An injured worker’s early and successful return-to-work benefits everyone. However, each injured worker’s injuries and circumstances are different. For instance, because of the nature of their jobs, a construction worker with a broken leg is expected to be off work longer than an office worker with the same injury. Therefore, an optimal return-to-work date is identified for each claim so the best course of action can be tailored to each injured worker. Return to work (and job retention there after) is the shared goal following every workplace injury.
The success of an early return-to-work program is dependent on appropriate planning, as well as attention to a host of physical, psychological and environmental factors. Positive outcomes require communication and cooperation from the employee, employer, claims management staff and treating physician.
Medical providers are critical players in the return to work process. Providers must manage return office visits and treatments with optimal return to work in mind and should release injured workers to work (with restrictions, if necessary) as soon as medically feasible. Therefore, they must understand the basis of optimal return to work planning and different return to work options and then help establish an injured worker’s return-to-work expectations.
Studies have demonstrated that prolonged time away from work makes recovery and return to work progressively less likely. The American Academy of Orthopedic Surgeons and the American Association of Orthopedic Surgeons (AAOS) support safe early return-to-work programs that help injured workers improve their performance, regain functionality and enhance their quality of life. Return to work in light duty, part-time or modified duty programs is important in preventing the deconditioning and psychological behavior patterns that inhibit successful return to work and in improving quality of life for the injured worker.
- The injured worker and the physician should discuss time frames for recovery, expected duration of pain, the potential need for medication and options for returning to work.
- The worker should resume, if possible, some form of work that meets the restrictions and requirements outlined by the treating physician. Such modified work is the cornerstone of job rehabilitation.
- The treating physician should be included in determining if the physical demands of a modified job are appropriate for the recovering employee.
- Workplace restrictions should be written out and provided to the employee and employer
- The treating physician needs to understand the patient’s work environment and occupational In difficult cases, a videotape of the job, formal job analysis or an ergonomic report may be helpful to assist in establishing workplace guides.
- Workplace restrictions should be considered flexible and should be updated to reflect the improving medical condition.
- Work conditioning, work hardening, and other forms of restorative treatment can be used to simulate specific job demands so that the worker can eventually resume previous work duties without re-injury during the return to work. Learn more about Transitional Work Therapy.
- An injured worker must be taught to recognize cause and effect related to symptoms and accept responsibility for symptom control through strategies such as pacing, energy conservation and proper body mechanics.
- If the treating physician and employer believe there are no suitable duties in the present workplace, it may be necessary to refer the injured worker to a vocational rehabilitation professional.
Employers realize benefits from early return to work through substantial reductions in disability compensation, medical treatment costs, absence from work, and overall workers’ compensation costs.
- The employer should communicate with the MCO to expedite return to work.
- The employer should maintain a list of modified or alternate work for injured employees.
- The employer should make the injured worker feel valued and encourage the worker to return as soon as possible.
Types of Return-To-Work
If an injured worker can return to work, but not to full duty, they may be able to work with restrictions. There are several types of return-to-work options, including:
- Transitional work — Work that uses real job duties for a specified period of time (generally not exceeding two or three months) to help progress to the original job.
- Modified work — Work in which physical barriers that may keep injured worker from performing the essential job functions are adapted, altered or removed.
- Light duty — Work in which job requirements are performed at a reduced physical capabilities. (i.e. reassignment)
- An Alternate Position — Work the injured worker can do if permanently restricted from the original job, but have other abilities and can be employed.
When a worker is released to return to work with restrictions, employers may not always be able to accommodate or have any idea how to provide accommodation. Below are some thoughts for consideration –
Criteria for assigning work (can be accomplished in a number of ways):
- Return the worker to his/her job with no restrictions for the worker’s particular job. (The restrictions don’t limit the worker’s ability to perform his/her job.)
- Return the worker to his/her regular job with restrictions as specified by the physician. This may involve assistance from another employee such as when the employee is lifting objects.
- Modify the worksite in a manner that reduces the impairment’s impact. This may involve purchasing equipment or modifying the work area. Modification may also include more frequent change of position, or reducing the amount of walking, lifting or bending.
- Modify the work schedule to allow the injured worker to work and participate in rehabilitation services. The worker may also return to work in a gradual return-to- work program which is on a graduated basis building up from four hours daily to full-time work status within 13 weeks. If this is a lost-time claim, this may occur in a vocational rehabilitation plan and may be included in an employer incentive contract.
- Establish which work tasks are within the worker’s functional capacities. The job’s demands and the worker’s capacities can be reviewed to determine the elements of the job that can be performed during the transitional work. Regular job duties can be intermixed with transitional work duties. An increase in work tasks occur as the worker’s restrictions/limitations decrease. These increases may include doing a task more often or for a longer time period, increasing work intensity or adding work tasks.
Alternative work options: Alternative work options include returning the injured worker to alternative work which may or may not be considered regular work duties. These options are within the scope of the worker’s specified limitations and the job tasks will exist for a definite time period.
Alternative work options to consider are:
- The worker may be transferred to another job which he/she may be able to perform without restrictions/limitations.
- The worker may be transferred to another job which he/she may be able to perform with restrictions/limitations or with assistance. This may involve assistance from another employee in lifting, tightening, carrying, etc.
- Employers having several related small businesses with different policy numbers may send their workers out to perform a temporary job at a related business.
- Similar businesses or groups that are related or unrelated companies may form an association or group and share transitional work tasks.
- Helper jobs/apprentice jobs should be considered. For example, a plumber on work restrictions can be a helper to a plumber on a temporary basis.
Non-profit agencies: Referral of the injured worker to a non-profit agency for a temporary work assignment that is within the worker’s capabilities. This will require monitoring of the worker’s assigned tasks to assure that the work tasks are within the worker’s capabilities. Time frames and a plan must be developed to determine when it is appropriate for the worker to return to his/her work site and resume their own job functions.