Return to Work Program Kit

There is no absolute in the prevention of workplace accidents and injuries. Even with the most comprehensive
safety program in place, accidents and injuries can only, at best, be minimized. So, when injuries or illnesses do
occur, management is then responsible to do everything possible to provide prompt medical care and to assist the
injured worker in returning to full, productive employment.

STEP 1 Formation of Return-to-Work Committee (or Team)

The first step to beginning a Return-to-Work program for your company is to develop the committee (or team).
The committee will not only establish the workplace policy but also guide and monitor the program’s
administration. The Return-to-Work team will be involved in all aspects of case management. Its collective goal
is to direct the injured worker's recovery toward a return to productive employment. Each injury requires
personal attention. To be successful, you will need to continually fine-tune your program to meet the ongoing
needs of your employees and your company.

Each company’s team will vary depending on the size and resources of the company. Each member of the team
is either assigned a specific role or provides important information and support during the treatment and
rehabilitation of the injured worker.

After an injury occurs, the information gathered during the Return-to-Work process allows for the evaluation of
job positions and work sites and the improvement of loss prevention and safety process. The assigned personnel
will also be able to identify questionable incidents and unsafe work conditions through aggressive investigation
and management.

It is essential, if you work in a union shop, to have union representation on your Committee. One of the greatest
benefits afforded to your workplace through establishing a Return-to-Work program is the spirit of collaboration
that occurs when employees and representatives from all areas come together with the mutual goal of returning
injured workers to the workplace. A Return-to-Work program depends on joint Labor/ Management
cooperation.

Additionally, any and all information relative to the employee’s medical history and/or condition needs to be
kept confidential and should be handled only by your Human Resources committee representative who can serve
as a case manager. Ensuring this high level of confidentiality will bolster your employees’ confidence in
program participation.

Management and Worker Representatives

It is essential to make sure there are representatives from both management and the workforce serving on your
Return-to-Work committee.

A firm commitment from top management to the necessity of the program and its benefits are demonstrated best
by representation on the committee. Part of management’s role on the committee will be to develop a strategy to
communicate support and commitment throughout the organization

The worker representative might be a union member or, in non-unionized workplaces, an employee
representative. This person(s) serves to provide information about the union requirements of modified duties,
monitors and assists in the creation of temporary accommodation positions, and acts responsibly on behalf of the
worker in matters of seniority and job assignments. Worker representation will also serve to benefit the entire
workplace community by acting as a liaison to the workforce by keeping co-workers and staff informed on the
progress of the Committee.

Suggested HR and Provider Representatives

Depending on the size and needs of your organization, you may want to include a representative from your
company’s HR Department and/or a representative from the medical community on your Return-to-Work
Committee.

An HR representative (or a staff safety employee) may serve on the committee to direct the company’s case
management activities. This member would maintain contact with the medical care provider and the worker

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while maintaining a recordkeeping and reporting system. This committee member would require a thorough
knowledge of workers’ compensation operations, have the ability to allocate resources to modify tasks or work
sites, and have the responsibility of coordinating the final arrangements for alternative work assignments and of
monitoring of the injured worker’s progress. As stated earlier, the HR committee representative will be a
member of the Return-to-Work team who should handle confidential medical information.

Additionally, your company may want to include a medical care representative. You may already have a
provider or occupational health nurse on staff or the possibility may exist to obtain a volunteer from your
company’s workers’ compensation panel. A direct medical representative would be an immense asset to your
team as you prepare to interact with the medical community. This advisor can assist you with suggestions on
form format, questions to ask, and follow-up advice. Additionally, if your company does not already have a
provider’s panel, these representatives can make suggestions on potential practitioners to consider during the
development of your panel.

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STEP 2 Develop a Return-to-Work Policy Statement
The Return-to-Work policy statement is a joint labor/management directive offering an introduction to the workforce of
your company’s Return-to-Work program. Your company’s policy statement will be a point of reference throughout the
entire development and maintenance of your Return-to-Work program as it sets the general scope and guideline for your
program.

As the first tool that will be used to inform the workforce of your company’s new Return-to-Work policy, a great deal of
care should go into its development. Critical to the success of this approach with your workforce are the suggestions and
guidance of a diverse Return-to-Work committee. Use your initial committee meetings as a forum opportunity to discuss
ideas, concerns, and all the pertinent aspects of your program that need to be addressed in your policy statement.

