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Introduction to Early Return To Work For Municipalities

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Presentation on theme: "Introduction to Early Return To Work For Municipalities"— Presentation transcript:

1 Introduction to Early Return To Work For Municipalities
Presented by John M. Cummings, MBA, PHR Personnel Director & Susan Peck, Workers’ Compensation Claims Manager Montana Municipal Interlocal Authority 2. CORE helped develop the integrated disability management industry as we know it today. 3. Our Peer Review Analysis division provides expert medical opinion on almost 60,000 reviews every year, including appeals, ERISA cases, grievance panels and forensic cases. CORE's Social Security Disability Consultants subsidiary manages over 13,000 Social Security Disability claims and appeals each year, and manages Medicare coordination of benefits for 1.2 million large group health plan beneficiaries.

2 Disclaimer (Please Note: All materials, recommendations, and draft personnel policy language provided in this PowerPoint presentation should be reviewed and approved by a City Attorney prior to utilization or adoption.)

3 Montana Municipal Interlocal Authority (MMIA) History:
Mid 1980’s Liability Insurance Crisis. Cities/Towns see dramatic premium increases. Many city policies are cancelled. League of Cities and Towns forms ad hoc committee. Efforts to work with conventional markets fail. Committee looks at self-insurance.

4 MMIA Administration Governed by a 13 member Board of Directors.
Board comprised of City/Town Officials. Six largest Cities have permanent seats. Six seats represent smaller communities. One at-large seat selected by the Board. Board governs insurance program independently.

5 MMIA Administration (cont.)
MMIA places emphasis on education. Quarterly newsletters/R.M. Bulletins. Training. Policy review and development. Contract Review. EPLI assistance and training. Risk Management Evaluations.

6 Workers’ Compensation Program
98 Cities/Towns currently enrolled. Total Annual Premium in excess of $4.6 million. Rates on average below State Fund. Offer coverage to statutory limits. Exposures are covered by cash reserves and excess insurance from conventional markets.

7 Workers’ Compensation
Every employer is required to provide coverage for their employees. Provides remedy for injuries that occur in the course and scope of employment. No fault insurance. Objective: To return a worker to work as soon as possible after the worker has suffered a work-related injury or disease.

8 Conditions Covered Injury/Accident Occupational Disease

9 Reporting Employee: Has 30 days from the date of injury to report to employer/supervisor. Must be specific with regard to date, time of injury, activity and the nature of the injury. Employer: Has 6 days to report to the insurer after notification of the injury.

10 Benefits Medical: All expenses directly related to the injury.
No out of pocket costs for the employee.

11 Benefits (cont.) Wage Loss:
Rate is based on 66 2/3% of employee’s average weekly wage at the time of injury. Current Maximum $504 per week. No payment for the first 32 hours or 4 days whichever comes first.

12 Wage Loss Benefits (cont.)
Temporary Total Disability: Total loss of wages that exists until the worker reaches maximum medical healing Temporary Partial Disability: Partial loss of wages that exists prior to the worker reaching maximum medical healing (return to work in modified or alternative employment).

13 Wage Loss Benefits (cont.)
Permanent Partial Disability: wage loss benefits after maximum medical healing is reached - worker is precluded from returning to time of injury position but is physically capable of returning to work in alternative employment. Based on 5 criteria: age, education, wage loss, impairment.

14 Wage Loss Benefits (cont.)
Impairment Award: Benefits paid to worker after maximum medical healing is reached at the permanent partial disability rate; medical determination established by objective medical findings pursuant to the Guides to Evaluation of Permanent Impairment published by the AMA.

15 Wage Loss Benefits (cont.)
Permanent Total Disability: Physical condition after maximum medical healing in which a worker does not have a reasonable prospect of physically performing regular employment. Death

16 Vocational Rehabilitation
Referral made when medical documentation indicates a possibility the injured worker will be precluded from returning to the time of injury position.

