CSRMA: Workers’ Compensation Management Program
WORKERS’ COMPENSATION COORDINATOR PROCEDURES
WCC RETURN TO WORK CHECKLIST
PAGE 1
This checklist will help the Workers’ Compensation Coordinator (WCC) spearhead the return to work process. The
WCC will gather information from the doctor and then work with the Supervisor and Employee to find productive
work within the physician’s recommendations.
Follow the response from the doctor on the Employee Status Report (ESR)*to determine the Employee’s work
status. The work status will fall into one of four categories:
A.
Released to Usual & Customary (U&C) work (i.e., Full Duty)
B.
Released with restrictions (i.e.: Restricted Duty)
C.
Temporarily Totally Disabled/TTD (unable to work)
D.
Permanent restrictions
(If the Agency’s customized ESR has not been returned with the Employee or if it is incomplete, fax the Work
Abilities Memo* to the physician with a blank ESR. If you need to contact the physician for information, refer to
the Treating Physician Communications Guidelines* for guidance.) Please note that if the injury is a
mental/emotional stress claim, please utilize the WCC Stress Claim Checklist.)
A. If the Employee is released to Usual & Customary (U&C) work (i.e., Full Duty):
 Advise the Employee’s Supervisor and Bragg & Associates.
 If treatment continues, monitor the ESRs each time the Employee returns from the doctor to ensure there is
no change in work status.
B. If the Employee is released with restrictions (i.e.: Restricted Duty):
 Initiate the Transitional Assignment Process:
o
Review the ESR and then discuss with the Supervisor and Employee to determine if the Employee
can continue his/her job with modifications (restricted or modified work schedule, elimination of
particular tasks such as no heavy lifting above shoulder height, etc.). If so, check the first box of the
Transitional Assignment Agreement* and complete the remainder of that form.
o
If a modification of the Employee’s usual and customary job is not possible, use the Transitional
Assignment Description Form* to assist you with building a transitional job out of appropriate
tasks that need to be completed with in his/her usual department or elsewhere in the organization
(ensure compliance with any labor agreements).
 If a Transitional Assignment is available:
o
Complete the Transitional Assignment Agreement* and send a copy to the TPA.
o
Review the Transitional Assignment Agreement* every two weeks until the Employee is returned
to full duty or the transitional assignment is terminated. Utilize the Two-Week Transitional
Assignment Review Worksheet* for this purpose. If after discussion with the Supervisor and
Employee, it is determined that the Transitional Assignment is no longer beneficial, either create a
new transitional assignment or refer the case over to TTD. Immediately advise the TPA.
 If a Transitional Assignment is not available:
o
CSRMA requires you to contact the CSRMA WC/ Return to Work Advisor, Heather Truro:
(925) 922-0305 or htruro@comcast.net.
o
*
Continue to monitor the ESRs after every doctor’s appointment to determine if the work restrictions
have changed and if a transitional assignment can be identified.
All forms are available in the Forms section of the Instruction Manual.
© 2007 HT Consulting
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WORKERS’ COMPENSATION COORDINATOR
RETURN TO WORK CHECKLIST
CSRMA: Workers’ Compensation Management Program
WORKERS’ COMPENSATION COORDINATOR PROCEDURES
RETURN TO WORK CHECKLIST
PAGE 2
C. If the Employee is Temporarily Totally Disabled/TTD (unable to work):
 Determine if you need to send a letter to the doctor about the Employee’s daily living activities. (Refer to the
WCM Program Instruction Manual, Forms Section).
o If yes: Send the letter, monitor for a response, and initiate the Transitional Assignment process if
applicable.
o If no: Continue to monitor the ESRs after every doctor’s appointment to determine if the work
restrictions have changed and if a transitional assignment can be identified or if return to full duty
is authorized. If TTD continues for 30 days or more, contact the CSRMA WC/ Return to Work
Advisor, Heather Truro: (925) 922-0305 or htruro@comcast.net.
o If unsure: Contact the CSRMA WC/ Return to Work Advisor, Heather Truro: (925) 922-0305 or
htruro@comcast.net.
 Call the Employee every two weeks to see how he/she is doing (Use the Telephone Contact Form & Guide in
the WCM Program Instruction Manual.)
D. If the doctor establishes Permanent Restrictions:
 Contact the CSRMA WC/ Return to Work Advisor, Heather Truro: (925) 922-0305 or htruro@comcast.net
 Initiate the Interactive Process as described on the Workers’ Compensation Coordinator’s Interactive
Process Checklist.
o
If you are able to accommodate the restrictions, follow the procedures outlined in the Workers’
Compensation Coordinator’s Interactive Process Checklist
o
If you are unable to accommodate the restrictions:

Contact the CSRMA Employment Practices Liability Hotline at: LCW (415) 512-3000 or
(310) 981-2000

Follow the advice of LCW and initiate Disability Retirement if applicable.
© 2007 HT Consulting
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WORKERS’ COMPENSATION COORDINATOR
RETURN TO WORK CHECKLIST