Develop a Return-to-Work philosophy based on the following principles:

• Involve the work force (management, supervisors, and workers).

• Establish a joint employee/management committee.
• Always treat an injured or ill worker with dignity, consideration, and respect.
• Make a commitment to support the injured worker's medical treatment.
• Focus on a person's capabilities, not their disabilities.
• Make a commitment to endeavor to return injured workers to their original jobs as effectively as
possible.
• Mandatory participation by both labor and management.

Please refer to the appendixes listed below containing samples to help guide your committee in the creation of your
company’s Return-to-Work policy.

See:

Appendix A - Sample Philosophy of a Return-to-Work Program

Appendix B - Key Decision Points in Transitional Employment
Appendix C - Return-to-Work Policy Statement Example
Appendix D - Return-to-Work Policy Statement Example
Appendix E - Return-to-Work Policy Statement Example

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 Appendix A

SAMPLE PHILOSOPHY OF A RETURN-TO-WORK PROGRAM

EMPLOYEES ARE OUR MOST IMPORTANT ASSETS!

(Name of company) Return-To-Work Program is based on the assumption that there is nothing more important than our
employees. When an employee loses time from his or her job, or is unable to return to work, everyone loses.
• The employee loses contact with his/her friends, relationships with coworkers, income, benefits
and, most importantly, self-esteem, which is often so closely tied to employment.
• Our company loses a valuable employee.

OUR PROGRAM

To meet our goal of enabling employees to return to productive employment as rapidly as possible, our company takes the
following steps:

• We try to meet with the treating provider at the employee’s first medical appointment to discuss the
physical demands of the employee’s regular job, or the demands of alternative temporary tasks. Every
effort is made to enable the employee to return to work either immediately or in the very near future.

• We staff the employee’s case internally on a regular basis, contacting you regularly to see if an
enhanced release can be obtained or whether alternate tasks or additional hours of duty can be approved
safely.

• We meet with you immediately if permanent limitations of any kind are projected to determine if these
will, in any way, affect the employee’s ability to return to his or her regular job or to determine whether
we need to consider permanent modifications or other alternatives.

Because everyone loses when an employee must be temporarily or permanently off the job, it stands to reason
that everyone wins when employees are returned to work as quickly as medically possible and become
productive, in even a small way, as soon as possible after injury.

YOUR ROLE

To achieve the goals of our Return-To-Work Program, we need you as our partner. We will communicate with you
regularly. We will provide you with the best possible information about the physical demands of transitional duties
available. We will let you know how the employee is doing on the job. We need timely information and communication
from you. We need to know as quickly as possible the physical limitations you will be establishing for a safe return to
work. We will utilize those restrictions in our Transitional Employment Plan. We need your comments about our
company’s Return-to-Work program that we provide to you. If there are permanent restrictions, we need your help to
evaluate the employee’s ability to return to his/her regular job or to evaluate modifications or alternate employment.

Should you have a question about (name of company) Return-To-Work Program, or concerning one of our employees,
please call ________________________ (Name) at __________________ (Telephone Number)

We look forward to working with you.

Sincerely,

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 Appendix B

KEY DECISION POINTS IN TRANSITIONAL EMPLOYMENT

The goal of the Return-To-Work Program is the safe, rapid return of our injured employees to transitional or regular
employment. We believe that our employees’ needs and the needs of (name of company) are best served when our
employees are able to maintain some form of medically appropriate employment from the time they are injured until they
are able to return to regular employment.

To achieve our goals, we must work together to ensure frequent communication and regular sharing of information. There
are key junctures or decision points in what we call the “Transitional Employment” process when we need special input
from you. These decision points are described below:

1. Day of Injury: We aim to meet or contact you within 24 hours of the time one of our employees has a
significant injury. In many cases, we hope to accompany our injured employees to the first medical appointment
following injury. Our goal at that point will be to provide you with an analysis of your patient’s regular job so
you can make an informed decision about whether the employee can return to the position safely. Other
alternatives may be discussed at the time, including temporary modifications to the employee’s regular job if
feasible, including reduced hours or changes in duties. If suitable alternate work is available--even if it is only
for a couple of hours per day--we will attempt to provide it. Your ability to evaluate these opportunities at the
time of the initial medical treatment is essential for successful management of each employee’s injury and
smooth return to productive employment.

