Transitional
Return-to-Work
Presented by QBE
Loss Control Services
What is a Transitional Return-to-Work
(TRTW) Program?
A program to enhance
the injured employee’s
rehabilitation and
facilitate their return to
normal job duties by
providing temporary
modified work
What is TRTW?
Plan for dealing with
return-to-work issues
before an injury occurs
TRTW
“You do not get injured workers
well to put them back to work.
You put them back to work to
get them well.”
Richard Pimentral
The Return to Work Process: A Case Management Approach
Injury Results
Injury Occurrence
Stress
Physical, Emotional, Social
Increased Medical Procedures,
Therapy/rehab/Surgical Costs
Employee Benefits of TRTW
• Generally gets employees back to work
50% faster
• Speeds recovery up to 3 times
• Reduces vocational rehab
• Reduces degree of permanent partial
disability
• Reduces possibility of re-injury upon
return
• Employee’s wage loss minimized
Employer Benefits of TRTW
• Helps control medical costs by as much
as 70%
• Reduces indemnity costs
• Less abuse of Worker’s Compensation
system
• Improves moral/employee relations
• Improved work ethic
• Enhanced company image
• Less litigation
Litigation
“People sue because noone cares more often than
because they felt they were
wrongly injured.”
Litigation
• 80% of claims involving
litigation result in higher
settlements
• Contacting the injured
employee within 1 week of
injury reduces chances of
litigation by 50%
Employer Benefits of TRTW
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Eliminate repeaters & malingerers
Reduced turnover
Reduces hiring & retraining costs
Maintains company productivity
Employer is in charge rather than
employee
Important Considerations
• The longer an employee is off
work, the more difficult it is to
get the employee to return to
work. (Disability Syndrome)
• The longer an employee is off
work, the larger the disability
awarded at hearing.
Absenteeism
• 20% of employees account for
80% of employee absence
costs
• Red Flag- Absenteeism
problems
Effective TRTW Programs
• Identification of potential jobs for
modified duty
• Early reporting of injuries and illnesses
• Accident investigation program
• Communicationsemployee/employer/medical/WC carrier
• Education of staff
A Hard Look at Lost Time
• Lost time typically constitutes 60%
of Worker’s Compensation costs
• For each 1$ paid out by the
insurance carrier, there may be as
much as $2 in increased workers
comp premium costs to the
employer
TRTW Vs. No Program
Example: Employee with one hand duty for
8 weeks wage $500/week WC pays 66.67%
of wages.
No TRTW
$500 x 8 x 0.67 = $2,680
With TRTW
$0
3-Year Cost in Increased WC Premiums
due to Indemnity
$2,680- $5,360
$0
Claims Costs
$15,720
Without
TRTW
$2,224
Indemnity
Medical
$6,120
With
TRTW
$1,097
$0
$10,000
$20,000
Crawford & Company 1995
TRTW Benefits
According to the Washington
Business Group on Health
there is a $8-$10 return on
every $1 invested in a TRTW
program
TRTW Team
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Injured employee
Upper management
Return-to-work coordinator
Front line supervisor
Physician/Medical provider
Worker’s Comp. provider
Management
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Commitment to TRTW
Develop TRTW policy
Develop TRTW team
Communicate
Return-to-Work Coordinator
• Develop/implement/coordinate
program
• Direct injury management
• Maintain contact with injured
employee
• Communicate with QBE/medical
provider and Management
Return-to-Work Coordinator
• Coordinate with medical
providers
• Maintain records
• Report to management
• Provide training
• Establish a plan for each injured
employee
Supervisor’s Role in TRTW
• The greatest road block to
an effective TRTW
program is supervisor
attitude.
• Program support
Supervisor’s Role in TRTW
• Get employee prompt medical
attention
• Promptly report to management
• Complete accident investigation
• Respond positively
• Assist in job evaluations
Supervisor’s Role in TRTW
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Keep in contact with employee
Make employee feel welcome
Identify light duty jobs
Never allow employee to work
outside restrictions
Injured Employee
• Financial concerns
• Health concerns
• Advise from friends,
neighbors, etc.
• Attorneys
Injured Employee Responsibilities
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Follow safety policies and rules
Promptly report injuries
Complete paperwork
Maintain contact with employer
when off work
• Provide updates on medical
condition
Injured Employee Responsibilities
• Follow medical recommendations
• Do not work outside restrictions
Physician/Medical Provider
• Make medical determination
• Be familiar with employee’s job
functions and the jobs physical
requirements
• Determine work restrictions
• Work with TRTW coordinator &
QBE or case nurse
Medical Considerations
• Develop relationships with
medical providers
• Give medical providers tours
of facility
General Information for Medical Provider
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Job descriptions
Job function analyses
List of transitional work activities
Written TRTW program
Videotapes of jobs
Specific Information to Medical Provider
• Job function analysis of injured
employee’s job
• Descriptions of available jobs
that fit restrictions
• Physical capabilities form
Job Function Analysis
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Job title
Describe job tasks
Equipment used
Physical demands
PPE needed
Other hazardous conditions
Job Function Analysis
Example:
An employee may tell the
medical provider they lift 50
lbs. The missing information
is that they lift 50 lbs. once
per week!
Physical Demands
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Standing/walking
Sitting
Lifting/carrying
Pushing/pulling
Bending
Twisting
Kneeling/crawling
Reaching
Types of Work
• Modified Work- Regular job with
modifications to accommodate
restrictions
• Alternate Work- A temporary
assignment until worker is able
to perform regular job
Modified Duty Jobs
• Try to return to same job first
• See what regular activities fall
outside restrictions
• Evaluate ways to reorganize
job to accommodate
restrictions
• Separate jobs tasks into
essential and non-essential
Alternate Work
• Should be identified before injury
occurs
• Should be meaningful and productive
• Develop a list of possible alternate jobs
• Look for things that never seem to get
done- inventory, painting, cleaning,
organizing, sorting, paperwork,
labeling, etc.
On the Day of Injury
• Get injured employee medical attention
• Send physical capabilities form and
notice of temporary modified duty
availability and job function analysis to
medical provider
• Contact QBE Claims Dept.
• Complete First Report of Injury
• Start accident investigation
Within 3 Days of Injury
• Send employee get well card
• Have supervisor contact
employee
• Contact physician and discuss
TRTW issues
• Develop specific TRTW program
for employee
Complete Every Week Until Release
• Contact or visit employee
• Contact physician after each
medical exam
• Continue to work with
physician, QBE and employee
until restricted or modified duty
provided
Written TRTW Program
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Policy statement
Roles & responsibilities
Procedures
List of job descriptions with
physical requirements
• List of modified duty jobs
• Should be reviewed by company
attorney
ADA and TRTW
1. Determine if there is impairment
2. Determine if the employee can still work
within the scope of their original job
3. If they can’t work within the scope of the
original job, can reasonable
accommodations be made
4. If reasonable accommodations can’t be
made is there another job the employee
can perform
Coordinating ADA & Workers Compensation
• Objective is to prevent employees from
getting a WC settlement and then
arguing they are able to return to work
to pursue an ADA claim
• Employers often make the mistake of
resolving a WC claim and then try and
determine employment status
Coordinating ADA & Workers Compensation
• Do not allow an employee to remain off
work indefinitely or leave the employee
indefinitely in a light duty job
• Make sure an employee returns to work
before resolving a WC case
• Employers should work closely with a
qualified attorney