Return to Work


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Return to Work

  1. 1. Return to WorkSusan ShemanskiVice President, Client ServicesSedgwick
  2. 2. 2SedgwickCMS©2011Confidential–Donotdiscloseordistribute.Why Return to Work?• Return to work is a critical component of any risk management programand requires skillful claims management and coordination• Indemnity benefits account for 42% of the total claim cost• Time away from work drives the ultimate claim cost with higher indemnitypayments and more medical treatment
  3. 3. 3SedgwickCMS©2011Confidential–Donotdiscloseordistribute.Benefits of early return to work programs• Injured workers who go back to work in a transitional duty job will returnto full duty 30 days faster than those who do not• Employers save an average of 30% lost time with a return to workprogram. Less lost time means less medical expenses, less staffing issuesdue to off work employees and less loss of productivity• Estimates indicate employers save between $3 and $10 for every $1 spenton a RTW program• Lowers the experience modification factor used to calculate workers’compensation premiums
  4. 4. 4SedgwickCMS©2011Confidential–Donotdiscloseordistribute.Benefits to the Injured Worker• Allows the injured worker to continue to be productive and tocontribute• Improves and maintains communications between thecompany, the injured worker and the treating physician whichleads to a more positive conclusion of the claim• Allows the employer to monitor the employee’s progress on a dailybasis• Promotes better morale and employee retention• Assists in compliance with the ADA act
  5. 5. 5SedgwickCMS©2011Confidential–Donotdiscloseordistribute.Keys to a Successful ProgramKEYSCommunicationEducationSolidWorkflowsConsistency
  6. 6. 6SedgwickCMS©2011Confidential–Donotdiscloseordistribute.Creating Your RTW TeamEmployerInjuredWorkerClaimsExaminerMedicalProviderAttorney
  7. 7. 7SedgwickCMS©2011Confidential–Donotdiscloseordistribute.Key Plays• Focus on Abilities• Act with a Sense of Urgency• Push for Progression• Have your claims examiner reference Disability Guidelines• Communicate with the Medical Provider• Communicate important changes in treatment or condition to theteam• Track Work Status• Consider partnering with non-profit organizations
  8. 8. 8SedgwickCMS©2011Confidential–Donotdiscloseordistribute.Focus on AbilitiesAlways focus on the injured employee’s “Abilities” rather than“Restrictions”Most injured employees are capable of some form of light duty workimmediately following the work injuryConsider the physical requirements of normal activities of daily living thatan employee continues after the work injuryPresent a job description to the DoctorAsk the injured employee to identify tasks from their normal position thatthey feel they are still capable of performing
  9. 9. 9SedgwickCMS©2011Confidential–Donotdiscloseordistribute.Act with a Sense of Urgencyof employees offwork for fourweeks will neverreturn to work10% of employees offwork for twelveweeks will neverreturn to work50% of employees offwork for fifty-twoweeks will neverreturn work98%Strive to obtain the initial release to light dutyat the earliest possible time
  10. 10. 10SedgwickCMS©2011Confidential–Donotdiscloseordistribute.Continuous ProgressionEmphasize a constantprogression of workabilities through thelife of the claimPursue incrementalmovement toward fulldutyContinue to focus onincreased abilities
  11. 11. 11SedgwickCMS©2011Confidential–Donotdiscloseordistribute.Reference Disability GuidelinesUtilize ODG to help with your RTW effortsGauge the employee’s functional progressPrepare for the initial release to light duty statusMake sure the treating doctor is aware of the guidelines
  12. 12. 12SedgwickCMS©2011Confidential–Donotdiscloseordistribute.Communicate with the Medical Provider Functional capacityWhat can the worker do today? Functional impairments or limitationsWhat can’t the worker do now that they normally could? Medically-based restrictionsWhat is the treatment plan and treatment schedule?What should the worker not do to ensure no additionalspecific medical harm?
  13. 13. 13SedgwickCMS©2011Confidential–Donotdiscloseordistribute.Speak to the EmployeeContact theemployee tounderstandcurrentactivities ofdaily living.Getemployee’sideas oftransitionalduty tasks.Considerexternalfactorsimpactingemployee’swillingness toreturn towork.Does theemployeeperceive anybarriers atwork?
  14. 14. 14SedgwickCMS©2011Confidential–Donotdiscloseordistribute.Return to Work OptionsTake the actions needed to resolve the situation:Normal Return to WorkReturn to Work with Temporary RestrictionsReturn to Work with Permanent RestrictionsConsider Non-Profits if nothing available atEmployer site
  15. 15. 15SedgwickCMS©2011Confidential–Donotdiscloseordistribute.Tracking ProcessTrackPermanentRestrictionsTrack Injuryand RTWprogressagainst ODGTrack Datethat EmployerProvides aTransitionalJobTrack Whenthe TreatingDoctorprovidesrelease toRTWNote ICD9and injurytypeData Allows You to Focus on Continuous Improvement
  16. 16. 16SedgwickCMS©2011Confidential–Donotdiscloseordistribute.Questions / Comments