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).

Defining Disability - Part II: The Workplace/Employer's Perspective

In our last post we introduced three different perspectives as they relate to how we define "disability."  The goal of these posts is to enlighten the respective participants in the WC/disability management community as to the various lenses through which others are viewing disability - doctors, injured workers, employers, and workers' compensation professionals.  With greater understanding, the hope is that we can cut out some of the miscommunication and confusion, creating a greater awareness of where people are coming from -- yes, we're talking about the radical idea of empathy in workers' compensation.

This post will outline some of the constructs we use to define disability when we're talking about it from the employer or workplace setting.

Workplace/Employer Perspectives - Workers' Compensation

We'll preface this post by stating that we're not going to address FMLA or short/long term disability - rather we will focus on disability as it relates to modified duty in the workplace.

It is common practice for an injured worker to bring their employer a "Return to Work" or "Work Status" note from their treating physician as a result of a work related injury.

The employer is now in a position to make a determination as to whether they can or cannot accommodate the restrictions.  Maybe the injured worker's pre-injury position falls well within their restrictions.  More often than not, the restrictions impact some aspect of that injured worker's job.  Consider a person who sits at a desk but has walking limitations.  They can perform their job, but may need a closer parking space or a wheelchair to navigate the building until they can reach their desk. 

With the exception of very large companies, most employers don't have one person who solely handles workers' compensation claims and manages the return to work of injured employees.  If they do, then the frequency of their lost time claims probably justifies their pay.  For the average employer, workers' compensation is not something they have to handle every day (and they're thankful for that). 

Considerations for Employers and Employees

We will assume that an employer has identified work within the injured employee's restrictions.  Much of the focus rests on the actual work the injured worker is performing and what work their doctor says they can and cannot safely perform. 

Employers aren't always considering the other factors that may impede or promote return to work outside of the "disability" note.  Does the supervisor understand what the injured worker is being asked to do on modified duty?  Do they understand that they cannot/should not ask the injured worker to do work outside of their modified duty work assignment if it falls outside of the work restrictions?  Who should the injured worker address concerns with? 

Does the injured worker have a good relationship with their employer and coworkers?  Have their been past performance issues that the employer may be weighing in to their ability or inability to offer work (right or wrong it happens)?

While many of these factors do not impact the injured worker's entitlement to benefits, it can impact the outcome of the claim and should not be overlooked.

From an employer's perspective, they are focused on the work that needs to be done to continue their operations, costs associated with having a workers' compensation claim, the costs associated with replacement labor/overtime to compensate for the injured worker's disability, and hopefully they're considering the positive impact that modified duty can have on all of these factors.

Tune in next time when we'll be discussing RTW from a regulatory perspective.  Rest assured, the title is far less interesting than the useful content provided in that post.

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

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

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

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

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

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

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

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

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

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

Injured Workers asking to RTW likely as a Blue Moon?

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

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

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

Do these questions sound familiar?

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

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

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

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

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

Discharge planning begins upon admission

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

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

What can you do to help plan for success?

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

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

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

One more reason to offer RTW: Stop giving injured workers a bad rap

So much for the 80/20 rule.

According to a study conducted by Harris Poll on behalf of Summit Pharmacy, Inc., 2 out of 5 Americans believe that people who are collecting workers' compensation benefit don't want to work.  Not surprisingly, roughly 35% of respondents agreed that "You need a PhD to complete all the necessary paperwork associated with a workers' compensation claim."  That last question was a bit leading, and a tad dramatic for my liking, but I digress.

You can read more about the survey here.

While the survey may not be free of bias, I think there are some opportunities for further discussion.  The survey fails to consider whether or not the employer offered modified work to the injured worker.  If someone is offered suitable work and refuses it, that's a different story.  If the employer has done nothing to offer an injured worker modified duty, or if the injured worker remains totally disabled, then they are likely justified in remaining out of work.  I understand I'm arguing against a stereotype, but the stigma and stereotypes cannot be ignored.

