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Return to Work
Susan Shemanski
Vice President, Client Services
Sedgwick
2
SedgwickCMS©2011Confidential–Donotdiscloseordistribute.
Why Return to Work?
• Return to work is a critical component of any risk management program
and requires skillful claims management and coordination
• Indemnity benefits account for 42% of the total claim cost
• Time away from work drives the ultimate claim cost with higher indemnity
payments and more medical treatment
3
SedgwickCMS©2011Confidential–Donotdiscloseordistribute.
Benefits of early return to work programs
• Injured workers who go back to work in a transitional duty job will return
to full duty 30 days faster than those who do not
• Employers save an average of 30% lost time with a return to work
program. Less lost time means less medical expenses, less staffing issues
due to off work employees and less loss of productivity
• Estimates indicate employers save between $3 and $10 for every $1 spent
on a RTW program
• Lowers the experience modification factor used to calculate workers’
compensation premiums
4
SedgwickCMS©2011Confidential–Donotdiscloseordistribute.
Benefits to the Injured Worker
• Allows the injured worker to continue to be productive and to
contribute
• Improves and maintains communications between the
company, the injured worker and the treating physician which
leads to a more positive conclusion of the claim
• Allows the employer to monitor the employee’s progress on a daily
basis
• Promotes better morale and employee retention
• Assists in compliance with the ADA act
5
SedgwickCMS©2011Confidential–Donotdiscloseordistribute.
Keys to a Successful Program
KEYS
Communication
Education
Solid
Workflows
Consistency
6
SedgwickCMS©2011Confidential–Donotdiscloseordistribute.
Creating Your RTW Team
Employer
Injured
Worker
Claims
Examiner
Medical
Provider
Attorney
7
SedgwickCMS©2011Confidential–Donotdiscloseordistribute.
Key Plays
• Focus on Abilities
• Act with a Sense of Urgency
• Push for Progression
• Have your claims examiner reference Disability Guidelines
• Communicate with the Medical Provider
• Communicate important changes in treatment or condition to the
team
• Track Work Status
• Consider partnering with non-profit organizations
8
SedgwickCMS©2011Confidential–Donotdiscloseordistribute.
Focus on Abilities
Always focus on the injured employee’s “Abilities” rather than
“Restrictions”
Most injured employees are capable of some form of light duty work
immediately following the work injury
Consider the physical requirements of normal activities of daily living that
an employee continues after the work injury
Present a job description to the Doctor
Ask the injured employee to identify tasks from their normal position that
they feel they are still capable of performing
9
SedgwickCMS©2011Confidential–Donotdiscloseordistribute.
Act with a Sense of Urgency
of employees off
work for four
weeks will never
return to work
10% of employees off
work for twelve
weeks will never
return to work
50% of employees off
work for fifty-two
weeks will never
return work
98%
Strive to obtain the initial release to light duty
at the earliest possible time
10
SedgwickCMS©2011Confidential–Donotdiscloseordistribute.
Continuous Progression
Emphasize a constant
progression of work
abilities through the
life of the claim
Pursue incremental
movement toward full
duty
Continue to focus on
increased abilities
11
SedgwickCMS©2011Confidential–Donotdiscloseordistribute.
Reference Disability Guidelines
Utilize ODG to help with your RTW efforts
Gauge the employee’s functional progress
Prepare for the initial release to light duty status
Make sure the treating doctor is aware of the guidelines
12
SedgwickCMS©2011Confidential–Donotdiscloseordistribute.
Communicate with the Medical Provider
 Functional capacity
What can the worker do today?
 Functional impairments or limitations
What can’t the worker do now that they normally could?
 Medically-based restrictions
What is the treatment plan and treatment schedule?
What should the worker not do to ensure no additional
specific medical harm?
13
SedgwickCMS©2011Confidential–Donotdiscloseordistribute.
Speak to the Employee
Contact the
employee to
understand
current
activities of
daily living.
Get
employee’s
ideas of
transitional
duty tasks.
Consider
external
factors
impacting
employee’s
willingness to
return to
work.
Does the
employee
perceive any
barriers at
work?
14
SedgwickCMS©2011Confidential–Donotdiscloseordistribute.
Return to Work Options
Take the actions needed to resolve the situation:
Normal Return to Work
Return to Work with Temporary Restrictions
Return to Work with Permanent Restrictions
Consider Non-Profits if nothing available at
Employer site
15
SedgwickCMS©2011Confidential–Donotdiscloseordistribute.
Tracking Process
Track
Permanent
Restrictions
Track Injury
and RTW
progress
against ODG
Track Date
that Employer
Provides a
Transitional
Job
Track When
the Treating
Doctor
provides
release to
RTW
Note ICD9
and injury
type
Data Allows You to Focus on Continuous Improvement
16
SedgwickCMS©2011Confidential–Donotdiscloseordistribute.
Questions / Comments

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