What insurers look for in recovery-at-work* programs

The implementation of a recovery-at-work program is on every insurer’s list of workers compensation best practices for employers. The benefits are well-documented. For the employee, the program improves morale, prevents a disability mindset, fosters a connection to the company, maintains social connections, promotes faster recovery times, and enhances self-esteem. For employers, the program helps retain experienced workers, builds employee relationships, and controls costs by reducing claim amounts, lowering attorney involvement, and eliminating the need for a new hire. The Great Resignation further reinforces the need to get the worker back to work as soon as possible and ensure that they feel their injury is being managed properly and that they are a valued part of the workforce.

Some employers, however, assume once in place, the program works effectively. Fast-moving changes in the workplace have probably impacted programs that were in place before the pandemic and it’s time to reexamine. Are job descriptions up to date? Are transitional tasks reflective of all current opportunities? How was the program disrupted by COVID-19? The quality of the program can make a difference in the selection of risk as well as pricing by the insurer during the underwriting process. Importantly, the program will only be successful if all stakeholders are fulfilling their responsibilities and employers are in the best position to take the lead. Each case must be managed individually and at times it will take creativity and commitment to keep the plan on track.

The NCCI recently published a new report highlighting insurers’ perspectives on successful programs. Management commitment that is ingrained in the employer’s culture was identified as the most important component of a successful program. When this exists, management and employees understand the organization is committed to returning injured employees to work in a position tailored to their physical abilities through a formal process that is beneficial for all parties.

Common tools that are effective include:

• Education on the recovery-at-work program: how it works, purpose, and benefits
• Job descriptions/analyses that provide a basis to adjust jobs to the physical conditions allowed for the injured worker. The more individualized and specific, the more helpful for medical providers
• Creating, updating, and maintaining an inventory of light-duty or transitional tasks, which can include off-site volunteer opportunities
• Establishing a relationship with a dedicated medical facility before the injury occurs
• A dedicated program coordinator who is responsible for facilitating light-duty work, acting as a single point of contact for the insurer and medical providers to help streamline communication, providing support for the injured employee, serving as an internal resource for the employer, and liaison with the injured worker’s supervisor
• Medical case managers and nurses who engage with the worker to overcome potential barriers to returning to work and help workers navigate through the managed care network and secure appropriate care
• Supervisor buy-in
• Ongoing communication with the injured worker and review of the modified work

Other key components identified in the report were collaboration, communication, quantification, and setting clear expectations running parallel with management commitment, both before and after an injury occurs. Collaboration between all the parties – the injured employee, the medical providers, the insurer, the agent, and the employer – is critical to establish expectations, monitor progress, and assess potential problems.

Addressing the social and mental well-being of injured workers and their families was considered critical by all insurers. In the industry, severity is largely equated with the costs of a claim. Yet, workers with injuries of very similar severity can have significantly different outcomes. A holistic approach to care and fostering trust in the system keep the recovery process on track.

While medical providers ultimately decide when an injured employee can return to work and establish restrictions, there should be no gatekeepers. The conversation among all stakeholders should focus on abilities and opportunities instead of disabilities and limitations. The claims adjuster is responsible for adjusting the plan to fit the changing abilities of the worker, but employers should proactively provide guidance on altering job descriptions, with input from the medical providers and the injured employee. All parties should work collaboratively throughout the process to ensure a safe and successful return.

The report describes the role of the insurer, the resources most offer, and discusses how to quantify a program’s success. A typical metric is the savings that result from reduced indemnity benefits and the positive impact on the experience mod, which leads to lower premiums. Workers who return to work within the state’s waiting period (three to seven days depending on the state) make their claims medical-only, which do not have the same adverse effect that paid lost-time wages have on an employer’s loss experience.

Many states value medical-only claims at 30%, while lost-time claims are valued at 100%. Contrast a claim where the medical costs total $7,500, but the injured worker returns to work on light duty before the state’s waiting period ends with a claim that has medical and indemnity costs of $7,500, but the employer does not offer a recovery at work program. Although the total cost is the same for both claims, only 30 percent of the first claim affects the employer’s mod, whereas 100 percent affects the second mod. Over the three-year period that impacts the mod, the lost-time claim would cost over $6,500 more than the medical-only claim.

On-going evaluation of the program is critical to ensure cost savings and employee satisfaction. What were the cost savings? Are anticipated timelines achieved? How many cases were litigated? Are there cases that did not progress? Why? As Certified WorkComp Advisors (CWCA), we are trained, certified, and mentored by the Institute of WorkComp Professionals (IWCP) to guide employers to the lowest possible workers’ comp costs. This is our expertise, and we are here to help.

*More commonly known as “return-to-work,” we prefer the term recovery-at-work as it more accurately describes what should happen and lets the injured worker know what to expect.