Stay at Work/Return to Work

Best Practices and Tools for Montana

WHERE TO BEGIN

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Despite our best efforts, employees get injured What do you do?

Effective RTW Strategy: Encourages communication between employer & injured employee Allows a skilled and experienced employee to continue working Keeps loss of productivity to a minimum Reduces the costs of training new employees Creates an opportunity to complete work usually left undone

How to create a successful RTW Program: Believe in the program – for your company and your employees Develop a written procedure for returning injured workers to workplace Designate a RTW lead

SUCCESSFUL RETURN TO WORK EFFORTS

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BENEFICIAL FOR EVERYONE

Program Benefits For Employers: Employers with fewer injuries pay less

Less time off work = less impact on your premiums Returning to work speeds an IW’s recovery Reduces the financial impact on worker Reduces physical & emotional health effects May reduce the risk of re-injury

Program Benefits for Employees: Keeps the employee active and speeds medical recovery Shifts focus from “dis-ability” to ability Provides a sense of job security Allows the employee to maintain contact w/ co-workers Shows you value your employee and their contributions to your

company

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KNOW ALL THE OPTIONS Informal Process:

Good communications exists between you and your employee Your employee is motivated to return to work or to keep working after an injury There is an agreement between both parties about IW’s abilities

Document Everything: Useful if your IW is not cooperating w/ your RTW efforts Use Medical Status Form to obtain work restrictions from healthcare provider Be specific and put in writing your light-duty job offer

RTW Options: Modified Work – an adjustment to the way a job is normally performed

Ex: Changing lifting requirements Part-time Work

Ex: Work restrictions only allow for ½ day of work Alternative Work – different job w/in your organization

Ex: Can be an existing job or an identified set of job tasks that you need done and no one has tackled

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MEDICAL STATUS FORM

Purpose of Form Facilitate communication between:

Worker with a work-related injury or occupational disease

The employer The healthcare provider

Provide necessary medical information to the insurer

An insurer can request additional info from healthcare provider, but the employer cannot

By law, the treating physician or designee is required to complete the Medical Status Form after each visit

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SAMPLE LIGHT DUTY JOB DESCRIPTIONJob Duties: In a dealer’s auto parts department, takes orders from customers, utilizing telephone, fax & Internet. Checks on availability and price of parts and advises customers. May write up order and invoice as appropriate.

Tools & Equipment: Telephone, computer, desk, chair, paper and pen or pencil

Frequency and Duration of Tasks: Worker can set task and speed level and has the flexibility to stand or sit as needed

Physical demands limited to the following:1. Frequent – Lift paper & writing implements weighing less than one pound2. Alternate sitting and standing as needed to write up orders and enter into computer3. Frequent – Hand and grasp writing implements to organize and record information4. Frequent – Fine finger manipulation to keyboard and organize paperwork

No additional demands will be required of the worker without approval of the attending doctor. Any reasonable accommodation can be considered.

Employer’s Signature:_________________________________ Date:____________________

Employee’s Signature: ________________________________ Date: ____________________

Seldom = up to 10% Occasional = 10% - 30% Frequent = 30% to 70% Constant = over 70%

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WHAT HAPPENSWHEN THINGS GO WRONG

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A TALE OF TWO INJURIES

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Tom:• 28-year-old construction worker• Suffered right ankle fracture 6 months ago• Sought care at local occupational clinic and completely recovered• Back to work with no issues• HAPPY PATH

John:• 28-year-old construction worker at same company• Identical injury and sought care at same clinic as Tom• 6 months later: out of work; can’t sleep; snapping at the family;

on anti-inflammatories and opioids and going for 3rd opinion• Someone thinks he may have CRPS (Complex Regional Pain Syndrome)

• DELAYED RECOVERY

PROBABILITY OF RETURNING TO WORKAFTER DATE OF INJURY - BY QUARTER

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90%

55%

32%

5%

Source: IAIABC Disability Management and Return to Work Committee 2016

NEEDLESS DISABILITY

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Definition: Time off work not really required by the medical condition itself Worklessness has number of consequences:

Financial impact to injured worker Economic toll to employer Social and emotional issues Tremendous health consequences

Increases in poor health, mental disorders and suicide 2-3X increase in poor health

heart disease, respiratory illness, lung cancer, etc 2-3x increase in mental health disorders 6x increase in suicide

INJURED EMPLOYEE PERSPECTIVE

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• I’m having a hard time sleeping

• I forgot our anniversary

• Covid-19

• The car needs a new suspension

• Bills are piling up

• Will I get fired?

IMPACT ON RETURN-TO-WORK

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Source: Injured Worker Survey, 2019

UNDERSTANDING DELAYED RECOVERY

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Biological Risk Factors:• Age• Gender• Comorbid conditions • Opioids

Work Risk Factors: • Heavy manual job • Workplace climate• Work overload and pressure• Long commute distance• Job satisfaction• Low social support• Dysfunctional family situation

Psychosocial Risk Factors:• Fear• Catastrophic Thinking • Recovery Expectation• Perceived Injustice

WHAT IS OUR ROLE?

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Employers/Manager/Supervisors: Identify and address barriers early on Functional approach Facilitate a return to preinjury function

Conversational Interview:• When do you think you’ll return to work?

• Follow-up question: Why do you think it will take xx weeks?• Why do you think this happened to you?• Is your pain sometimes more than you can bear?• How are you coping with the injury?• Anything you’re afraid of that we haven’t talked about?

SOURCES

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*Jurisic M, et al. The Personal Physician’s Role in Helping Patients with Medical Conditions Stay at Work or Return to Work, JOEM. 2017

*Waddell G, Burton AK. Is work good for your health and well-being? London: The Stationery Office, 2006.

*Gerdtham UG and Johansesson M. A Note on the Effect of Unemployment on Mortality. J Health Econ. 2003; 22(3): 505-518

*Comorbid Conditions in Worker’s Compensation. AMA Guides newsletter. 2019.

*Psychological Factors in Delay and Failed Recovery and Unnecessary Disability. AMA Guides Newsletter. 2019

Questions