A Return-to-Work process should become part of your business solutions for both the worker and enhanced profit margins.
By Michael Ladd
Many companies today are re-examining their efforts to control workers’ compensation (WC) disability costs. In our current business environment, the return-to-work (RTW) process is no longer simply nice to have, it has become an owner or boardroom issue.
The primary purpose of the RTW program is to return eligible employees to the workforce as safely as possible at the earliest, medically allowable date. A big opportunity for cost savings may come in the avoidance of litigation. The company’s resources for managing the RTW process determine the overall effectiveness of its program. When implemented, these simple steps could result in fewer lost days, decreased wage loss for employees and greater employee morale. That is a good outcome for everyone.
So where do you start? The best practical solution is to expand your safety program by adopting a formalized RTW program. Write a policy statement and identify a return-to-work coordinator. The policy statement should outline your company’s commitment to the RTW process and to help injured employees get back to work. Include the expectation that all employees will participate.
Every business in the United States faces three important emerging issues. The first is health care costs, which continue to rise faster than inflation. Those costs are reflected in the medical care costs. Employers are feeling increased pressure to contain the workers’ direct compensation costs.
The second emerging issue is the average age of the U.S. workforce. The majority of the baby-boomer generation is now in their late 50s to mid 60s, but the economic recession, rising medical costs and low retirement savings have influenced workers to delay retirement. According to the U.S. Bureau of Labor Statistics, the total labor force was projected to increase 8.5% between 2006 and 2016. The most dramatic growth is projected for the two oldest groups: workers aged 65-74 and those aged 75 and older, both of which are predicted to soar by more than 80%. Older workers typically require more total loss days to recover from an injury, so WC expenses are expected to be higher.
The third emerging issue is the rising obesity rate of working adults and teenagers who are entering the workforce. The percentage of adults from 20 to 74 years old and clinically classified as obese has more than doubled. A study published in 2010 by the National Council on Compensation Insurance Inc. noted that there is nearly twice the injury frequency for obese workers. In addition, the medical costs for the same injury are three times higher among obese claimants in the first year, rising to five times higher at 60 months.
12 steps for an effective program
The RTW process has multiple steps. Naturally, implementing all of the steps will provide your company the opportunity for the most potential cost savings through improved productivity and increased employee morale. Start with a few steps at first. As your program evolves, add more steps until your company has its own fully customized program in place.
Step 1. Explain to the workforce that the company’s WC insurance will pay for their medical bills related to on-the-job injuries and compensate them for their lost salary based on your state’s WC commission regulations. List the WC benefits employees can expect to receive, and detail how much pay the worker would be entitled to and the maximum allowable payment under the law.
Also, outline a basic action plan to prepare employees to respond correctly to work-related injuries. Employees who are injured should understand the procedures and be given a handout that explains their coverage in whatever languages they speak.
Typically, the employee is paid two-thirds the average weekly wage. The amount is not taxed, but it will be less take-home pay and therefore may present a potential economic impact on the worker and family.
Step 2. Pass out insurance cards that list your company’s name, address, phone number, insurance company’s name, policy number and WC policy expiration date. The card helps the clinic or hospital start the process correctly. Even better would be to have a RTW kit that provides the insurance card along with names and phone numbers of people you want the medical caregiver to contact for information. Also, include a job description and a job function evaluation (JFE) form in the kit. The job description and JFE give the medical provider a better understanding of the job’s physical expectations. Step 11 provides more specific details.
Step 3. Workers need to report injuries to their supervisor or crew leader. If the potential injury is not a broken bone, deep cut or something worse, many workers will want to wait and see if the pain goes away. That is not what you want them to do! Remind workers to report injuries even if they do not go to a clinic or hospital. Contact the worker the next day to find out if the pain from their injury persists or if he or she has a limited range of motion. If the pain has not diminished, advise them to seek medical attention. The company then needs to notify its insurance carrier of the injury.
Step 4. Provide the injured employee with immediate assistance to stabilize and address any bleeding until the emergency service arrives. Basic first aid supplies are necessary for compliance with state and federal employee safety laws and regulations. Local Red Cross chapters provide first aid training.
Step 5. Pre-select a physician or a clinic where your company would send an injured worker for treatment. This is an important step; however, you should be mindful of specific state laws that may restrict the employer’s ability to participate in the selection of medical providers for injured workers.
When selecting a medical care provider, consider the clinic’s hours, security, location, credentials, customer service and quality of care. Take every opportunity to communicate with your selected medical provider and build a working relationship.
