Understanding the Challenges of Permanently-Restricted Return-to-Work Claims

In transitional return-to-work (TRTW) claims, overall claim exposure is minimized because the worker will eventually return to work. The indemnity exposure ends when the worker returns to the job, whether in a week, a month, or four months. Permanently restricted return-to-work (PRRTW) claims expose employers and carriers to financial, operational, legal, and reputational risks.

“For PRRTW claims, the maximum exposure is calculated much differently and varies per jurisdiction,” said Jayde Laxton, Director of Workers’ Compensation Claims at Safety National. “The employer is unable to accommodate the worker’s permanent restrictions, and the injured worker may not return to alternative gainful employment. In response, there is no anticipated cap like there is for TRTW claims because there is no anticipated return-to-work date.”

Here are five risks associated with PRRTW claims.

1. High Claim Costs

Often, medical costs for a PRRTW claim can continue for life, inflating claim costs. Once maximum medical improvement (MMI) is reached, ongoing medical treatment, medications, or adaptive equipment may be necessary.

 2. Risk of Permanent Total Disability (PTD)

PTD is awarded by arbitrators, judges, or commissions when there is evidence that the injured worker can never work again due to the injury sustained. PTD equates to lifetime benefits for the injured worker with no obligation to work again to receive benefits. To avoid PTD, a return-to-work vendor needs to identify open, viable, and suitable jobs that adhere to the injured worker’s physical restrictions, geography, and educational level.

 3. Operational & Accommodation Burdens

Employers must evaluate the physical demands of each job to match the physician’s restrictions. This may involve modifying existing roles (on-site, alternate duties), identifying or creating suitable positions, or sourcing outside jobs if internal accommodation is not possible.

 4. Documentation & Proof Requirements

Even if not required by state law, it is a good idea to ensure PRRTW job offers are in writing, which can provide evidence in case of dispute or refusal. It is a best practice for employers and carriers to document communications, job analyses, and efforts made to find work compatible with an employee’s restrictions.

 5. Employee Engagement, Morale, and Return Motivation Risks

Injured workers left unengaged or off work might lose skills, routines, or motivation, which can lead to poorer outcomes, delayed recovery, or refusal of modified work that is offered.

To mitigate the potential impacts and exposures of PRRTW claims, it is important to design an effective return-to-work program that addresses the physical and emotional needs of the injured worker.