17 General Workers’ Comp Questions
What are your questions, thoughts, concerns regarding Workers’ Compensation?

18 Modified Duty Accommodations Transitional Duty Functional Capacity
The Many Faces of ERTW Modified Duty Part-time Transitional Duty Productivity Light Duty Accommodations Alternative Work Own Occupation/ Any Occupation Functional Capacity

19 Employer Benefits of ERTW
Reduce Medical Costs Employees who return to work early typically recover faster, resulting in medical cost reductions up to 70%.   Improve Productivity Employees working at a transitional assignment is more productive than hiring a temporary employee.   Improve Employee Morale Implementing an ERTW program tells employees their employer is concerned about their well-being.  

20 Employer Benefits of ERTW
Reduce Potential Fraud Claims An ERTW program that returns injured employees to work immediately following an injury reduces the incentive to file a false claim in order to take time off work.   Decrease Attorney Involvement Employers who do their best to return employees to their job show they care. Employees who know their employer values them generally will not hire an attorney Reduces Workers Compensation Premiums Involvement Improves employers WC experience rating

21 Employee Benefits of ERTW
Reduce Financial Impact Many injured employees experience reduced wages due to an injury while they are away from work.   Increase Self-Esteem Employees feel like productive members of society and it promotes wellness through contact with fellow employees.     Contribute to a Speedier Recovery Keeping the injured employee physically active and on a normal work schedule contributes to a faster the healing process.

22 Employee Benefits of ERTW
Reduced chance of a “permanent” disability Loss of physical fitness and muscle tone are prevented Job skills are maintained Employee benefits such as vacation and sick leave are preserved Workplace seniority maintained Less disruption to the employee’s (and his or her family’s) daily life Stress, boredom, anxiety, and depression are lessened

23 Elements of a Successful ERTW
Incorporating these basic elements can maximize the opportunity for a successful early return to work program.

24 Successful ERTW Develop ERTW culture
Commitment to the program by all managers and supervisors; Consistent application of the program; Emphasis on safety and prevention; Prompt medical care following an injury; Periodic evaluation of the program.

25 Successful ERTW Continuous education and dissemination of information about the return to work program beginning before injuries occur; Review of accident and injury history; Development of job descriptions for most jobs that clearly explain essential job functions and tasks required;

26 Successful ERTW Information to help doctors understand the employee’s regular job, the return to work program, and available alternative assignments; Designated person to coordinate the early return to work program, monitor assignments, be responsible for reporting and record keeping, and communications with the treating doctor and injured worker; Compliance with ADA and FMLA, and state or federal law that might apply; and

27 SUMMARY: Successful ERTW Programs…
Involves the Employee, their Supervisor, and their Health Care Provider, early on and throughout the process Requires special consideration and coordination between the Employee and the Employer Utilizes key management activities such as Early Notification, Clinical Management, Administrative Controls and Return to Work Policies

28 Summary: Successful ERTW Programs…
Allow Employers to consistently see a return on their investment in ERTW for their Employees Focuses on the Employee’s abilities and job “activities” versus their illness or injury Fosters flexibility in the workplace

29 Barriers to Accommodating ERTW
Condition is too serious for Early RTW (i.e. Alzheimer’s disease, cancer, post-surgery) Supervisor and/or Agency Motivation lack of budget drivers perception of “problem employee” immediate staffing needs Lack of cooperation by the Employee

30 Barriers to Accommodating ERTW
Relapse - inadequate recovery can result in subsequent disability and lost work days Increased need to modify the work environment Need for higher levels of emotional support for the Employee in the work environment More complexity in payroll administration

31 Workers Compensation & ERTW
EXAMPLE

32 Steps to Implementing ERTW
These steps will assist in implementing a successful early return to work program.

33 Steps to Implementing ERTW
EMPLOYEE INVOLVEMENT IN ERTW PROGRAM DEVELOPMENT Involving employees in developing and implementing an ERTW encourages a feeling of ownership in the program and maximizes the opportunities for success. Involved employees will be more likely to encourage and accept ERTW efforts on their own behalf and on behalf of their co-workers.

