Modified Duty Closing the Claim

Overview  Elements of an effective Modified Duty Program  How to implement a successful program.  Branch level roles and responsibilities in following through with a Modified Duty Program.

What is Modified Duty?  Modified duty assignments must be given to injured employees with any kind of job restriction if at all possible.  These modified jobs are assigned when injured employees are not able to perform their regular job duties, and when the treating physicians have provided job restrictions to the employer. –The restrictions are designed to promote healing and prevent further injury.

Modified Duty Program Goals  Maintain the health and productivity of employees who have been injured.  Prevent abuse of workers compensation insurance.  Reduce the cost of temporary disability benefits, or indemnity payments (lost wages).

Implementation  A Modified Duty Program consists of three elements: –Program guidelines –Roles and responsibilities –Enforcement of program

Program Guidelines  Modified duty offer protocols  Nature of assignment  Length or duration of the assignment  Procedures for monitoring assignments

Program Guidelines  Procedures for returning to full duty  Procedures for non-modified duty candidates  Procedures for refusal of assignment  Performance standards and expectations

Roles and Responsibilities  Employee –Should be given thorough review of policies and procedures regarding the Modified Duty Program during the new hire orientation. –Injured employees who are offered modified duty should be provided with instructions regarding the details of the modified duty assignment. –Injured employees are expected to attend all medical appointments as outlined by physicians. –Other expectations should be outlined at this time as well (contact staffing company when restrictions change by doctor, etc.).

Roles and Responsibilities  Staffing Company Risk Manager –May have all of the responsibilities of overseeing a Modified Duty Program. –Identifying and securing of modified duty assignments throughout the organization, as well as with customers and other entities.

Roles and Responsibilities  Staffing Company Branch Manager –Primary responsibility is to show concern for the needs of injured employees. –Immediate response to accident scene. –Providing supervised transportation to the treating facility. –Offer available modified duty. –Maintain high level of communication with staffing company corporate office regarding the injured employee’s status.

Roles and Responsibilities  Claims Administrator/Carrier –TPA/Carrier plays vital role in adjusting the dollars reserved/paid on all claims. –It is very important that the TPA/carrier is provided with all relevant information regarding modified duty job offers or refusals.

Roles and Responsibilities  Medical Providers –Must provide quality medical treatment for injured employees. –Relationship must be formed with preferred medical provider. –Preferred medical providers should also communicate effectively to the staffing company in providing a diagnosis, treatment plan, employee restrictions, and possible modified duty options.

Roles and Responsibilities  Customers –Benefits of a Modified Duty Program should be discussed with customers. –Do customers have any availability of modified duty assignments on location? –Establish this before a claim, when possible.

Benefits of Modified Duty Programs  Lowers workers compensation premium Back Injury$50,000 Medical Cost(70%)$35,000 Indemnity Cost(30%)$15,000  What is the difference between paying $15,000 out of pocket to your employee vs. letting the insurance carrier pay $15,000 to your employee?

Benefits of Modified Duty Programs  Maintains an experienced workforce  Increases employee morale  Maintains productivity  Decreases litigation costs

Benefits of Modified Duty Programs  Discourages predators by eliminating the “paid for staying home” scenario.  Provides continuous employment with little or no wage loss to exemplary employees. –This reduces negative influences on the semi-conscious predator.

Things to know…  Certain state regulations apply –Example - AZ has passed legislation that states modified duty assignments must be completed at the branch or client location. Alternatives like not-for-profit organizations are not allowed.  Certain states have verbiage that must be included in the modified duty offer to be considered bona fide –Example - TX Department of Workers Compensation Rule  Use your resources –Check with your adjuster, TPA and/or insurance carrier.

Summary  Modified Duty assignments are designed to maintain the health and morale of injured employees and to prevent workers compensation fraud.  Have policies, procedures, and guidelines in place and inform employees of these during orientation.  Individual roles are clearly defined and communicated to all involved in dealing with an on-the-job injury.