2. Points of Medical Improvement: During Transitional Employment we will evaluate every injured employee’s
case on a regular basis and considering all information provided regarding the employee’s physical abilities. We
will evaluate this information in terms of opportunities for return to regular or modified work.

3. When permanent or Long-Term Limitations are projected: At some point, an employee will reach a time
where you are able to project whether he/she is likely to have permanent or long-term limitations. At that point,
even if an employee is not yet medically stable, we will consider the feasibility of permanent or long-term
reasonable accommodations.

4. Point at Which Maximum Medical Improvement is reached: This is the point at which the employee has
recovered as fully as possible. At this point, we will consider any permanent or long-term limitations and their
impact on the employee’s ability to return to his/her regular job.

If necessary, we will consider accommodations, including modification to the regular job or placement in
suitable alternative vacant employment. Should the employee be unable to be accommodated, this would also be
the point where we would consider such possibilities as vocational rehabilitation.

Your contact person for ___________________________ is ___________________________

Agency or Site Location Name Title, Phone

Please call with any questions or concerns.

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 Appendix C

RETURN-TO-WORK POLICY STATEMENT EXAMPLE

Policy Statement Example

In fulfilling this company’s commitment to provide a safe and healthy working environment, a Return-to-Work Program
has been established for employees who have sustained an injury/illness.

(Name of Company) undertakes to accommodate the injured/ill employee through an early rehabilitation and placement
where possible, to the benefit of both parties. This program provides gradual and consistent rehabilitation for employees.

(Name of Company) will work toward facilitating the injured/ill employee to an appropriate and timely return to work in
the original position where they were employed at the same time of the injury/illness. If the original department is unable
to place an employee in a suitable position, the company will try to identify an appropriate position in another department.
All attempts to place the employee in another area must be done in cooperation with managers, workers, union
representatives, and the employee.

Signature ___________________________________ Date ___________________________

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 Appendix D

RETURN-TO-WORK POLICY STATEMENT EXAMPLE

(Name of Company) shall make every reasonable effort to provide suitable employment to any employee unable to
perform his or her duties as a result of an injury or illness. This may include a modification to the employee’s original
position or providing an alternative position, depending on the employee’s medical restrictions, providing that this does
not create an undue hardship to the company. Only work that is considered to be meaningful and productive shall be
considered for use in the Return-to-Work Program. Participants placed on the Return-to-Work plans will be expected to
provide feedback in order to improve the program. All employees, regardless of injury or illness, will be considered for
placement through the Return-to-Work Program.

Signature ___________________________________ Date _________________________

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 Appendix E

RETURN-TO-WORK POLICY STATEMENT EXAMPLE

It is the company’s policy to make every reasonable effort to provide suitable alternative employment to an employee who
is unable to perform his or her normal duties as a consequence of injury or illness.

Each department will attempt to accommodate employees who cannot perform the basic duties of their former positions.
Where this is not possible, all departments will cooperate in meeting the company’s policy of trying to locate suitable
alternative employment.

Signature ___________________________________ Date _________________________

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Step 3 Develop Your Company’s Medical Provider Referral List
Medical Provider Referral Defined:

Employers have the right to establish a list of designated medical care providers. When the list is properly posted, injured
workers must seek treatment for the work injury or illness with one of the designated providers for 90 days from the date
of the first visit.

If a designated list is established, the employer must provide a clearly written notice to an injured employee of the
employee’s rights and responsibilities.

Employers should not require treatment with any one specific provider on the list, nor should the employer restrict the
employee from switching from one designated provider to another designated provider. The employee is free to choose
any provider on the list.

If there is an emergency situation, the employee should not be required to obtain emergency treatment from a listed
provider. However, once the emergency condition no longer exists, the injured employee shall seek treatment with a listed
provider.

If an employer chooses not to establish a list of designated providers, the employee has the right to seek medical treatment
from any provider of his or her choice.

