Presentation on theme: "Introduction to Early Return To Work For Municipalities"— Presentation transcript:
1Introduction to Early Return To Work For Municipalities Presented by John M. Cummings, MBA, PHRPersonnel Director &Susan Peck, Workers’ Compensation Claims ManagerMontana Municipal Interlocal Authority2. 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.
2Disclaimer(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.)
3Montana 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.
4MMIA 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.
5MMIA 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.
6Workers’ 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.
7Workers’ 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.
9ReportingEmployee: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.
10Benefits Medical: All expenses directly related to the injury. No out of pocket costs for the employee.
11Benefits (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.
12Wage Loss Benefits (cont.) Temporary Total Disability: Total loss of wages that exists until the worker reaches maximum medical healingTemporary Partial Disability: Partial loss of wages that exists prior to the worker reaching maximum medical healing (return to work in modified or alternative employment).
13Wage 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.
14Wage 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.
15Wage 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
16Vocational Rehabilitation Referral made when medical documentation indicates a possibility the injured worker will be precluded from returning to the time of injury position.
17General Workers’ Comp Questions What are your questions, thoughts, concerns regarding Workers’ Compensation?
18Modified Duty Accommodations Transitional Duty Functional Capacity The Many Faces of ERTWModified DutyPart-timeTransitional DutyProductivityLight DutyAccommodationsAlternative WorkOwn Occupation/Any OccupationFunctional Capacity
19Employer 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.
20Employer 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 attorneyReduces Workers Compensation Premiums Involvement Improves employers WC experience rating
21Employee 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.
22Employee Benefits of ERTW Reduced chance of a “permanent” disabilityLoss of physical fitness and muscle tone are preventedJob skills are maintainedEmployee benefits such as vacation and sick leave are preservedWorkplace seniority maintainedLess disruption to the employee’s (and his or her family’s) daily lifeStress, boredom, anxiety, and depression are lessened
23Elements of a Successful ERTW Incorporating these basic elements can maximize the opportunity for a successful early return to work program.
24Successful 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.
25Successful ERTWContinuous 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;
26Successful ERTWInformation 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
27SUMMARY: Successful ERTW Programs… Involves the Employee, their Supervisor, and their Health Care Provider, early on and throughout the processRequires special consideration and coordination between the Employee and the EmployerUtilizes key management activities such as Early Notification, Clinical Management, Administrative Controls and Return to Work Policies
28Summary: Successful ERTW Programs… Allow Employers to consistently see a return on their investment in ERTW for their EmployeesFocuses on the Employee’s abilities and job “activities” versus their illness or injuryFosters flexibility in the workplace
29Barriers to Accommodating ERTW Condition is too serious for Early RTW (i.e. Alzheimer’s disease, cancer, post-surgery)Supervisor and/or Agency Motivationlack of budget driversperception of “problem employee”immediate staffing needsLack of cooperation by the Employee
30Barriers to Accommodating ERTW Relapse - inadequate recovery can result in subsequent disability and lost work daysIncreased need to modify the work environmentNeed for higher levels of emotional support for the Employee in the work environmentMore complexity in payroll administration
32Steps to Implementing ERTW These steps will assist in implementing a successful early return to work program.
33Steps to Implementing ERTW EMPLOYEE INVOLVEMENT IN ERTW PROGRAM DEVELOPMENTInvolving 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.
34Steps to Implementing ERTW ERTW POLICY & FORM(S) DEVELOPMENTThis 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 DESCRIPTIONSEnsure all employee JD’s are up to date and include accurate depiction of physical requirements
35Steps to Implementing ERTW DESIGNATE AN ERTW PROGRAM COORDINATOR - This helps ensure consistency and accountabilityCommunicates 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
36Steps to Implementing ERTW IDENTIFY TRANSITIONAL DUTYAn 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.
37Steps to Implementing ERTW IDENTIFY TRANSITIONAL DUTYBe creative in developing modified assignments. This enables the employee to be productive while meeting medical guidelines.Consider the following:Part-time employmentTemporary jobsAlternative tasksJob sharingJobs in other departmentsTransitioning through different jobsJob modification
38Steps 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.
39Steps 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 MMIAPHYSICAL 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
40Steps 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
41The Basics of Early RTW Early Return Return to Work prior to full recovery from disabling conditionLight DutyReturn to less physically or mentally demanding level of workModified dutyTemporary modification of work environment or job requirements that allow Employee to work productively given current conditionPart-Time DutyReturn to one’s own job on a part-time basis
42Communicating 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……
43Don’t Let Them Forget To.. Focus on getting wellTalk with their doctorKeep in touch with their employer:Supervisor,Human Resource Department, orOther point of contact with your employerWork toward returning to their regular job, full-timeDon’t give up!