Building a Great Return-To-Work Program

By Kevin Ring

Kevin Ring is the Lead Workers’ Compensation Analyst for the Institute of WorkComp Professionals, which trains, certifies and mentors insurance agents to help employers reduce workers compensation costs. A licensed property and casualty insurance agent, he is the co-developer of a workers comp software suite that will help insurance professionals in working with employers.

No matter what term you use – Light Duty, Return-to-Work, Recovery-at-Work – virtually everyone involved in workers’ compensation knows it is an important component of a successful program. Multiple studies have conclusively shown that injured employees recover faster and are more likely to return to their jobs when they return to work in a restricted duty position rather than staying home until they are fully recovered. Recovery-at-Work also decreases the likelihood an injured employee will retain an attorney, which doubles the cost of an injury (at a minimum). Bringing employees back to work can limit or eliminate lost wage payments as part of the workers’ compensation claim, reducing the impact of the injury on the experience mod down the line.

Why, then, do so few employers have objectively successful Recovery-at-Work programs?

Let’s start with what it means to have a program that is “objectively successful.” It starts with the employer’s approach to Recovery-at-Work. The American College of Occupational and Environmental Medicine (ACOEM) has identified three reasons an employee cannot return to work within three days:

• The injured employee is hospitalized.
• The worker is contagious, and it is unsafe for them to be around other workers
• It is unsafe for them to get to/be at work either because they are medicated or it is otherwise medically necessary for them not to travel

For a Recovery-at-Work program to be successful, an employer must embrace this framework and be committed to bringing any injured employee back if they don’t fit into one of these three buckets.

Being willing to bring injured employees back is only the first step. The employer must have a physician treating their injured employees who shares the same philosophy about Recovery-at-Work. Almost all states give employers some ability to direct injured employees to specific physicians for workplace injuries. It is imperative to take advantage of this right.

While insurance companies frequently provide employers with a list of physicians in their area, employers need to do their homework to make sure the doctor is a good fit.

• Can the office treat the most common injuries? For example, do they perform X-rays in-house or do they have to refer the worker to a radiology clinic? Do they have a slit lamp to assist in getting small objects out of someone’s eye?
• Will they commit to actively communicating with the employer and the insurance company about work restrictions and the worker’s recovery?
• Are they willing to commit to seeing your injured workers promptly and not leave them waiting for hours?

By selecting a doctor to see injured employees, employers can be confident that their employees receive care from a physician who understands occupational medicine and the importance of Recovery-at-Work.

When an injured employee is left to choose their doctor after an injury, they will likely wind up in one of three places:

1. Their primary care physician
2. The nearest urgent care clinic
3. The emergency room

There can be issues with each of these.

The primary care physician

Several things can go wrong when an injured employee sees their primary care physician.

First, it is extremely unlikely that the doctor has any experience with occupational medicine. This doesn’t mean they are unqualified to treat the injury; treating the injury is all they are likely to do. Doctors with training in occupational medicine understand that returning to the workplace plays an important role in the injured worker’s recovery.

Another issue is that an employer who tells an injured employee, “Just go to your doctor,” is unlikely to have done anything to communicate with the doctor about the availability of Recovery-at-Work. This communication can be something as simple as a letter from the employer informing the doctor that they are willing to bring the employee back. Without confidence that the employer will respect any restrictions they might prescribe, the doctor is correct in sending the employee home until they are ready to return to their full-duty job.

The nearest urgent care clinic

Urgent care clinics can be excellent partners in the injury management process. Most urgent care clinics advertise workers’ compensation services and have some degree of knowledge of occupational medicine.

The issue with the employee picking the urgent care that is most convenient to them goes back to employer communication. If the individual treating the injured employee has no information about the availability of a Recovery-at-Work program, they will have no choice but to send them home.

The emergency room

If an injured worker requires emergency medical treatment, or the employer’s selected doctor is not open, the emergency room is where the injured worker should seek treatment. However, too often injured workers will go to the emergency room because they don’t know where else to go. According to the National Association of Community Health Centers, nearly a third of Americans (roughly 75 million adults) do not have a primary care provider. This creates a host of issues, but thinking about work-related injuries, those individuals without a primary care provider frequently go to the emergency room when they have medical issues.

Emergency room waiting times are often very long, particularly for those who don’t have emergency needs. In an emergency room, you are not seen in the order that you arrive, rather the most serious cases are treated first.

The cost of care in emergency rooms is substantially higher than receiving the same treatment in another setting. A 2021 report from Accenture estimated that there is approximately $47 billion in “avoidable” medical spending in emergency rooms each year. This number is for the medical system overall, including employee injuries.

Because emergency rooms are designed to stabilize a patient, the doctor is extremely unlikely to engage in any conversation about returning to work. The injured worker will have to see a different doctor for their follow-up treatment because you don’t go to the ER for follow-ups.

Once an employer has committed to bringing injured employees back and has a relationship with a skilled occupational physician or clinic, the Recovery-at-Work program can begin to take shape.

A common problem in ineffective Recovery-at-Work programs is a lack of planning about the tasks injured employees can do. This leads to situations where the employee is sent back to work with restrictions, and the employer can’t think of anything the injured employee can do.

The solution is to build a Recovery-at-Work job bank. The employer can create an ad hoc committee for this task or assign it to the safety committee if they already have one. Start with the question, “What isn’t getting done as often as it should, or not at all?” Employers are rarely short of tasks that they know need doing, but they never have the time.

Consider the question broadly. Employers frequently think about light-duty jobs exclusively as sedentary work with no physical demands, but that is not required. A light-duty job must simply meet the physical restrictions the doctor has given the injured employee. That might be sedentary, but frequently, it is not. If the employee has a 20-pound lifting restriction, you can assign them work that doesn’t require them to lift more than 20 pounds.

Next, think about what elements of work that could be completed by someone with restrictions. If the business has drivers that deliver goods to customers, perhaps an injured employee could still drive the truck while another employee rides with them to do the lifting and moving of the product. An employee with an arm injury might still be able to place products on shelves with their one good arm. It’s not important that the work get done as quickly as it would by a healthy employee, just that they are back at work being productive.

Employers can also consider partnering with local non-profits. If the employer doesn’t have any suitable tasks, the employee may be able to work the cash register at a local thrift store or work at a soup kitchen. The employer continues to pay the employee their regular wage and the non-profit benefits. There are companies in the marketplace that will help facilitate these relationships.

Bringing injured employees back to work has a tremendous number of benefits. The employee will recover and be back in their job more quickly, the workers’ compensation claim will be less expensive, the injured employee is less likely to retain an attorney, and the employer’s experience mod will be lower. It’s simple, it’s just not easy. The first step is for the employer to commit to building an effective Recovery-at-Work program.

For more information regarding the creation of a comprehensive return-to-work program, schedule an appointment with one of our financial professionals.