Designated List of Medical Care Providers

• the list should contain at least six providers

• three of the six providers should be physicians
• not more than four provider should be physicians
• each provider’s name, address, telephone number and area of medical specialty
• should be included on the list
• listed providers should be geographically accessible and their specialties appropriate for the anticipated work-
related medical problems of the employees

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Step 4 Conduct Job Task Analyses
Task analysis can be used to assess workstation and job design. In the Return-to-Work process, task analysis serves two
functions:

 Loss prevention:

 Analyze jobs and work stations to minimize or eliminate hazards that may cause injuries or illness;
 Identify jobs and tasks that are particularly risky and make their redesign a priority; and
 Avoid the accident before it happens.

 Identification of alternate work assignments:

 Identification of alternate work assignments:

 Managers and workers will review existing job descriptions and perform task analysis on each using
the task analysis checklist.

Task Analysis Checklist

Task analysis allows Return-to-Work team members to:

 Identify the root cause of unsafe conditions in the workplace;

 Prioritize workplace hazards so the worst problems can be addressed first;
 Make hazard prevention a part of new workplace design;
 Provide information to the medical care provider treating the injured worker; and
 Determine the job modifications required to enable the worker to carry out job activities based on
information provided by the medical care provider.

Questions to be Included during a Job Task Analysis

 What activities are involved?

 What are the physical functions required?
 How frequently are they performed?
 What is the duration?
 What is a typical daily schedule?
 What equipment and tools are required?
 How are tools used?
 What postures are involved?
 What skills are required?
 What weights are lifted?
 How often are they lifted?

It is important that workers, as the people closest to day-to-day operations, participate in the preparation of task lists on
their own jobs, and it is helpful if all members of the Return-to-Work team are familiar with the work environment. If
feasible, conduct tests to quantify the force and exertion required to perform the duties of the job.

Additionally, the best time to conduct job analyses in your company is before a workplace injury or illness occurs. When
a new employee is hired, or once a job task analysis is drafted for a current employee, have the employee sign off on the
job task analysis before the injury occurs. This not only aids in the accuracy and consistency of the document but it also
eases the burden of participating in a job analysis on the injured or ill employee during what could otherwise be a very
difficult and confusing time.

An important thing to keep in mind is that your Job Task Analyses need to be kept up to date as the positions within your
company change. It is very important to constantly review and update your records to ensure that they are accurate should
you require them.

Appendix F - Job Description - Essential Functions

Appendix G - Provider Examination Report

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 Appendix H - Return-to-Work Program Provider Form

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 Appendix F

JOB DESCRIPTION – ESSENTIAL FUNCTIONS

Job Title:
Essential Functions of the Job:
Physical Demand Classification:

PHYSICAL REQUIREMENTS

REQUIREMENTS % OF TIME FORCES/ REPETITIONS DISTANCE ITEMS COMMENTS

WEIGHT /HEIGHT
Occasional 0-33 Occasional 0-32

Frequent 34-66 Frequent 33-200

Cont. 67-100 Cont. 200

Standing

Sitting

Driving

Walking

Lifting

Carrying

Pushing

Pulling

Squatting/Stooping

Crawling

Climbing
• Stairs
• Ladders
Reaching
• Overhead
• Below
Kneeling

Bending
• Knees
• Elbows
• Torso/Back
Hand Function
• Close Grasp
• Pinch
• Fine Manipulation

WORK CONDITIONS

NOISE LEVEL: INSIDE OUTSIDE TEMPERATURE CHANGES:

WORKING HAZARDS: EXPOSURE TO DUST, FUMES, GASES:
TOOLS USED FOR THE JOB:
ACCOMMODATION AVAILABLE:

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 Appendix G

PROVIDER EXAMINATION REPORT

Name: Date of Exam:
Date of Injury: Date of Birth: ________________________________
Employer: Occupation:

History as Related by Patient:

Are your findings consistent with history and type of injury? Yes No Unsure

Is the injury work- related? Yes No Unsure

Are there any current conditions that may affect recovery? Yes No Unsure

Please explain: ______________________________________________________________________________

Diagnosis:

Treatment Plan:

Patient Status: Return to work with restrictions (see below)

May return to full duty work
Unable to return to work

If unable to return to work full duty, anticipated date of return to full duty:

Work Status: (Circle the level of limitation if applicable)

Lifting:
Sedentary <10 lbs occasionally and up to 5 lbs frequently
Light 10-20 lbs occasionally and up to 10 lbs frequently
Medium 20-50 lbs occasionally and up to 20 lbs frequently
Heavy 50-100 lbs occasionally and up to 50 lbs frequently
Very Heavy >100 lbs occasionally and up to 100 lbs frequently