34 Steps to Implementing ERTW
ERTW POLICY & FORM(S) DEVELOPMENT This serves notice and explains your ERTW policy to employees and establish necessary forms. We recommend presenting this to new employees upon orientation and redistributing this on a regular basis to all employees. Employees should know what to expect if they are injured on the job, and that their healthy recovery is a top priority that involves them, their doctors and their supervisors. ACCURATE JOB DESCRIPTIONS Ensure all employee JD’s are up to date and include accurate depiction of physical requirements

35 Steps to Implementing ERTW
DESIGNATE AN ERTW PROGRAM COORDINATOR - This helps ensure consistency and accountability Communicates program information to supervisors and workers. Monitors the recovery status of injured workers. Manages correspondence from injured workers, medical providers and MMIA. Works with supervisors to ensure that consistent and appropriate communication with injured workers is ongoing and documented

36 Steps to Implementing ERTW
IDENTIFY TRANSITIONAL DUTY An important first step is performing job analyses on the various positions in your organization. The actual demands and essential elements of each position must be identified. This can be used for developing individual modified assignments. The key is to find ways to make use of the worker's skills and knowledge, rather than "make-work" assignments.

37 Steps to Implementing ERTW
IDENTIFY TRANSITIONAL DUTY Be creative in developing modified assignments. This enables the employee to be productive while meeting medical guidelines. Consider the following: Part-time employment Temporary jobs Alternative tasks Job sharing Jobs in other departments Transitioning through different jobs Job modification

38 Steps to Implementing ERTW
NOTICE TO MMIA OF AN ERTW CASE - This alerts MMIA that you have identified an injured employee as a possible participant in your ERTW program. In some cases, MMIA will notify your company to a claim potentially appropriate for ERTW. DOCTOR NOTIFICATION LETTER - This advises the doctor of your company's ERTW Program, directs the physician's attention to information about the employee's job demands, and asks the doctor to fill in, sign and return information concerning the employee's physical capabilities. This should be provided to the injured worker to give to the physician or sent to the physician directly by you. Copy MMIA after the doctor completes the form.

39 Steps to Implementing ERTW
JOB REQUIREMENTS ANALYSIS - This is filled in by the employer and accompanies the Doctor Notification Letter. It summarizes the employee's current job duties and physical requirements of that job. You can also use this form to identify transitional duty throughout your company and present the doctor with a transitional position for your employee. Copy MMIA PHYSICAL CAPABILITIES WORKSHEET - This form accompanies the Doctor Notification Letter to be completed by the doctor upon examination of the injured worker. It should be provided to your employee to start the ERTW process once an injury is reported. You should also send it to the treating physician on a regular basis, so that work restrictions can be addressed at each examination. Copy MMIA

40 Steps to Implementing ERTW
RETURN-TO-WORK AVAILABILITY LETTER - This should be sent to the injured worker by certified mail as a documented offer of a transitional duty position; a copy should be kept on file by the employer, and a third copy sent to MMIA. This letter is an important document if transitional duty is refused

41 The Basics of Early RTW Early Return
Return to Work prior to full recovery from disabling condition Light Duty Return to less physically or mentally demanding level of work Modified duty Temporary modification of work environment or job requirements that allow Employee to work productively given current condition Part-Time Duty Return to one’s own job on a part-time basis

42 Communicating With Your Staff
It is everyone’s responsibility to communicate with staff off due to injury and/or staff coming back on ERTW. Don’t let them forget to……

43 Don’t Let Them Forget To..
Focus on getting well Talk with their doctor Keep in touch with their employer: Supervisor, Human Resource Department, or Other point of contact with your employer Work toward returning to their regular job, full-time Don’t give up!

44 Questions?


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