Return-to-work programs

Scope

Return to work programs are not required by any law or regulation. Effective RTW programs seek to bring employees back to work after an absence due to an injury or illness that physically restricts the worker. When injured or ill employees are off work for an extended period of time, they often develop a set of common problems other than the injury or illness itself. Examples of common problems may include:

• Progressive loss of self-esteem and depression
• Fear of re-injury, and of a delayed recovery
• Exaggeration of the physical and psychological demands of their job
• A feeling of loss of control over their lives, often seeing themselves as victims
• Marital or family problems
• Alcohol/substance/medication abuse
• Weight gain

Regulatory citations

• None

Key definitions

• None

Summary of requirements

The primary goals of establishing a return-to-work program are to decrease costs associated with disability, improve outcomes through a speedy recovery, and generally improve employee morale.

An effective RTW program should benefit all employees, whether or not the disability is work-related. To reserve assistance for only work-related cases tends to encourage employees to turn non-work-related disabilities into workers' compensation claims to get the additional benefits. It also sends the message that you are only concerned with managing these costs.

The likelihood of a successful RTW program is enhanced if both the injured employee and you perceive it as being beneficial. Unfortunately, the general rule is that employees and employers often hold diverging perspectives concerning the consequences of a work injury. Understanding the perspectives of each is necessary in dealing effectively with work injury and work re-entry.

Multiple factors may potentially affect an employee's return to work following a work-related injury/illness. Work re-entry may be affected by the following:

• Medical status
• Physical capabilities and limitations
• Physical status
• Work tolerance
• Psychological/behavioral resources
• Worker traits
• Psychological readiness
• Pain management
• Work demands
• Bio-mechanical (physical)
• Psychological

Employee education. Develop an employee education packet for all employees who sustain a work-related injury, and in a caring manner, explain what will happen. Inform the employee which company representative will be following the medical case to ensure best possible care. Indicate that you will be assisting in a safety investigation to provide accurate information to the insurance carrier.

Give a thorough explanation of how workers' compensation works in your state and how the law regulates the claims process and benefits. Be sure that you have all of the names and numbers to call if there are any questions related to benefits, scheduling, or human resources. Explain the early RTW program, and the employee's responsibility to provide timely RTW information from the doctor. The employee needs to know who the workers' compensation carrier is, and that the carrier may contact the employee. Check back with the employee regularly to see if there are any questions about the system.

Many employees have the sense of being out of control and at the mercy of the system; however, providing education, and establishing responsibilities for return-to-work issues can put them back in control. Providing this information in a caring way can help their self-esteem and give them confidence that they are an important part of the team. Focus on the employee's well-being so that you are not perceived as pushy or nosy, act as a resource and a liaison, and allay fears that they will lose benefits for asking questions.

Support for the injured/ill worker. Develop a company policy whereby management personnel or the immediate supervisor is on hand immediately after the injury. When the employee needs emergency medical treatment, someone should accompany the employee to the hospital/physician's office, even if the employee is taken by ambulance, thus reassuring the injured worker that he or she will receive proper care.

There may be urgent questions regarding the employee's work environment or exposure that the company nurse or supervisor can provide for the medical provider. The supervisor can inform the provider that work restrictions will be accommodated if at all possible.

Management and supervisory personnel must understand all the components of work injury, and they need to appreciate their role in the management of the injury. At your company, it may mean that they accompany the individual to the doctor, or they may supervise the restricted duty.

Your company policy should be made known to supervisors, and it should indicate what their roles are within the company. In general, the supervisory staff should be taught how to stay in weekly contact with the employee and offer support when he or she returns.

Enlist the supervisor's involvement and cooperation and participation in:

• Knowing the facts surrounding the incident by being involved in the investigation.
• Knowing the nature of the injury, and how long any resulting disability or restricted duty is likely to last.
• Reviewing the return to work restrictions by consulting with others if necessary - nurse, treating physician, human resources, or safety personnel.
• Being responsible for the identification of appropriate restricted duty, consistent with the physician's recommendations. The job or task should be meaningful and necessary, but need not be necessarily desirable in the employee's mind.
• Being responsible to see that the injured worker assigned to a restricted duty job understands the restrictions.
• Maintaining regular and personal contact with the injured worker.
• Determining the source of any problems the employee experiences in the performance of the assigned, restricted duties; the supervisor should determine the source of these problems and deal with them accordingly.

Communicate with the medical provider. Communication with the treating doctor is one of the most important factors in return-to-work programs. Provide the attending physician with a written summary of the physical demands of the employee's customary job, and notification of the availability of restricted-duty assignments.

A great frustration for company officials is that a physician may feel in charge of determining the employability or placement of the injured employee, while not having first-hand knowledge of the employee's original job. It should be the treating physician's primary duty to offer specific restrictions and statement of the returning, injured worker's capacities -- not to determine placement or employability of that worker.

If the physician is uncertain as to the injured worker's functional capacities, and the company requires a more accurate statement of what the employee can do, a Functional Capacities Examination (FCE) will assist all interested parties in the work accommodation process.

Following are some common categories of medical restrictions for which work accommodation are often sought:

• One-handed limitations,
• Force and weight restriction,
• Range of motion restriction,
• Standing/sitting/walking,
• Bending/twisting/stooping/squatting,
• Climbing,
• Limited work hours,
• Wetness restriction, and
• Repetition limitation.

Priorities when establishing return-to-work objectives. An effort must be made to return the employee to the previous job under the same supervisor; this accommodation will best use the employee's prior work experience. The transition back to work will be less stressful because the tasks, personnel, and work area will be familiar.

In the event that the employee is unable to perform the customary job with/without job modification, place the employee in a transitional job within the same department or customary surroundings and under the same supervisor. When a transitional job is unavailable within that department, place the employee in an alternate department or situation where acceptable transitional work is available.