"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.

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.

Upset About your Workers' Compensation costs? What are you going to do about it?

There's ample research and discussion about factors that may lead to delayed recovery or poorer outcomes for workers' compensation claims.  We're all really good at pointing the finger and saying that it's because of the doctor, the unmotivated injured worker, or the employer who just doesn't get it.  I'd like to ask one simple question to those who are frustrated or angry about workers' compensation outcomes.  What are you going to do about it?

In the extreme case, an employer could shut down the business, throw in the towel.  Highly unlikely.  Realistically there are several steps employers and other stakeholders can take to GET INVOLVED in their claim management programs.  Here's just a few of my favorite.

• Report all injuries as soon as possible.  It's fairly common knowledge that the sooner everyone knows about an injury, the sooner it can be managed.  This leads to the next important point.
• Get the injured worker prompt appropriate medical care.  Get them the best care a workers' compensation dollar can buy.  If you want the best outcome, why would you skimp here?  Who would you want to see if it were your injury -- the doctor who just processes injuries and prescribes anti-inflammatories, tells you to follow up with your family physician if not better in a week or the occupational health physician who understands how to approach work injuries, what is necessary to help you get better and back to work, and what the signs of trouble may be?  Do you want a physician who follows what massive amounts of research says provides the best outcome, or the doctor who disregards evidence-based medicine in exchange for their anecdotal, 30 year old medical school training.  I wouldn't want a mechanic who only worked on cars from the 1970s to work on my 21st century car that's basically a computer running on gasoline (or electric, for that matter).  Get your employees to the best providers who are on top of the most current medical practices, and follow evidence-based treatment guidelines.
• Reduce delays in care by getting treatment approved, appointments scheduled, and referrals made TIMELY.  The sooner we can help that injured worker get the care they need, the sooner everyone can learn what the true injury is, what the treatment plan will look like and assess the RTW opportunities.  Nurse case managers can help with this process.
• Communicate effectively!  Communication is often the cause and the solution to all problems in a claim.  Keep everyone in the loop -- find a way to do it. Maybe it's a list of everyone who you need to update, written down on a sheet of paper.  Maybe it's an email distribution list that you create for each employee's claim.  Whatever your strategy is, keep everyone up to date.  As the saying goes, communicate by a factor of 10, and then say it one more time.  This group includes the injured worker, the employee's supervisor, the claim representative, nurse case manager, medical providers, and whoever else may be involved in the claim.  Documentation will be key in communicating technical, detailed information.  One example of this is the injured worker's pre-injury job description.  Document it, send it around for review and approval (including the injured worker) and then send it to the treating physician, physical therapist, and nurse case manager.  After all, how can you plan to get an injured worker back to work if you don't know what they need to do?  Identify barriers to return to work early on and develop a plan to address them.

These suggestions are based upon evidence.  Researchers from the Department of Physiotherapy and the Department of Epidemiology and Preventative Medicine at Monash University in Melbourne, Australia conducted a study involving the aforementioned interventions.  The results?  In their study, their intervention reduced costs associated with RTW claims by 34% and cut the days away from work by 58% (Iles & Wyatt, 2013).

References:
Iles, R. A., & Wyatt, M. (2013). Applying the evidence: a real-world example of an intervention to reduce workers' compensation costs. Physical Therapy Reviews, 18(5), 395-402.

Returning Starfish to Wellness

“Once upon a time, there was a wise man who used to go to the ocean to do his writing. He had a habit of walking on the beach before he began his work.

One day, as he was walking along the shore, he looked down the beach and saw a human figure moving like a dancer. He smiled to himself at the thought of someone who would dance to the day, and so, he walked faster to catch up.

As he got closer, he noticed that the figure was that of a young man, and that what he was doing was not dancing at all. The young man was reaching down to the shore, picking up small objects, and throwing them into the ocean.

He came closer still and called out, "Good morning! May I ask what it is that you are doing?"

The young man paused, looked up, and replied, "Throwing starfish into the ocean."

"I must ask, then, why are you throwing starfish into the ocean?" asked the somewhat startled wise man.

To this, the young man replied, "The sun is up and the tide is going out. If I don't throw them in, they'll die."

Upon hearing this, the wise man commented, "But, young man, do you not realize that there are miles and miles of beach and there are starfish all along every mile? You can't possibly make a difference!"

