Best Practices for Transitional Return-to-Work Programs: Light-Modified Duties & Permanent Return

Lost time is one of the top cost drivers in workers’ compensation.

Effective transitional return to work (TRTW) programs are the best tool for reducing lost time.  A TRTW program significantly reduces workers’ compensation costs, strengthens employee engagement, and helps employees quickly recover from injuries.

Return to work is one of the best tools for the injured worker to help facilitate the recovery from an injury. Early return to work also reduces the litigation rate.  

Companies that do not or will not provide light or modified duties shoot themselves in the foot regarding their workers’ compensation costs and results.  Light and modified duties should be one of the underwriting criteria for insurance companies.

The most effective TRTW programs include the following components: 

• Pre-injury planning on the part of the employer
• Post-injury implementation
• Establishing, capturing, and monitoring TRTW goals and metrics

Building the RTW infrastructure pre-injury

Steps employers can take to develop an effective TRTW program:

• Develop current job descriptions and share them with the Treating Physician, Physical Therapist,  Nurse Case Manager, and Claims Examiner.  A current, accurate job description can be used by all parties to help focus the injured worker’s treatment and recovery toward complete duties.
• Identify potential temporary light-duty assignments for each appropriate job category. Some companies may not be able to return injured employees to temporary positions. If so, work with your TPA or insurer to identify potential temporary light-duty assignments in local non-profit organizations and volunteer sites.
• Develop and publish a formal return to work program. Clearly define the company’s TRTW goals, establish a clear and consistent policy, communicate that policy throughout the company, and regularly measure and report performance. Consider how that program might help beyond workers’ compensation, such as in returning employees out on short-term and long-term disability or for non-work-related medical issues.
• Communicate the company’s TRTW policy to set expectations for the front-line supervisor and employees. Train supervisors not only on the process but also on the best ways to communicate. A Liberty Mutual study found that employees reporting to supervisors with proactive, open communication styles were away from work less often and for shorter times.
• Partner with a claims administrator who understands the importance of RTW and will implement it within the claims process. Can they identify the small number of claims with psychological and social issues that can lead to more extended absence and hinder RTW? Do they have the professional resources to address these issues and effectively coordinate RTW?
• Review all internal incentives (claims chargeback, assignment of payroll for light and modified duties) to determine if there are any unintended financial incentives or consequences that may hinder the TRTW program.
• Review all internal HR programs that may hinder the implementation of a TRTW program (for instance, a union contract that forbids injured union employees to perform duties outside of their specific union, geographic local, or job description)

Following an injury
The most effective TRTW programs set the expectation of returning to work internally with the front-line supervisors, the treating doctor, and the injured worker. 

• The front-line supervisor should regularly contact the injured worker to encourage a return to work.
• Engage the injured worker. Filing a workers’ compensation claim can be a confusing and tense process. Educating the injured worker on the workers’ compensation process and the claim status is critical to engaging the claimant along the way, including TRTW. For example, Liberty Mutual has seen tremendous value in sending claimants a custom video summarizing what they can expect and providing critical claim information such as their claim number and contact information for their dedicated claims manager.
• Screen for the “yellow flags” shown to predict longer recovery and delayed return. There may be psychological and social issues associated with claimants who catastrophize an injury and pain, have tense relationships with their employer, or fear re-injury, for example. Should any of these be detected, the TPA or insurer should quickly assign the resources needed to address those issues.
• Help the treating physician understand the injured employee’s job duties and the willingness of the employer to return that individual to light duty. A vocational rehabilitation specialist should work with the employer, injured worker, and treating physician to develop a formal RTW plan based on the claimant’s injury, limitations, restrictions, return date, and job requirements.
• Monitor progress when the injured employee comes back to work. An employer should expect the TPA or insurer to track the employee’s progress in the temporary assignment, suggest reasonable accommodations that could allow that worker to return to the former position, and identify and resolve any issues that arise as the employee returns.

TRTW Axioms

• Return to work facilitates early and complete recovery.
• The fear of reinjury is one of the most significant barriers to return to work (for both employers and employees)
• Some injured workers, labor representatives, and applicants’ attorneys do not trust the “company” doctor as a treater because they believe pushing an early return to work creates greater injury exposure. This belief is untrue.

A comprehensive functional job description allows the treating physician and physical therapist to set the ideal treatment plan and recovery goals.