Bending None Occasional Frequent Constant

Squatting None Occasional Frequent Constant
Kneeling None Occasional Frequent Constant
Climbing No Fixed Stairs No Ladders
Reach Not with Right Not with Left
Grasping Not with Right Not with Left
Pushing/Pulling Not with Right Not with Left
Sit None Occasional Frequent Constant
Stand None Occasional Frequent Constant
Walk None Occasional Frequent Constant
Drive None Occasional Frequent Constant

Other:

Next Appointment Date and Time:

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Medical Care Provider Signature: Date:

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 Appendix H

RETURN-TO-WORK PROGRAM
PROVIDER FORM
To: Medical Care Provider Subject Employee:

From: Company Name SS#:_________________________________________________

We want to assist our employee and your patient to return to work as soon as possible and assist him/her in performing
essential job functions at this institution. The information you provide on this form is vital and will be used for the
following considerations:

• Allowing the employee to work without risk of further injury;

• Revision of a temporary assignment if necessary that meets the employee’s needs and the needs of this
institution;
• Provision of any temporary reasonable accommodations to aid the employee in performing his/her duties.

The employee’s job description is attached for your consideration:

Regular Job Description Temporary Assignment Job Description

If you have any questions regarding the information requested on this form, please contact:

Name & Title of Hosting Department Supervisor Telephone Number

TO BE COMPLETED BY MEDICALCARE PROVIDER

Considering this employee’s job duties and health condition, this employee may perform work in the following manner:

Full Duty (no restrictions) Beginning: _____________________

________Temporary Assignment Job Description Beginning: _____________________

________Regular Job Description Beginning______________________

Less than Full Duty (some restrictions) Beginning:

*Additional Restrictions to Temporary Assignment Job Description should be noted on the Temporary Assignment Job
Description.

Off Work until Re-evaluated by Provider Beginning:

Next Office Visit Scheduled:

Medical Care Provider’s Signature Date

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Step 5 Develop Suitable Alternative Work Assignments

Completed task analyses are used to identify jobs for returning injured workers. Work activities are designed to
accommodate limitations such as restricted lifting, standing, walking, or sitting. Alternate work activity can be a modified
version of the injured worker's original job, the same job with reduced hours, or a combination of tasks from other
positions. It can be full or part time, but should be a time-limited assignment that is directed toward the injured worker's
full return to his or her pre-accident job. The work must be productive and suitable to maintain the worker's sense of
worth.

To identify alternate assignments, determine:

• What necessary tasks could the injured worker perform?

• What tasks, now performed occasionally, need to be done more frequently?
• What tasks could be assigned to someone else?

Be certain to know the physical and other demands of the alternate jobs or assignments that your company develops. It is
essential that they match the limitations as prescribed by the injured worker’s medical care provider to ensure prevention
of re-injury and the full rehabilitation of the employee.

During recovery, injured workers need their capabilities emphasized rather than their limitations. It is best to consult the
employee’s treating medical care provider on what temporary work assignment would be best suited to the employee’s
needs and most beneficial to the rehabilitation process.

See: Appendix I - Examples of Accommodations

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 Appendix I

THE FOLLOWING LIST WILL HELP YOU IDENTIFY WAYS IN WHICH AN INJURED
WORKER MIGHT BE ACCOMMODATED

Temporary Accommodation

Light Duties: Demand less physical exertion than pre-injury job. Worker's duties are limited according to the
recommendations of the medical care provider.

Lesser Duties: The worker performs reduced duties at a slower pace.

Alternate Duties/Tasks: Although the worker may be unable to perform regular duties, he or she may be able to perform
other duties within his or her limitations. The worker must have the necessary skills and abilities to perform these duties
competently and safely. A short-term skill development-training program to upgrade skills may be required.

Reduced Hours: The number of work hours may be reduced to match the worker's tolerance level.

Temporary Accommodation as Treatment: The employer may be asked by the medical care provider to make certain
additional modifications to the worker's job to accommodate the treatment process. These modifications include work
hardening, extended therapy, and graduated duties.

Work Hardening: Work duties may be used as part of a conditioning and strengthening process. The work is designed to
progressively increase the worker's physical ability until he or she is able to perform his or her regular duties.

