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Claims Management

3 Return-to-Work Scenarios Explained

Understanding return-to-work (RTW) program strategies is a critical part of managing an organization’s workers’ compensation claims and achieving the most beneficial outcomes for all parties involved. These methods can help engage injured employees and gradually reintroduce work into their recovery plan.

November 6, 2023

Return-to-work programs allow injured workers to resume working in a manner that is mindful of their physical restrictions following an injury, benefitting both the employer and the employee. It helps workers retain their skills and knowledge, stay active, and return to health. At the same time, it helps organizations reduce the risks and costs associated with a worker’s extended time away from work.

“Communication with injured workers is critical throughout the RTW process, especially early in the life of the claim,” said Dan Clayton, Senior Claims Manager at Safety National. “Challenges may arise when an injured worker is legally represented as all communication is typically filtered through the attorney’s office; however, that should not discourage RTW efforts. When an employer communicates clear expectations and stays in frequent contact with the injured employee, it can provide a noticeable impact on motivation and ultimately a RTW success.”

Here we outline the processes and benefits of three common RTW scenarios.

Scenario 1: Transitional Placement at Employer

This RTW method is utilized only when an employer is able to accommodate worker’s restrictions with an on-site job. RTW program policies should include a clear description of the program’s objective, an outline of the steps in the RTW process, and roles and responsibilities.

Evaluating the physical demands of each job in an organization is an essential step in developing a RTW program. A job analysis is a process used to collect information about the skills, tasks, responsibilities, outcomes, and work environment required to perform a particular job. This is useful to create a clear picture of the core requirements of any position.

A job analysis can simplify the process of identifying alternate duty jobs, producing a list of jobs with physical requirements. When an injured worker is released by their physician with work restrictions, employers can identify suitable, alternate duty jobs by comparing the physical requirements of the jobs in the organization to the restrictions assigned by the physician. To help facilitate the RTW process, it may be beneficial to send a list of the qualified jobs, along with their descriptions, to the worker’s physician.

The work schedule, the equipment, or the responsibilities are modified so the employee can perform useful tasks for the employer, which may vary from their original job duties. For example, the employee can use a stool or a chair if they are unable to stand for long periods of time. The number of hours an employee stands may be reduced when they initially come back to work but will be gradually increased as they build strength.

Scenario 2: Transitional Return-to-Work (TRTW)

If there is no way to accommodate an injured employee, TRTW services should begin as soon as possible to keep them active and engaged during recovery, readying them to return to their pre-injury job as quickly as possible. In this scenario, injured workers are released to work under restrictions into temporary job placements at local charities or non-profits. TRTW may be appropriate when:

  • The injury is usually not severe.
  • The injured worker is assigned temporary restrictions by his or her physician.
  • The injured worker is expected to make a full recovery.
  • The injured worker is still employed by the insured/employer.
  • The employer’s plan is to return the worker to his or her pre-injury job once recovered.

TRTW benefits both employers and employees for several reasons. For the employee, working or remaining active in some capacity while recovering from an injury promotes faster healing, maintains motivation to work, and improves quality of life. For employers, when injured workers remain away from work, claim costs escalate. TRTW allows injured workers to be as active as possible, maintaining good work habits while expediting the recovery process and mitigating claims costs.

Scenario 3: Permanently-Restricted Return-to-Work (PRRTW)

PRRTW applies to workers’ compensation claims that are assigned permanent restrictions. These restrictions will likely never change or improve, making them lifelong. In this scenario, the injuries are typically more severe, where the injured employee has had one or more surgeries, resulting in months or years away from work. They are not expected to make a full recovery and are no longer employed due to the employer’s inability to accommodate permanent restrictions.

In many states, when an injured worker reaches a point where their condition will never improve, they have reached maximum medical improvement (MMI). In most states, the injured worker is released to work once MMI is reached. In certain states, once the injured worker is released to work, they must cooperate with a RTW program should the insured or carrier offer one. Any job offers should be made in writing, even if the state workers’ compensation rules do not require it. This provides proof in case of disputes or RTW refusals and can be critical evidence in litigation.

The main reason to utilize RTW on permanently restricted claims is to mitigate claim exposure and eliminate costly permanent total disability (PTD) possibilities. When an injured worker has been released to work under permanent restrictions, chances are the claim’s exposure is high, and the claim’s costs are only rising. In the case of PRRTW claims, job sourcing is considered the most important aspect of the RTW program and often the strongest argument against permanent total disability by showing available alternatives. Finding opportunities for injured workers can also help them remain active and maintain motivation to work, learn new job skills, expand their personal and professional network, and regain their employment status.