1. Return to Work (RTW)
After an injury

2. Return to Work Goals Early, safe, sustainable Focus on ability
Improve worker retention and satisfaction
Increased time at work, productivity
Stable employment
Implemented fairly
Reduced cost-direct medical and indemnity

3. Return to work program Formal- Written policies and procedures
Guides supervisors and employees
Consistency
Informal- No written policies
Case by case
Relationship based
Department practices

4. Why is early return to work good for the worker?
Earning wages
Maintain benefits
Social aspect of work/be with co-workers
Self esteem
Focus on ability
On the job work conditioning
Communicate with the employer
Keep their job/sense of job security
Likelihood of RTW diminishes over time

5. Early return to work is good for the employer
Promote faster recovery
Reduce loss of productivity
Keep skilled worker
Reduce training costs of new workers
Decrease WCF premiums
Decrease indemnity costs
Complements health and wellness

6. Work Releases
Physician discusses goals for early and safe return to work with the worker
Physician provides objective restrictions
Use medical guidelines if available
Communicate restrictions to employer
Ask for regular job description
Ask for modified duty job description
Support the employee and employer for early and safe return to work

7. Why keep moving? Newton’s law of motion:
A body in motion tends to stay in motion and body at rest tends to stay at rest, unless acted upon by an outside force.
Return to work
Patients who are active, tend to have better outcomes
Patients who are taken of work, tend to remain off work

8. Provide restrictions Identify impairment
Identify restrictions or functional limits
Make restrictions clear and objective
Ask the employer for job descriptions
Ask the employer for modified duty job descriptions
Employer determines accommodation

9. Tips: Do’s and Don’ts Don’t Write: Instead, write:
Patient should work in a stress-free environment
Patient to work in quiet environment to minimize frequent distractions and interruptions.
Patient should not multi-task
Multi-factorial assignments must be broken down into discreet tasks or Memory prompts may be supplemented no more than 3x’s daily with personal check-ins or reminders by supervision personnel.
Patient should be off on Mondays
Patient should only work 32 hours per week. It should be the employer’s decision as to how they assign their employee to the work schedule.
No night or evening shifts (this assumes that impaired night vision is not a relevant medical diagnosis)
Patient should only work 8 hours per day. Again, it should be the employer’s decision as to how they assign their employee to the work schedule.
Patient should be allowed to go home, early, or as needed
Patient may work 6 hours per day form (Date) to (Date), followed by 7 hours per day from (Date) to (Date) and 8 hours per day beginning (Date).
No overtime
Patient may perform their usual and customary duties, within regular working hours.
Patient should only drive the new buses
Patient is to avoid strong vibrations or jerking movements affecting the pelvis, lower back regions while seated to include driving activities
Patient should not work with their present supervisor and should be assigned to a different department
Patient should be assigned tasks he/she is fully competent to perform and is encouraged to review daily accomplishments and any difficulties, 2x a day with a supervisor/manager.

10. Job Descriptions
Employer may have
Clinic can provide service

11. Employer Successful Return to Work
Commitment to health and safety
Fewer lost work days
Support the injured worker (highly predictive of successful RTW)
Make modified duty available
Meet with the injured worker quickly
Responsible Return to Work Coordinator
Communicate with the health care provider about work and demands
Reduced costs and work comp experience

12. How is the clinic doing? Measure: Length of time away from work given
Claim duration to Med Stat
Medication prescribing
Complementary treatment-PT, Acupuncture, Chiropractic
Share results with the physicians; how the department is doing and how they compare with their colleagues
Use evidence based guidelines, if available: Reed, ODG, ACOEM

13. How is the employer doing?
Multiple measures:
Written policies and procedures
Modified duty tasks identified
Direct medical costs decreased
Indirect costs-indemnity/lost work days, experience rating lower
Relationship with the physician
Employee satisfaction
Supervisor satisfaction

14. Case Study Burton Blatt Institute, Syracuse University
Heavy construction concrete company
Informal RTW program in 2005
49 time loss WCF claims and 1,176 lost work days in 2005
2005 annual cost $464,000
Applied RTW strategies…
In 2010, 7 time loss claims
2010 annual claims cost $1,088
2010, Work Comp Modification Rate decreased by 25%

15. RTW Strategies Applied
Meetings with physicians to explain RTW program
Meetings with injured employees to show support
Review work restrictions and determine work ability/tasks
Same day contact with physician, provide job description, work with the physician to find appropriate work
Conduct accident investigations on all injuries, by safety best
Monitor recovery and adjust work tasks
Ongoing contact with the injured worker

16. What questions do you have?
Thank you!
What questions do you have?