In previous posts, I've written about injured workers who start to feel that they have to prove how disabled they are to justify their injury to people.  In an environment where a good portion of the American population thinks injured workers are just lazy, I can't imagine that makes anyone feel too good about being out of work.  It may even lead to them citing limitations and disabilities to demonstrate that they're not "faking" their injury. 

Conversely, when an injured worker is in a supported environment where they can trust that people surrounding them (including their employer and coworkers) believe their injury occurred and the subsequent pain is real, I'd venture to guess that they'd be less likely to point to their inabilities as they have nothing to "prove."

One thing we can do to fight this stigma (aside from preventing injuries from happening in the first place), is to offer modified duty to injured workers.  If they unjustifiably refuse the work, i.e., they really don't "want to work," then their benefits may be suspended and everyone can loosely conclude that they really don't want to work.  I'd like to see a survey that focuses on that.

We can also do a better job of helping injured workers fill out claim paperwork.  It may not require a PhD, but it is filled with jargon and legalese that those outside the WC industry have a difficult time understanding. A word of advice -- if you know the form you're about to mail out causes outrage or panic in injured workers -- give them a head's up that it's coming and what it means.  The wording on the forms typically makes it sound worse than it really is.

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. 

Why employers should support employees before and after a work injury

When employees are treated fairly, they are more likely to have a stronger commitment to their workplace.  When employees feel they are not being treated fairly, they will be less motivated to return to work or put in extra effort to overcome even minor obstacles. 

In a 2006 study of social support as a factor in the return-to-work process, researchers found that social support was reported as a key contributor to a successful work re-integration (Lysaght & Larmour-Trode).  The authors of this study found that the so-called "soft" aspects of the RTW process were relevant to RTW and important to injured workers and supervisors alike. 

Relationships, in and out of the workplace, help us deal with stress.  When you have a work issue, you may confide in someone outside of work, or maybe a co-worker who understands the situation.  When you have an issue at home, a co-worker can be an objective third party to help make sense of things.  These forms of social support also apply to work-related injuries and the RTW process. 

Previous research has identified four sources of support in the workplace (p. 256):

• Informational:  information, suggestions, recommendations

In the RTW context, injured workers need information about how to complete paperwork, what the RTW process involves, as well as advice on what they can and cannot safely do within their work limitations.  While it would appear some that the onus to obtain this information is on the injured worker, supervisors or other parties, can assist injured workers by providing them with information or assisting them with obtaining that information.  Sometimes it just takes a simple conversation to alleviate mounting concerns.

• Instrumental:  compensation/wages, hours, work

Employers can provide instrumental support by providing ergonomic assessments, modifications of job duties, or work schedule accommodations.  Any step that an employer can take to increase an injured worker's sense of autonomy and contribution will aid in their re-integration into the workplace.  Meaningful work duties with a clear business purpose are ideal options for RTW.

• Emotional:  listening, genuine concern and caring about employees

Employees want to know that their employer genuinely cares.  The aforementioned study found that co-worker support was also repeatedly mentioned by the interviewees.  Some reported their coworkers worked to assist them, asked how they were doing, and included them in social activities outside of work before they returned to modified duty.  Others recalled negative experiences of co-workers making hostile comments, or ignoring the injured worker.  Management has a key role to play in addressing negative treatment of co-workers who return to modified duty after a work injury.

• Appraisal:  feedback regarding performance, social comparisons

While this can be a delicate topic, it's important for supervisors to understand an injured worker's need for feedback once they return to work.  This allows for open communication about the injured worker's recovery, the appropriateness of the duties assigned to them, and their overall experience back at work.  Treating employees fairly, whether on restrictions or not is key and should not be overlooked.

An employer's relationship with their employees should provide support in these four areas before an injury occurs.  Work to strengthen these relationships today and it will undoubtedly help when you are working with an injured worker on modified duty.

Source:  Lysaught, R. M., & Larmour-Trode, S. (2006).  An exploration of social support as a factor in the return-to-work process.  Work, 30, 255-266. 

The Snowball Effect of Employee Satisfaction

If the words “employee satisfaction” incites eye rolls from your management staff, then share this post with them next time you discuss your workers’ compensation program. 

