers participate in their recovery, follow the advice and restrictions of their physicians, and to keep their employer and claim representative apprised of any changes in their work and treatment status.  Injured workers should participate in the RTW process.  How?  Injured workers can make suggestions about what parts of their job they think they can do. 

Claim Representatives can make or break the outcome of the majority of claims.  Yes, it is true that at the end of the day people will do what they feel they need to do, but we need to take a few steps back and think about what led up to the current situation.  Did the injured worker have unanswered questions?  Did they receive another collection notice for an unpaid bill (because the biller simply didn’t have the WC claim information)?  Did they hear rumors that their job was in jeopardy?  While we can’t prevent every outcome, we can lay the foundation for open communication, education, and understanding.  We should never lose sight of the fact that we’re providing a benefit to an injured worker on behalf of their employer.  The goal is to provide appropriate medical treatment to rehabilitate the injured worker to their pre-injury state, or as close as possible.

It truly does take a village.  We didn’t even mention the roles of the medical providers, case managers, or attorneys...  

I’m not saying that at the end of the day we’re all going to be “friends” on Facebook, or that we’ll go to happy hour together after work.  My point is, the sooner we all realize that we have a responsibility and an interest in getting an injured worker back to work, the sooner we will see RTW challenges resolve.

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?

Meet JAN, your new best friend

Who is JAN?

The Job Accommodation Network (JAN) is the leading source of free, expert, and confidential guidance on workplace accommodations and disability employment issues.  Working toward practical solutions that benefit both employer and employee, JAN helps people with disabilities enhance their employability, and shows employers how to capitalize on the value and talent that people with disabilities add to the workplace.

JAN’s Workplace Accommodations:  Low Cost, High Impact  reports  the results of a recent survey of 723 employers who utilized JAN’s services.  We’ve provided some of the most relevant findings below.

An astounding 57% of accommodations didn’t cost anything.  Zilch.  They were free.  The average cost of a one-time expenditure was $500 for employers.   Do the accommodations work?  76% of employers reported they found the accommodations to be “very effective” or “extremely effective.”

What benefits have employers utilizing JAN received?

Direct Benefits
 

39% reported a savings on workers’ compensation or other insurance costs

90% reported the retention of a valued employee

71% reported increased the employee’s productivity

60% reported the elimination of costs associated with training a new employee.

Indirect Benefits

66% of employers reported improved interactions with coworkers

61% cited an increased overall company morale level

45% reported increased workplace safety

57% reported increased overall company productivity

99% of employers stated they would use JAN again.

There’s a Searchable Online Accommodation Resource (SOAR) database which provides information, suggestions, examples and resources for employers interested in implementing a job accommodation.  These suggestions are sorted by impairment or by industry.

 

References:

Job Accommodation Network (Original 2005, Updated 2007, Updated 2009, Updated 2010, Updated 2011, Updated 2012). Workplace accommodations: Low cost, high impact. Retrieved August 12, 2013, from http://AskJAN.org/media/lowcosthighimpact.html

 

Have a RTW program? Think your employees know about it? Think again!

Why put all of the time, energy, effort and resources into developing a RTW program, if no one knows about it?  If your injured workers don't know about it, it probably means no one is telling them about it, let alone utilizing it.

In a study of over 4,000 disability insurance recipients, only 20% of them (or, 800) knew that they had access to a work trial program. Why is this a big deal?  The 800 or so people who knew about the program were 2 times more likely to return to work.¹

If you offer RTW, make sure EVERYONE knows about it.  Make it ridiculously clear.  From the top to the bottom and anyone who is responsible for treating your injured workers, regardless if they are on a physician panel or not, be sure that they know you have modified duty.  As you may have read, one of the number one reasons physicians don't release injured workers is because the injured worker tells their doctor that their employer doesn't have modified duty. 

This brings me to another point -- Doctors should be commenting on ability to RTW regardless of whether work is available or not -- if the injured worker shouldn't lift more than 20 lbs., they shouldn't be hoisting a 30 lbs. toddler or a 30 lbs. bucket of cement.  Restrictions aren't just for work!

Communicate your RTW policy to employees at hire, at time of injury, and at the time of annual benefit renewals. 