Step 6. For minor injuries, appoint someone to transport the injured worker to the medical provider and take along the prepared RTW kit for the medical provider to review. Naturally, an ambulance will transport a seriously injured person to the closest hospital emergency room (ER).
Step 7. Having the foreman or supervisor on board with the RTW process ensures the injured employee gets the help he or she needs. Having the key people understand and support the RTW program may prevent an unnecessary ER visit, ensures the injured worker will not be mistakenly billed for the medical treatment, and provides another source of information for the physician. The foreman or supervisor should speak to the physician after the exam to determine how to modify the injured person’s original job or work tasks so the employee can return to work and not aggravate the injury while recuperating.
Step 8. If the injured worker requires extensive medical care involving prolonged time away from work, contact him or her within 24 hours of the accident to determine his or her condition, family needs and treatment progress. It is critical to make contact with a spouse or other family member, as family is important in making the employee feel wanted and needed back at work. Follow up with the injured worker at least every other week and assure him or her of your company’s commitment to his or her well-being. While expressing concern, remember to honor the privacy protections afforded personal medical information.
Step 9. Report the accident to your insurance carrier promptly so cost containment efforts can begin. Reporting a WC injury to the insurance carrier within 24 hours can lower the accident’s total direct costs by 5 to 6%. A delay in reporting can increase the cost of the injury.
Establish a RTW record that includes a copy of the accident report, a job description, copies of medical bills, progress reports from the physician, and a log of your conversations with the physician and your employee. This will assist you in tracking the current claim and establishing a model for handling future claims. Maintain control of the process to help the employee return to work as soon as practical.
Step 10. Complete an accident investigation and secure any evidence as soon as possible to understand the circumstances that led to the accident or injury. The primary focus is to prevent future occurrences. Contact the insurance carrier’s claim department for further guidance in handling the evidence.
Step 11. Present the medical provider with a job description and a JFE document when the injured employee goes to the doctor for the first time. The JFE provides the treating physician with an objective description and quantification of the injured worker’s job tasks. The evaluation should be completed for all jobs within your company to help the treating physician and related health care professionals determine the suitability of alternative job tasks, which may allow the injured person to return to work sooner with a temporary medical restriction. Explain the basic work activities needed to perform the job functions and estimate the frequency for each posture during a work shift.
Indicate whether the work is performed indoors or outdoors, and whether the job is performed in extreme temperatures. List or describe any personal protective equipment required, such as face shield, safety shoes, hard hats, etc.
Step 12. Having an effective transitional work assignment might result in a 10 to 25% reduction of WC indemnity costs. Identifying opportunities for transitional work at your plant, considering modifying existing jobs and involving employees in the development and implementation of the transitional work encourages a feeling of ownership and maximizes the opportunities for success.
It is common to limit the timeframe for a modified job to just 30 days. After that time period, it may be appropriate to establish another transitional work agreement with expanded physical capabilities and lesser medical restriction. Each revised work agreement sets new goals while the worker regains strength, flexibility and endurance. Do not forget to notify the insurance claim department so the adjuster can coordinate any change in benefits.
Implementing an early RTW process has the potential to control the work-related injury costs and reduce the frequency of injuries by being aware of a worker’s tasks. It provides workers the ability to return to work in some capacity when they cannot immediately return to their original positions due to injury or illness.
Paying injured workers their pre-accident rates of pay while on modified work keeps costs down while allowing them to focus on their recovery until they return to their original jobs. WC costs grow as income replacement benefits continue to be paid during the injured worker’s absence.
An effective RTW process could result in an estimated savings of much as 10 to 40% of WC medical costs and 10 to 25% of wage replacement. Having an effective RTW process in place makes good business sense.
To see how much money your company could save by reporting injuries sooner and returning injured employees to work sooner, please visit www.CNA.com/returntowork. There you will find two cost savings calculators. You can also download various forms, questionnaires and checklists to help start a RTW program or strengthen an existing one.
Michael Ladd is the consulting director of industrial hygiene services for CNA Insurance’s Risk Control Department. He is a certified safety professional, a certified industrial hygienist and an Underwriters Laboratory-recognized risk engineer. He has more than 30 years of experience providing various consulting health-hazard services to a wide range of manufacturing, construction and service industry clients.
This material is for illustrative purposes and should not be construed as legal or other professional advice. All products and services may not be available in all states and may be subject to change without notice. CNA recommends professional counseling for these situations.