A 2011 prospective study of work-related low back injuries indicates that what employers do after a work injury can have a significant impact on the injured worker’s recovery level.

Loss reduction efforts that improve employee satisfaction may also improve the injured worker’s outcome.  This study found that injured workers who were both satisfied with their employer’s response to the injury and their doctor’s treatment experienced better scores on leg and back pain scales, tests of function, and quality of life scales.  It’s important to point out that it wasn’t because the doctor wrote them out of work or gave them a warm and fuzzy feeling – the study indicates that satisfaction regarding the effectiveness of treatment is what contributed to the reduction in symptoms and functional limitations. 

The effect of the employer’s treatment of the claim was just as important as the medical provider’s treatment of the injured worker at 6 months post-injury.  Even more interesting is that at 1 year post-injury, the importance of employer’s treatment of the injured worker continued to grow.

In practical terms, this makes sense.  Think about an injured worker who has been disabled from working for a period of 3 months as the result of a significant injury.  If an employer responds negatively, or fails to stay in contact with the injured worker, the relationship begins to deteriorate.  How would you feel if you were out of work for a significant duration and no one seemed to care?  An understanding employer who is willing to work with an injured worker will gain the reputation of an employer who cares about the well-being of their employees.  This reputation travels faster than the speed of light.  I’m sure you could name three places right now that you swear you’d never work – and not just because of the type of work, but because of how they reportedly treat their employees.  Fact or fiction, it doesn’t matter if potential, future job applicants hear this.

Using deductive reasoning, one could conclude that what is good for the injured worker’s recovery is also good for reduction of claim costs (and good for the company).  The authors report a 30 percent reduction in claim costs attributable to higher satisfaction with claim treatment and likely due to a reduction in lost time claims.

Reference:  Butler, R. J., & Johnson, W. G. (2011).  Loss reduction through worker satisfaction:  The Case of workers' compensation. Risk Management and Insurance Review, 14(1), 1-26.  doi: 10.1111/j.1540-6296.2010.01188.x

Did this topic interest you?  Check out our related posts:

RTW and Injured Workers -- Its all in their heads!
Call me -- maybe?
Modified duty job offer letters communicate more than just RTW details

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?

What's the deal with blame in a 'no-fault' system?

Although this may sound like the intro to an episode of Seinfeld...it's not. No bulky white sneakers, classic cut jeans, or improv-funk music playing in the background here...

There's a lot of information about social support for people suffering from non-occupational illnesses, but it is less common to hear about the role that social support plays in an injured worker's recovery from a work injury. 

Why??
As humans, we tend to seek out the "why" and a justification to events that we can't explain -- some may refer to this as fault finding, or the blame game.  Maybe it's easier for us to give sympathy to people who are diagnosed with a non-work related illness because "it isn't their fault."  Despite work accidents being just that, accidents, it is human nature to attribute some individual responsibility for what happened.  However, come to think of it, I've never met anyone with a back injury or an amputated finger who wanted to experience the pain or fear associated with these injuries -- very few people ever intentionally cause themselves harm in an attempt to "get workers' compensation benefits."  We could just as easily say to ill individuals -- well, you really should have done a better job washing your hands, or perhaps done more exercise or improved your diet.  Either way, how we got here doesn't really matter (except for future injury prevention, and maybe subrogation potential -- but that's for another blog). 

So, you've experienced a work related injury -- what are you going to do about it?  

The goal of any workers' compensation program is to restore an injured worker to their greatest level of function and earning capacity by providing appropriate, prompt medical attention.  Early, suitable, return to modified duties is one of the best ways to assist in an injured worker's recovery. 

Instead of pointing a finger at an injured worker, point them in the right direction for recovery.
Numerous studies have shown that an employer's initial response to a work injury and continued follow-up can have a significant impact on the outcome of the claim - including when an injured worker returns to work, the amount of treatment they require, and their eventual return to full duties after a work injury. 