Why is this so important?
Having a modified duty program sends the message to employees that their employer is going to help them recover – physically, financially, and vocationally if they sustain a work-related injury.  It also sends a message to an employee that getting injured does not mean that they are going to be out of work.  While the overwhelming majority of work injuries are legitimate, having a modified duty program will take any motivation to file an illegitimate claim off the table.

How can I communicate our RTW program?
As previously mentioned, explain it in conjunction with your company’s annual benefit renewal process, include it in the company newsletter, send out a company-wide email or flyer, post it along with your other mandatory postings, discuss it at employee meetings. 

Make sure that you are using it!
Unless a RTW program is consistently used, it will be worth little more than the paper it is written on.  Some of the best RTW programs we’ve seen aren’t formal, shiny programs, they are a strong commitment from the employer to do whatever it takes to bring someone back to modified duty when medically appropriate.  It’s like a gym membership, you can say you have one, but it’s usually fairly obvious those who utilize it and those who fail to take advantage of the opportunity.

References:

1.       Krause, N., Dasinger, L. K., & Neuhauser, F. (1998). Modified work and return to work:  a review of the literature. Journal of Occupational Rehabilitation, 8(2), 113-139.

Have an injured worker out of work? The meter is running.

If you're an employer with an injured worker who is currently out of work, the temporary total disability (TTD) meter is running!  Whether it's staring at the meter at the gas pump, silently praying that it will soon stop, or imagining dollars going out the door everytime the air conditioning kicks on and you see your electric meter hypnotically spinning in circles...cha-ching, cha-ching, cha-ching, most of us have at least felt the pain at the pump or cringed when reviewing your summer-time electric bills.

We can blame the meteorologists and global warming, or grumble about the price of oil, but it's unlikely that we're going to stop using gasoline or electricity.  The same goes for workers' compensation (WC) insurance.  It's a requirement for the overwhelming majority of employers, and while there's little you can (legally) do to avoid having WC coverage, there are many ways to avoid overpaying.  Don't worry, you won't have to start biking to work or start adopting the ways of the Amish life.

One of the most influential ways to reduce workers' compensation claim costs (and resulting impact on premium calculations) is to offer modified duty.  If you have an injured worker who has restrictions that you [think] you cannot accommodate, the TTD meter is running.  As a claim representative I was often outraged at the number of employers who didn't seem to be alarmed by this statement:  "Each week that you do not offer modified duty, your policy is paying out $422 per week!  Over the course of 12 weeks, that is $5,064!"  It's not Monopoly™ money, it's real claims dollars.  Dollars paid to an injured worker, who is capable of performing productive work. 

Out of sight, out of mind? 

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.

Rx meds putting a kink in RTW plans? Read this...

Hank is a material handler who sustains a compensable work-related injury.  As part of his treatment, his physician prescribes prescription pain medication, particularly a narcotic pain medication, such as Oxycontin.  Hank's treating physician also releases him to return to modified duty, with restrictions of no lifting greater than 10 lbs., can drive a vehicle, but no heavy equipment or tow motor. Fortunately for Hank, his employer has a modified duty program and is interested in bring him back to work --- but there's one problem.  His employer has concerns about Hank's ability to perform the modified duty job they have for him.  They were hoping to have Hank perform light courier work between plants, but they don't want him "all drugged up while operating a company vehicle."

These are legitimate concerns. Many employers find themselves in this same predicament:  there is a release to return to work, but the injured worker is on heavy pain medications which may create additional liabilities for the employer.  What's an employer to do?

Communication is key

If there is a nurse or medical case manager assisting with this claim, send him or her a list of the modified duties, or a modified duty job analysis form, to discuss with the physician.  Often times having something to demonstrate the availability of modified duty will help facilitate a RTW, but can also encourage the physician to prescribe medication that will not impeded an injured worker's ability to operate a vehicle, etc.  Perhaps they can provide some alternative medication for the injured worker to take during working hours.  If it is an injured worker who has been on heavy pain medications beyond the recommended time frames, it may also give the physician another basis to adjust the patient's pain regimen.

Understand the risks

Not all medications will prevent an injured worker from driving, just not all dosages will have the same impact on each individual.  Unfortunately there is no magic screening to determine how each individual will react to a particular dosage.