At this, the young man bent down, picked up yet another starfish, and threw it into the ocean. As it met the water, he said, "It made a difference for that one.”
― Loren Eiseley


In an industry riddled with challenges, competing interests and seemingly endless uphill battles, we should always remember "the starfish story."  As insurance professionals, we are given the opportunity to apply our expertise and experience to  positively influence the lives of others-- to help an employer retain an employee despite their work restrictions, to help an injured worker return to wellness through productive, meaningful work, to prevent injuries from occurring.  We have the knowledge and skills to help guide our insured employers and their injured workers through the workers' compensation system.  A system that is rife with black holes -- one in which an injured worker can, far too easily, slip through the cracks.  We can't convince every employer to offer modified duty work, nor can we convince every injured worker to take the steps to get off of their narcotic pain medications, nor prevent every injury from happening, but we can help in this case...and the next one...and the next one...

It may not always feel like it, but everyday we are presented with a unique opportunity to make a difference in our employers' worlds, our injured workers' worlds, and our own.  What we do on a day to day basis may prevent us from seeing the impact we can have on the lives of thousands of injured workers and employers each year.  Within the confines of our system, we can have a positive impact and successfully fulfill our promise to deliver a better outcome. 

There will always be another starfish to toss back into the water, and with each one we have the responsibility to help them get back into the ocean.

More tips to ensure your RTW program is worth more than the paper on which it's written

Last week we wrote a post about ways to measure the effectiveness of your return to work (RTW) program.  As you may recall, the prior week's post gave some tips to measure the effectiveness of a newly implemented RTW program.

Let's discuss the more mature RTW program.
For employers who have had more experience with modified duty and lost time claims, the methods to evaluate the effectiveness mentioned in the prior post will also apply.  If you're looking for more targeted or "next level" metrics, there are some simple ways to accomplish this.

• The window of opportunity to positively impact the outcome of a workers' compensation claim is very short and it begins closing the day the injured worker is taken out of work. Employers must create a sense of urgency with regards to RTW.  Most of our insured employers feel that they are "pretty good" "in most cases" at identifying modified duty.  Assuming this is how you perceive your company, and this judgment is factually substantiated, you may want to start measuring the days until a RTW opportunity is found/offered.  Measure the days that pass between the time the claim representative or injured worker provided a RTW note and the date they received an offer to RTW.  Employers can be even more aggressive in their standards and measure from the actual date the injured worker was released to modified duty until the day they returned.  This would assume that the expectation is for any release to modified duty to be reported to the employer as soon as possible, likely by the injured worker.  These "lag time" days are wasted days of productive, meaningful work -- and days where temporary total disability are unnecessarily being paid.  Setting a goal and starting the clock will create that sense of urgency that is essential in an effective RTW program, and give you something to measure against.
• If you're an employer who really wants to challenge themselves, take a look at the Occupational Disability Guidelines (ODG) return to work recommendations. These are evidence-based guidelines for expected RTW targets based on diagnosis and categories of work (light, heavy, very heavy, etc.).  Holding your RTW outcomes to these standards gives you a benchmark to measure against.  Obviously there are going to be scenarios that don't comport to a set of guidelines, but it gives you an opportunity to look at a benchmark and investigate what the deviation stemmed from -- was it due to complications with treatment, or lack of a modified duty offer?  Another benefit of using guidelines is that it gives realistic projections for various timeframes of when an injured worker reaches different levels of work.  The guidelines also consider certain comorbidities (things that will impact recovery times).  Here's an example:
• ODG Treatment and Return to Wellness guidelines: 724.2  Lumbago
• Severe, manual work:  14-17 days
• Severe, heavy manual work:  35 days
• Obesity comorbidity (BMI >= 30), multiply by 1.31
• Because this particular injured worker was considered obese, ODG projects their recovery time to take about 31% longer than an injured worker who has a BMI of 29 or lower.

While it is sometime difficult to measure results, it's best to measure something -- and be sure to do it consistently.  Put some thought into what your goals are and how you're going to measure them.  Communicate these goals (repeatedly -- we mean it, every chance you get!) and share your progress.  The gold standard would be to find a way to make managers/supervisors accountable for their results.  As "they" say, you manage what you measure.