Sure, if there's a safety violation or concern, they should be investigated and addressed.  But focus on the processes your employees are completing and the environment in which they are completing them. Yes, we should be concerned if the individual is acting in unsafe ways, but don't be afraid to look at the big picture (or in the mirror) to determine if the structure and company culture "allow" it or make it the norm.  We all have a role to play in injury prevention...just don't forget about the role each of us play in an injured worker's recovery.

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

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

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

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

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

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

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

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

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

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

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

Changing discourse by changing the injured worker's course

This week's post was inspired by another blog (Managed Care Matters) as two quotes in an April 10, 2013 post hit on two very important points when discussing RTW:

"... 'there’s no condition so disabling that there isn’t someone in the US with that condition working full time today.'”

and...

"You don’t get better and go back to work, going back to work is a part of getting better!”

Disability means different things to different audiences.  According to the U.S. Social Security Administration a person is "disabled" based upon their inability to work and if:

oYou cannot do work that you did before;

oWe decide that you cannot adjust to other work because of your medical condition(s); and

oYour disability has lasted or is expected to last for at least one year or to result in death.

Here's an experiment for you to try at home.  Ask someone what they think of when they first think of a disabled person.  I would be inclined to state that their initial response includes some description that focuses on the physical abilities or limitations of the person rather than the limitations placed on their ability to earn wages.  Now, ask someone what they think of when they think of someone out of work due to a work-related injury.  Was their response the same?  I'd be inclined to state that their response related to the monetary impact.

Why?

Why 'make work' doesn't make sense

Some jurisdictions prohibit it.  Others allow it.  Employees despise it.  We're talking about make-work.  Also known as "busy work."  Sometimes overzealous employers proudly state, "I'll make him count paperclips for 8 hours a day if I have to!"  The good news is, with ecovery, you don't have to.

If you are one of those employers, or a person who has personally suggested this as an option for modified duty, please ask yourself what benefit is being gained from this?

An employer is paying an injured worker wages to do a non-productive task 
Why not try to develop some type of work that provides some productivity in exchange for the wages they are receiving?  How is this helping you reduce costs or make a case to highlight the benefits of modified duty to your employees? 

It sours the employer-employee relationship
How would you feel if you were legitimately injured and were brought in to do such menial, tedious, tasks?  I'm not so sure I would be motivated to get better -- some may be motivated to be taken out of work altogether.  Employers may think that if the work is undesirable, it will motivate someone to return faster. The message really being communicated is that the employer questions the legitimacy of the injury or the restrictions and thinks they can motivate the injured worker to "miraculously recover faster."  This can lead to an injured worker returning sooner than medically advisable and result in a re-injury.  Modified duty does not mean "light duty."  It is a modification of an injured worker's pre-injury job, or a group of productive tasks that are grouped to create a modified duty position temporarily.

Reasons Injured Workers Return to Work

In a 2010 study of 168 individuals who sustained non-life-threatening orthopedic injuries, it was found that participants who reported "high social functioning" two weeks post-injury, were roughly 2 1/2 times more likely to return to work (Clay, et al., 2010).  This same study reported that financial security and perceived ability to return to work were not statistically significant. 

Clay et. al, (2010) also found that "Ninety-three percent of respondents who reported the need to use work "to fill the day" were back at work by three months, compared to 66% who indicated other reasons" (p. 7).

The psycho-social factors and environment are equally important as the physical injury in the return to work process.  While we cannot influence the injury we can influence the socialization of injured workers. 

What amount of effort does it take on behalf of an employer or coworker to make a phone call to chat with the injured worker, keep them apprised of any developments at their workplace, or even to send a "get-well" card?  Very little.  The ROI on a 99 cent get well card is potentially tremendous.

So when an employer feels as if they don't have control over the WC claim, and that all power rests in the hands of the injured employee and their treating physicians, remember this post, and it might be a good idea to reference this post as well, oh and this one is probably useful, too. 

When we discuss the concept of Return to Wellness as opposed to return to work, we’re focusing on all aspects of a workers’ compensation claim.  Not just the financial impact, but how we need to treat the injured worker as a person who has sustained an occupational injury and not as a claimant. Returning injured workers to wellness using a bio-psycho-social approach -- treating the injury, treating the individual and acknowledging the positive impact that returning to the workplace (environment) after an injury can have on recovery.

