Return To Work Program

The Laraway Group LLCLoss Prevention Services

A post injury procedure created to ensure quality medical care, contain medical costs, and reduce opportunities for litigation.

Objective is to return the injured worker to full duty at the earliest possible time.

Definition of Return To Work

Be proactive in the process. Focus resources on:

Educating your employees. Loss reporting. Be open, flexible to modified work duties.

Does management have a role ?

Work is always the best medicine. Companies commitment to partial/total

immediate accommodation is required. Communication with all parties is vital.

◦ Employee◦ Family◦ Physician◦ Insurance carrier◦ Medical Case Manager

Things you should know

The success of this process is reliant upon a solid partnership between management, employees, medical providers, and your insurance carrier.

Without this, it’s bound to fail!

Things you should know

Modified Work

When an injured employee is brought back to work and placed temporarily in an existing job that is not as difficult or strenuous as their normal job.

Must meet the attending physicians restrictions.

Methods to return your employee back to work

Restricted Work

This is where an injured worker is brought back to their normal position/job, but with restrictions placed by the attending physician.

Examples of this could be a 15 lbs. weight restriction and/or no more than 20 hours a week.

Methods to return your employee back to work

Temporary Assignment

This involves positions that are specifically created to accommodate the restrictions of a doctor. They may have been previously established or created as injuries dictate.

Methods to return your employee back to work

Sometimes known as a Return To Work Coordinator.

They facilitate the process of returning the injured worker back to work as soon as medically appropriate.

They also act as a liaison between the employer, doctor, and the insurance carrier.

They are a medical professional in some area of healthcare.

What is a Medical Case Manager?

Ensure quality medical care for your employee.

They help contain medical costs by analyzing doctors orders/requirements, and challenges if deemed unnecessary or inappropriate.

They have access to all medical files. Vast majority of the time they will

accompany the injured worker to appointments.

What is a Medical Case Manager?

They work for the insurance carrier or they are sourced out to a Medical Case Management contractor.

They also give patient education regarding their injury and treatments.

They reduce opportunities for litigation when they are an independent third party.

Their sole purpose is to return that injured worker to full gainful employment at the earliest possible time.

What is a Medical Case Manager?

Please have a compassionate response. Be sure to give an explanation of benefits. Fill out the WC-1. Maintain the employee communication. Provide the doctor or the Medical Case

Manager with a Job Analysis. Obtain the doctors physical capacities

evaluation or release.

When an Injury Occurs

Put together a Work Transition Offer or sometimes referred to as a Return To Work Offer.

Make sure the offer is within the attending physicians parameters.

Decide the hours and days to work. Agree on a rate of pay. Present the offer to employee with

managements presence.

Employee released to light duty

Provide the doctor with a modified job description.

Ask what it would take to have the employee released back to work.

Employee not released to light duty

It is his/her right to do so. Employees may reject a RTW offer, but

rejection of such an offer may present cause for termination of benefits.

In addition, if an employee misses 3 consecutive doctor visits, termination of benefits may proceed as well.

Employee refuses to accept the RTW Offer

It is the right of the employer as well. If the employer is receiving premium credits

from their insurance carrier, they may lose them.

Injured worker may self refer to vocational rehabilitation.

The employer is liable for expenditures related to it.

Employer refuses to offer RTW

He/She initially does not have to disclose the claim to the additional employer.

This is predicated on if it’s the same type of work.

Claims adjusters will know this when they do their 3 point contact.

Many variables may affect this concurrent employment.

If employee has another job

1 year? 3 years? 2 years? 5 years?

How long does an employee have to file a claim?

Irrelevant. Carrier is still stuck with the claim.

What if the employer lays him/her off?

Irrelevant. Carrier is still stuck with the claim.

What if the employer closes operations?

The employer has the right. The carrier will determine validity. If employer does not file a WC-1, then the

injured worker can file a WC-5 at the DLIR. Employer and the carrier will be notified via

mail.

Does the employer have a right to deny a claim?

Anything paid out on a claim will affect your experience modification rate and loss ratio (which are contributing factors in dictating your premium), so it is in your best interest to find something for that injured worker to do to lessen the expenditures of the insurance carrier.

This has a direct relationship.

INSIGHT!

Mahalo for your time.

Aloha