Tips to ensure your RTW program is worth more than the paper on which it's written

A recent survey found that 90% of healthcare employers had a RTW program, but only 65% actually had metrics in place to monitor its effectiveness.  What's the point of putting something in to place if you have no way of knowing how it's working?

This is a common occurrence -- safety committees that are created to obtain a premium discount, a customer satisfaction survey conducted so that companies can say that they did it, or a declaration that a company is going to implement a wellness program to say that they're a healthy workplace.  These are all great things to talk about, but if you don't measure and monitor your results, what's the point?  You may have a safety committee, but if they don't perform or impact safety in the workplace, other employees will see it as a waste or worse yet, not take their recommendations seriously.  This can sometimes have a more harmful effect than not having one at all.  Any wise employer would prefer a highly performing, informal return to work program over a formalized, ineffective program any day.  Results are what matter.

'Tis the season for resolutions to lose weight, eat better, save more money, etc.   If you're trying to lose weight, you're probably weighing yourself at frequent intervals to track your progress and monitor the need for modifications to your routine.  If you're trying to save money, you've probably gotten into the habit of shaking your piggy bank to verify it's heft on a regular basis.  The old adage is, "you manage what you measure."  Why should RTW programs be treated differently?

Your company went through the efforts of putting together a RTW program, so why not measure its progress and make it as effective as it can be?  If you're not measuring your RTW results, then your program is worth about as much as the paper on which it's printed.

As with any goal, you have to decide what a realistic, measureable goal is.  Here are some tips on how to set realistic goals with respect to your shiny new RTW program.

For the fledgling RTW program:
You may need some data to timely demonstrate your program's return on investment.  Money is probably the biggest pressure point.  You can track this in a few ways. 

• Obtain a copy of your loss runs for the prior year.  Record how many lost time claims you had and how much was paid in indemnity (wage loss) benefits per claim.  Your target may be to reduce average indemnity payments per claim by 10%, or something along those lines. 
• Look at the frequency of RTW offers being made compared to the claims where no modified duty was offered. Separate the offers by modified duty offers and full duty RTW offers.  This is a good measure of the success or comprehensiveness of your program.  Sometimes your missed opportunities (and related costs) are more impactful than demonstrating savings, particularly if your program is very new and successes are rare.
• If your program is still getting off the ground, look for very basic areas of opportunity. Is someone at your company following up with the injured worker on a regular basis to check in and discuss potential modified duty options? What is the lag time between the injured worker getting restrictions and the employer finding work? 

Stay tuned for the next post with more tips on how to measure your RTW program's effectiveness.

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. 

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.

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!

The "rules" of WC aren't a secret -- really anyone can find them...

Workers’ compensation has existed in the United States for over 100 years.  Unarguably, things have changed since 1911.  One acronym says it all:  EDI.  Don’t worry, this isn’t a post about EDI at all – we’re trying to gain a following here, not see how quickly people “x” out of their browsers.

Every year we hear of a few states who are taking a crack at this reform or that amendment.  These changes are typically a fusion of neighboring states’ systems, but with a twist!  Each state’s laws address workers’ compensation it a bit differently but whether you’re in Texas or PA, there are some similarities that, amazingly, people still don’t know about. So, here are a few common things about WC that I wish more people knew.

Medical providers:  If you want to get paid you need to submit your bill with medical records.

Would you pay a bill if you had no idea what it was for?  Despite they average person's usual philanthropic tendencies, I’d bet not.  Why would you expect an insurance carrier to pay for something when they don’t know what they’re paying for? 

Here’s what happens.  The carrier gets a medical bill or invoice without records.  The carrier denies it and requests that it be resubmitted with medical records.  Maybe the billing company is a separate entity and can’t just print out the records.  The billing company then has to request the records from the provider, who then sends them to the billing company who sends them, hopefully, with the appropriate bill, back to the carrier.  This could take a few weeks.  Suppose that in the interim, the provider identifies this as an account with a balance on it and they send a second notice to the injured worker, causing all sorts of outrage and frustration, when all the while letters and requests are crossing in the mail. 

An avoidable mess is the most frustrating mess!

Modified duty reduces claim costs

It’s as if this is a big secret!?  I’ve always said that for every attorney billboard along the major highways that we see, I wish there was one explaining why modified duty makes sense – if done properly.  I bet if you asked people what happens to their rates when they file a homeowner’s or auto damage claim the overwhelming majority of people would say, “My rates go up.”  It’s so prevalent NBC’s Today Show website has an article on this topic from just 6 days ago! The more a claim costs, the more it impacts your policy (in most cases).  WC coverage is no different.  Modified duty is one of the most effective ways to reduce indemnity (wage) loss costs on your policy.  Carriers don’t make this stuff up!