Source:  Clay, F. J., Newstead, S. V., Watson, W. L., Ozanne-Smith, J. & McClure, R. J.  Bio-Psychosocial determinants of time lost from work following non life threatening acute orthopaedic trauma, Bio Med Central Musculoskeletal Disorders 2010, 11:6. http://www.biomedcentral.com/1471-2474/11/6


 

Hold your fire!

Things to consider before you terminate an injured worker who is receiving workers' compensation benefits.

Please note, we are not employment/labor law specialists, nor do I play one on tv -- this post should not be construed or used as legal advice on how to handle employee terminations, it is simply an attempt to make employers aware of the impact a termination may have on their workers' compensation program.  Now we've got that covered...

Don't terminate an injured worker simply because you [think you] can't accommodate their restrictions

Often times an injured worker is given challenging restrictions that an employer believes they cannot accommodate.  The employer sees no possible way of bringing the injured worker back to work, but somehow temporary restrictions result in a long-term action.  The injured worker served a key role in their operations, and they need to replace him. 

I see two problems with this line of thinking.  Problem #1:  The employer has assumed that the injured worker can do nothing.  That is contradicted by their release to return to work -- the doctor is stating that they can do something, albeit not their pre-injury job.  I implore employers to take 45 minutes (not even an hour) to sit in a room and come up with 5 examples of modified duty work the injured employee could perform.  Act as if your livelihood depended on it, because in some cases it does.

Example:  The employer values the employee's contributions, but needs someone to help pick up the slack.  So, while you have Joe working to make up for Maria's work, can't you have Maria help out with some of Joe's duties?  Or, perhaps you need to bring in a temporary worker -- there is a learning curve which equates to lost production, increased hours, increased error rates or declining piece rates -- use Maria's skills and knowledge to help train her temporary replacement. 

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

Last week's post addressed Maslow's needs of Biological, Safety and Belongingness.  Picking up where we left off, here are the last two...

Esteem Needs

Esteem is the human desire to be respected, valued and accepted by others.  Independence is closely tied with self-esteem.  Not until an individual has satisfied their basic biological, safety and belongingness needs, will they be able to focus their efforts on striving for more, achieving more and gaining status among the group.

How can an employer help satisfy this need?

Employers should treat employees, injured or non-injured, with respect and provide them with the opportunity to return to modified duty.  Transitioning an injured worker from restricted to unrestricted work increases a sense of responsibility, control and independence. Without support of esteem needs, learned helplessness may develop, leading an injured worker to lose a sense of accountability, ownership and ability to influence their own situation, despite being given opportunities to do so.

Self-actualization Needs

From 1980-2001, the Army’s recruitment slogan was “Be all you can be.”   It’s about personal growth and performing at your peak.  I highly doubt that any of us will ever reach our peaks in all areas of our lives, as the bar will continuously be raised, just out of reach.  Self-actualization is reached when a person's mental and physical needs are met, enabling an individual to operate at their maximum potential.  Think of it as the best "you" that you can be.

How can an employer help satisfy this need?

Employers play a key role in providing employees with opportunities for growth, advancement, and fostering potential in their employees.  Take the skills of an injured worker and allow them to be used as a modified duty option.  Cross-train employees in various departments to help improve their skills and knowledge within the organization.  By improving an employee’s skills, you’re improving the competitiveness of your company.  After all, your employees are your most valuable asset.

While this is an extrapolated and somewhat diluted take on Maslow’s theory, there is a relationship between employee motivation and returning an injured worker to wellness after a work related injury.  There has been much debate and criticism of Maslow’s "Theory of Motivation," but it remains one of the most widely referenced theories on human motivation, from introductory psychology courses, to risk management books, to political activism.

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

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

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

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

 

Biological Needs

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

How can an employer help satisfy this need?

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

Safety Needs

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

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

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

How can an employer help satisfy this need?