Following a workplace injury for which the doctor prescribes restricted work upon the patient’s return to employment, companies have two options: providing
Bob Eckhardt
Following a workplace injury for which the doctor prescribes restricted work upon the patient’s return to employment, companies have two options: providing restricted work, or paying compensation until the doctor releases the injured worker to perform regular duties. Of the two choices, restricted work programs Û also known as Îmodified work,Ì Îlight duty,Ì Îtransitional duty,Ì or Îalternative workÌ Û offer significant benefits as compared to the alternative.
Unknown is the number of companies that implement restricted work programs. However, a 2001 Canadian study published in the Journal of Occupational and Environmental Medicine by Ann-Sylvia Brooker, M.S.; Donald C. Cole, M.D.; Sheilah Hogg-Johnson, Ph.D.; Jonathan Smith, M.S.; and, John W. Frank, M.D., M.S., concluded:
÷only a minority (36 percent) [of injured workers surveyed] were offered arrangements by their employer to help them return to work after developing a work-related soft-tissue injury. Most arrangements that were offered to injured workers consisted of such temporary modifications as reduced hours (24 percent), flexible work hours (25 percent), or a lighter job (57 percent), rather than more permanent changes to the way that work is conducted, such as changes to the work layout or equipment (8 percent).
Employers who do not provide these programs typically advise that (1) providing Îlight duty workÌ functions as a reward encouraging employees to seek easier work, and (2) employing injured workers in nonproductive capacities is costlier. In concrete production, most employers simply do not have useful assignments to offer workers who cannot perform their regular duties. Inappropriate work assignments, e.g., a production worker performing menial office tasks, are also common. Therefore, some companies contend, providing a restricted work program entails a loss for the employer.
Yet, workers’ compensation constitutes a loss through the insurance program, although it ultimately may be recovered by the insurance company, depending on the type of policy in effect. Nevertheless, a term during which the employer experiences a high loss rate is invariably followed by a period of higher insurance premiums. The Experience Modifier, familiar to insurance professionals, is used to determine the rates assigned to specific employers.
If Maslow and others who profess that people innately want to lead productive lives are to be believed, then working in a reduced capacity does not constitute a reward. Additionally, it could be argued that providing restricted work for injured employees is a job benefit that might contribute to reduced turnover. If the workplace is experienced as a site of punishing labor, however, restricted work possibly would be preferred to regular duties.
Paying compensation to keep injured workers off the job site arguably incurs far greater expense than providing restricted work. Yet, in citing reasons for the financial advantages of a restricted work program, fairness requires an acknowledgment by this author that actual cost studies evaluating the gains or losses could not be located.
Among insurance and claims management professionals, the positive impact of early return to work on employee self-esteem, worker-employer relations, and cost containment is incontestable. The key to this success is providing work that does not aggravate the injury. Many employees experience multiple failed returns to work as a result of exposure to the same stressors involved in pre-injury tasks, e.g., repeated bending, awkward posturing, forceful motions.
Injured workers actively engaged in a work environment, rather than idle at home, typically heal more quickly. A 1998 Journal of Rehabilitation article, by Niklas Krause, Lisa Dasinger, and Frank Neuhauser, evaluating 13 independent studies concluded:
The main finding of this review is that modified work programs facilitate return to work for temporarily and permanently disabled workers. Injured workers who are offered modified work return to work about twice as often as those who are not. Similarly, modified work programs cut the number of lost workdays in half. The available evidence also suggests that modified work programs are cost-effective.
Another published report by Baxter Worldwide cites a 38 percent improvement in the company’s lost-days rate from 2004 to 2005. That progress is attributed to the deployment in 2004 of a companywide case-management initiative, which included a strongly promoted return-to-work program.
A further benefit of restricted work programs is reducing the number of lost-time incidents in the Occupational Safety and Health Administration calculation for lost workdays, although OSHA maintains yet another rate for combined lost and restricted workdays. Moreover, since an OSHA-recordable incident occurs whenever a treating physician prescribes restricted work for an injured worker, another method of reducing the number of incidents is to provide competent first aid at the plant. An invaluable resource for reducing the incidence rate is a person on site trained in first aid, or a qualified emergency medical technician, who can treat minor workplace incidents without having to send an injured employee to the doctor. Thus, initial incident management can be highly effective.
To formulate a return-to-work program, an early step involves consulting the Human Resources department regarding the company’s description of physical demands for the job, as well as policies related to the Americans with Disabilities Act. Key terms to consider in reviewing policies and formulating programs are Îtemporary restrictionsÌ versus Îpermanent restrictionsÌ.
Additionally, case-by-case reviews with respect to workplace accommodations are essential before a decision is made regarding eligibility to return to work for any injured worker who has a Îpermanent total disabilityÌ rating, usually expressed as a percentage. Restricted work programs for employees temporarily disabled due to workplace injury are provided for a specified Înot to exceedÌ time frame. Following that period, the injured worker is released from the restricted work program, sent home, and placed on workers’ compensation.
For nontraumatic incidents, taking injured workers to an industrial clinic provides better treatment than that likely received at an emergency room. Trauma care doctors typically are not trained in industrial medicine, and evaluating a sore back or a cut finger is often regarded as a nuisance. Consequently, when a nontrauma patient is taken to an emergency room, the attending doctor may off-handedly prescribe pain medication and time off work. Thus, most cases treated in the emergency room become instantly recordable.
Noteworthy is the fact that during the research of this article no evidence was found definitively demonstrating the precise financial benefit of a restricted-work program. Nonetheless, all articles reviewed emphasized the financial benefit of such policies for employers. Repeatedly identified was the far faster rate of return to regular work for injured employees who were managed by a restricted work program. Perhaps, the evidence of simply returning injured employees to work faster constitutes sufficient financial analysis. Without a return-to-work program, the toll of employees staying off work Û which tends to grossly prolong recovery time and increase the likelihood of not returning to work at all Û could be debilitating.
RESTRICTED WORK PROGRAM
The following steps are key in implementing a restricted work program:
- Formulate a written return-to-work program
- Identify a return-to-work and injury coordinator
- Establish a relationship with a qualified clinic or licensed healthcare professional, preferably a clinic specializing in industrial medicine
- Supply healthcare professionals with descriptions of the work’s physical demands
- Inform treating healthcare professional of the plant’s return-to-work program availability
- Implement a system for case assignment to a regional occupational health professional, such as a claims adjustor, for immediate claims control
- Promote the return-to-work process among employees
- Always accompany an injured worker to the doctor, communicate the process to the employee, and coordinate paperwork related to the incident for the worker