The “rules” of WC aren’t a secret – really anyone can find them.

Employees say the darndest things...

A few months ago, I wrote about the importance of communicating your RTW program.  Maybe some of our loyal blog-followers have taken steps to communicate their modified duty or RTW policy.  Maybe not.  No matter which group you find yourself in, here’s a little experiment to help you gauge just how much your employees know, or don’t know, about RTW.

That’s right an experiment.  Please don’t feel as if you must limit yourself to workers’ compensation and return to work programs.  Expand the scope of this very non-scientific study I’m about to propose, and see what comes back. 

Drum roll, please.

Ask your employees what type of benefits they have available to them.

Ta-da!  Voila!  Profound, isn’t it??

Here’s my point – the results will likely surprise you.  I envision the responses reminiscent of the interviews on “Kids Say the Darndest Things”.  Ask anyone open-ended questions, and you just never know what responses you’re going to get.  I’d be willing to bet that modified duty and workers’ compensation aren’t on the top of the list.  That’s a problem, particularly if you have a RTW program that you’ve put a lot of effort into.

So, what can employers do?

Obviously the first step is to communicate the message to your employees.  This message should be clear, consistent and simple.  Like most things in life, the fewer words the better.  There are many suggestions on how to do this (newsletters, posters, payroll stuffers, wallet cards, annual compensation statements, etc.) As an aside, we’ve created a lot of these things already.

You’ll probably feel like I do when I talk about modified duty or return to work (or, as we say, wellness) – you feel like you’ve communicated your message a thousand times.  The amazing thing is that there are still many people who haven’t heard it.  Maybe they were in the restroom, or maybe they were on vacation or out sick, or sadly, maybe they were present but don’t remember the message.  The point is, not everyone has heard it, and it’s worth saying again, and again, and again, until your employees can communicate the message back to you – or until they start mimicking (in jest) your catchy saying you’ve come up with as part of your communication strategy.  Spoof or no spoof, you’ll know they’ve got the message!

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.

A RTW Case Study: How a $500 wage loss claim cost this employer thousands

Five hundred dollars if $500, right?  Not for this Indiana employer. 

Using actual claim figures and premium calculations, this post will demonstrate how $500 in indemnity (wage) payments resulted in a premium increase of more than $4,000.

Each year, an employer’s experience modification factor is calculated based on prior years’ losses. 

In some states, such as Indiana in this example, medical-only claims are reduced by 70%.  Medical-only claims are claims in which only medical costs were paid, and no indemnity (wage) payments were made under the claim.  So, for explanatory purposes, if an employer has a $1,000 medical-only claim, it is reduced (for the sake of calculating their experience modification factor) by 70%, to $300.  The claim still cost $1,000, but only $300 of that will be considered in their “mod” calculation.

So, how does $509 end up costing the employer $4,000?

If the employer would have brought the injured worker back to modified duty without incurring any wage payments under their policy, it would have reduced the costs of their indemnity claims dollars paid to $0.  They would have also counted as medical-only claims.  However, because these claims in their loss history were not kept as medical-only, the employer loses the benefit of the 70% reduction in claims.

Think of keeping claims as medical-only like a discount coupon at the grocery store.  You must return all injured workers to modified duty to get 70% off your [medical] claim costs.

So, how does $509 end up costing the employer $4,000?

What's the ROI on RTW?

It’s no surprise that claims-people like to use acronyms and abbreviations.  It’s as if we’ve got our own language…TTD, IME, PPD, IRE, RTW, ABC…just kidding with that last one, but it’s plausible.

The knee-jerk response of any business owner when asked to bring someone back to modified duty is typically, what’s this going to cost me?  It is important that employers understand what their potential return on investment is with a return to wellness (or, as others call it, return to work) program, but that is only part of the picture.  Examining the opportunity costs associated with modified duty will help an employer/business owner make the best decision, for their business and their employees.

What’s the return on RTW programs?
A 1993 study conducted by Crawford & Company estimated returns ranging from $8-10 for every $1 invested in a RTW program.  This same study noted an overall reduction in WC costs of 54%.

