Report Card on Return to Work: B -

Tuesday, November 11, 2014 | 0

The American employer’s performance in returning injured employees to work after an injury has been improving. This reflects greater awareness of the value of promoting return to work and, it appears, better problem-solving skills of those involved. I have cobbled together this report card.

The employer, doctor and insurer are far better equipped today to make the right return-to-work efforts. Listed in the further reading below, you will see some authoritative studies and guides to bolster skills for early return to work.

To grasp how return to work is big business, look at Labor and Industries, Washington’s exclusive state fund. It has wrapped itself around return to work, promoting awareness among the employer community and engendering a large medical provider network in part to prompt and reward medical doctors to develop return-to-work skills among clinicians. Dozens of employees assist employers and claims adjusters to make timely decisions, offering targeted financial incentives through four programs and aggressively promoting “stay at work.” All parties can access a claims data platform that can track in detail return-to-work progress of individual claims.

Ever fewer injured workers suffer long separations from their assigned work due to injury. Between 2002 and 2012, the rate per hundred workers who incurred any lost time from their assigned work declined by a third. Of those who did incur lost time, 38% remained at work in restricted or alternative work. This raises a question: Does “lost time” mean what people think it means?

Workforce experience with what I’ll call “convalescing” from injury varies greatly by type of industry, size of employer and determination and skills of the involved parties.

Let’s look first at variances among industries. In 2012, among warehousing and storage workers, 53% of convalescing cases went directly to restricted or other duty. In construction, only 30% of these cases were restricted duty cases. Some industries are clearly not suited for worksite-restricted duty. That’s why ReEmployAbility, which places injured workers in temporary nonprofit assignments, such as food banks and thrift stores, says it has a good business with long-haul trucking companies. 

Size of employer matters.

Texas reported that between 2004 and 2009, return-to-work rates improved. For employers with at least 500 employees, RTW rates were high at the start, 92%, and remained high. Very small employers started with distinctly poorer results but improved through the years.

The Windham Injury Management Group accumulated information on many thousands of worksite consultations it did to remedy return-to-work failures. Sebastian Grasso, the firm’s CEO, tells me that “small and midsized employers are trying to be productive, reduce expenses, and the supervisor is tempted to give 10 or 15 minutes to the problem. In their minds they have many more pressing issues.”

Liberty Mutual and Canadian researchers also report on imbroglios that complicate return to work. Standard task restriction forms fail to address unique aspects of the job.

A supervisor told one researcher, “Even if the functional abilities form tells me that some doctor has said 'yes this worker is allowed to lift so many pounds over their head, or stand so long, or walk so long,' it really doesn’t give me a great picture as to what they’re capable of.” Grasso notes that a workstation may be set up for the 50th percentile of workers, 5' 6", 150 pounds, but the workers come as a 4' 11,” 155-pound woman and a 6', 206-pound man.

A cloud of mistrust may hang over the worker and supervisor, both of whom may be overly emotional. Privacy is compromised. The returning worker faces the prospect of pain flair-ups and re-injury. Fellow employees observe all this; the claims adjuster and telephonic case manager are literally and figuratively in another area code.

It’s time to raise the bar of expectations for claims payers, in four ways. One way is to make sure that an objective, trained, and articulate third party is available for a visit to the worksite to coach all parties toward a positive solution. 

A second way is to insist on accurate work disability data for each injury. Rising Medical Solutions’ survey of claims practices reveals that while claims executives regard return-to-work management as a core competence, less than half use actual results to measure performance.

Third, employers and insurers need to take a deep breath and commit to harmonizing their return-to-work approach with the American with Disabilities Act’s demand that all job accommodation practices of an employer be reasonably consistent, and that the worker be engaged to the extent possible. Many (most?) workers compensation professionals treat the ADA with studied avoidance. California’s tough laws are now close to turning this avoidance into something approaching professional malpractice.

Jeff Kadis, a workers’ compensation defense attorney in Charlotte, tells me that he is “working more and more with the employment law practitioners” in his firm because job accommodation has become a global issue at the worksite. He will talk at the National Workers’ Compensation and Disability Conference in Las Vegas this November.

Finally, let’s consider changing the name of what we are doing from Workers’ Compensation to Workers’ Recovery, as Bob Wilson has been urging.

Further reading:

American College of Occupational and Environmental Medicine. Preventing needless work disability by helping people stay employed. 2006.

American College of Occupational and Environmental Medicine. The personal physician’s role in helping patients with medical conditions stay at work or return to work. 2008.

Disability Management Employer Coalition. How accommodating is your RTW program? Employer best practices in ADA accommodations. 2013.

Integrated Benefits Institute. How employers look at integrating health and productivity management: a survey of integrated benefits best practices. 2002.

RAND. How effective are employer return to work programs? March 2010.