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).

Concurrent employment conundrum: Return to Work for those who work more than one job

Some states provide benefits for concurrent employment if the injured worker is unable to work one or both (or more, I suppose) of their pre-injury jobs.  The workers' compensation policy covering the injury pays for the lost wages the injured worker sustains due to the work injury, which includes wages lost at another job.

Here's the scenario:

Steve works for No Leaks Plumbing as a plumber.  He also works part time as a bartender at Ps and Qs,Pub on the weekends.  While Steve is working to loosen a pipe under a sink at a customer's home (working for No Leaks Plumbing), he injures his right shoulder.  After going for treatment, he is given one-handed restrictions.  The good news is, No Leaks Plumbing is insured with Eastern Alliance and has a solid return to wellness program.  No Leaks Plumbing can bring Steve back the following day to work within his restrictions.  Unfortunately, Ps and Qs Pub cannot. 

What's the big deal, right?

Well, if the state that Steve files a claim in considers concurrent employment wages as part of the claim, then it can have implications for No Leaks Plumbing.

When calculating the compensation Steve is due as part of his injury, the claim representative would obtain wage information from No Leaks Plumbing and Ps and Qs Pub.  These wages would be combined to determine Steve's pre-injury average weekly wage (AWW).  Based upon the AWW, Steve's compensation rate, or temporary total disability rate, would be roughly 66 2/3% of the average weekly wage.

Let's say Steve makes $1000 per week at No Leaks.  He makes $200 working at Ps and Qs Pub.  One may think that since Steve is working for No Leaks without a loss of earnings, his wages from Ps and Qs Pub wouldn't matter. That is incorrect.

Steve's AWW would be $1200.  If Steve is able to earn his pre-injury hours, earning his pre-injury wages on modified duty, the compensation carrier would still owe Steve 2/3s of the difference between his post-injury earnings and his pre-injury average weekly wage.  In this example, it would be $1200 (AWW) - $1000 (wages working modified duty) = $200.  66 2/3% of $200 = $133.33.  Steve would receive a paycheck from No Leaks, and a temporary partial disability (TPD) check for a percentage of his lost wages from Ps and Qs Pub, in the amount of $133.33.

This puts No Leaks in a difficult position.  They support modified duty but Ps and Qs Pub does not.  The claim representative can attempt to work with Ps and Qs to bring the injured worker back to modified duty, but the pub really has no reason to, other than to have an employee performing some type of work. 

Keep in mind, as long as an injured worker's earning capacity is reduced, due to the work injury, then there is likely going to be benefits due to that worker.

What can be done in this situation?

• The claim representative can encourage the injured worker to discuss modified duty with their concurrent employer
• Obtain a job description from the other employer to help the treating physician determine what the injured worker can safely do at the pub.
• The primary employer (No Leaks) could consider placing the injured worker at a local not-for-profit organization through transitional duty to reduce exposure under the claim, rather than simply paying the injured worker their pre-injury wages.
• If all attempts fail to bring the injured worker back to work at the other employer, the primary employer (No Leaks) may be forced to cover the secondary employer's wages until the injured worker is recovered to perform the work at the pub.

Concurrent employment creates a unique challenge for employers and insurance carriers.  An effective RTW program can help control workers' compensation costs, and can help employers control the aspects of their claims that are within their control.  Sharing expertise and experience with the secondary employer may help them understand why it is a good idea to bring an injured worker back to modified duty.

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.

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

 

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. 

Return to Work (RTW) Interventions

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

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

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

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

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

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

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

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

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.

Useful tool! Job Description Writer

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

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

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

Disciplinary problems after RTW

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

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

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

Top Reasons Physicians Keep Injured Workers Out of Work

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

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

Sources:

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

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

The Importance of Job Analysis Forms

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

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

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

What is the purpose of modified duty JAs?

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

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

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