Roto Rooter Services Co. experienced a reduction in incurred WC losses from $1.4 million to $356,000 in one year, which was largely attributed to their RTW program¹. 

Gibson Greetings’ RTW program reportedly reduced their incurred WC losses from $400,000 to less than $50,000 the following year¹.

The RAND Institute (2010) published a working paper which examines the effectiveness of RTW programs.  The study suggests that for large employers, RTW programs are highly effective at reducing duration of absences due to work injuries, resulting in about a 3.6 week reduction in the median number of weeks away from work for an injured worker.²

Obviously, individual companies will experience varying results.  These statistics represent case studies that are likely not applicable to every industry nor every employer. 

What is the cost of doing nothing?
Without going into the nitty-gritty of calculating experience modification factors (if you’re a glutton for punishment, you can learn more on this by going visiting your state’s compensation rating bureau), the higher your experience mod is, the higher your premium calculation will be.  A credit score is used to assess a creditor’s risk when lending you money.  Similarly, an experience modification factor is used, among many other factors, to determine an insurer’s risk of insuring your company for workers’ compensation insurance.

The impact of a RTW program, or not having one, will depend on what type of policy you have.  If you’re an employer with a large deductible, you will see more “immediate” savings than someone on a guaranteed cost policy.  If you’re an employer who has a retrospective rating plan, then you have an incentive to lower your claims – a dividend! 

These are the direct costs associated with insurance premiums.  Consider your profit margin.  Think about how much more you would have to sell to offset a WC premium increase of $10,000.  Now, reconsider the cost of offering a few hours of modified work per day for 6 weeks.  There’s an opportunity for even greater savings in some states when a claim remains medical only as opposed to becoming a lost-time claim in regards to your experience modification factor.

We haven’t even discussed the indirect costs associated with having an injured worker out of work…lost productivity, decreased employee morale, increased potential of illegitimate claims, increased turnover, increased injury rates, increased costs of overtime, increased health insurance costs…  We’ll save that for another post.     

References:
1.   Friedman, S. (May 8, 1995).  Back-to-work WC programs pay big dividends.  National Underwriter, 99(19), 3;26.
2.   McLaren, C., Reville, & Seabury, S. A. (March, 2010). How effective are employer return to work programs? (Working Paper No. WC-745-CHSWC).  Retrieved from RAND http://www.rand.org/content/dam/rand/pubs/working_papers/2010/RAND_WR745.pdf.

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.

RTW: Everybody’s doing it

…or at least for the majority of cases.

According to the Bureau of Labor Statistics (BLS), nearly "60% of the most severe cases in private industry include at least some days of job transfer or restricted work, with the remainder resulting exclusively in days away from work." (2013, p. 31). So what's the big deal? Well, in 1970, less than 5% of severe cases involved job transfer. We've come a long way, baby.

In 1985, only 8.6% of all lost-workday cases involved restricted work (2013, p. 32). In 2001, this number rose to 39.9% (2013, p.32). That is good news! BLS classifies restricted work cases as cases where the injured worker returns to work with restrictions, without losing time from work. In other words, injured workers return to modified duty without losing more than a day of work. 

Does business size matter?
According to the BLS: somewhat. Their research has found that establishments increased in size, the proportion of restricted work days also increased, measured at years 1985, 2001, and 2009, until employer size reaches about 1,000 or more employees where it levels out and drops off slightly.
While peer pressure is typically not a good basis for doing something, particularly when it involves important business decisions and employees, it's clearly not just us who believe RTW is beneficial.

Exciting news!
Well, I find it exciting. In their future surveys, the BLS plans to capture more worker characteristics such as:

• Occupation
• Age
• Race or ethnic origin
• Gender
• Event or exposure leading to injury or illness
• Nature of injury or illness
• Part of body affected
• Source of injury
• Number of days of job transfer or restricted work
• Number of days away from work
• Length of service with employer
• Day and time of event or exposure
• Amount of time on shift when event or exposure occurred

It is expected that the BLS will release the results of their most recent survey sometime in 2013.

For more information, you can access the original article here, or visit www.bls.gov
 
Reference:
Ruser, J. W. & Wiatrowski, W. J. (2013). Restricted work due to workplace injuries: a historical perspective. Monthly Labor Review, 136(3), 31-43.