Extended Therapy Program: The medical care provider designs a treatment program incorporating actual work duties in
a work setting. Under supervision, the worker's usual work duties are gradually added. This ensures that the duties are
performed correctly and are within the worker's ability.

Graduated Return-to-Work Program: Work accommodations are made to allow the worker to return to work as soon as
medically able and to gradually resume regular duties as recovery allows.

Permanent Accommodation

If it is determined that the injured worker is unable to return to his or her pre-accident duties, a permanent accommodation
may be required. The employer may be asked to participate in identifying an appropriate job change. This may include
training on the job and work assessment.

Training on the Job: The work site may be used to train an injured worker in a new job. Work is performed under the
supervision of a qualified worker and the program is intended as preparation for a specific job. This program is most
effective if a job is available with the training employer following the training period.

Work Assessment: The worker performs the job under supervision to evaluate if he or she has the ability to perform their
job duties. This may be required prior to training on the job or enrolling in academic or technical training programs.

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Step 6 Develop a Provider Form
A Provider form needs to be developed so that injured/ill workers can inform the treating provider of your company’s
Return-to-Work program and so the company can gather relevant information to find a suitable temporary job assignment
for the employee.

Crucial in your consideration of provider forms is to first identify the information necessary to your needs. Once you
know exactly what that information is, selection of the proper form, style, and content should follow.

Additionally, remember to consult medical community representatives that may be present on your Return-to-Work
Committee or provider panel for their advice and counsel. The first-hand knowledge and experiences that these
individuals bring to the table will truly ease the provider form creation process.

See:

Appendix J - Letter to Medical Care Provider about Return-to-Work

Appendix K - Return-to-Work Program Temporary Assignment Job Description

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 Appendix J

LETTER TO MEDICAL CARE PROVIDER ABOUT RETURN-TO-WORK

Dear _______________________:

(Name of Company) is committed to returning injured or ill employees to work within their capabilities. We believe that
an employee who returns to work as soon as medically appropriate, and within his or her work restrictions, regains
economic security, physical strength and flexibility, and has improved psychological well-being.

I am writing to ask for your opinion concerning Mr. /Ms. ______________’s ability to return to work at this time.
Enclosed is an analysis of Mr./Ms._______________’s regular job (and/or proposed Transitional Employment Plan).
Based on your review of the enclosed Return-to-Work Program (and/or proposed transitional employment plan) and your
examination of Mr./Ms. ________________, please choose one or more of the following:

I release the employee to the job as described in the Return-to-Work Program (or proposed Transitional Employment
Plan) effective _____________.

I release the employee to the activities as described under the following conditions:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
________________________________

I cannot release the employee to any part of the duties described at this time.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
________________________________

An appointment to review the employee’s condition further is scheduled for_________________.

Provider’s Name____________________________________ Date_______________________

Please feel free to provide any additional comments you have concerning Mr./Ms.___________’s ability to work.

Thank you for your assistance with this matter.

Sincerely,

Enclosure (Your Company name) Return-to-Work Program Details (and/or other attachments)

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 Appendix K

RETURN-TO-WORK PROGRAM
TEMPORARY ASSIGNMENT JOB DESCRIPTION

Employee Name: ______________________ Hosting Department/Location: ____________

Position Name: ________________________ Effective Date: __________________________

Essential Functions: (Medical Care Provider: Indicate if the employee can/cannot perform the essential function listed by
circling Yes or No. Supervisor: List essential job functions.)
__________________________________________________________ Yes No
__________________________________________________________ Yes No
__________________________________________________________ Yes No
__________________________________________________________ Yes No
__________________________________________________________ Yes No
__________________________________________________________ Yes No
__________________________________________________________ Yes No
__________________________________________________________ Yes No

Physical Requirements: (Supervisor: Check those that apply to job described above. Medical Care Provider: Check Yes
or No)

Requirement: Yes No Requirement: Yes No

___ Lifting ___ ___ ___ Walking ___ ___
___ Moderate (15-45 lbs) ___ ___ ___ Standing ___ ___
___ Light (up to 15 lbs) ___ ___ ___ Sitting ___ ___
___ Carrying ___ ___ ___ Crawling ___ ___
___ Heavy (45 lbs and up) ___ ___ ___Twisting ___
___
___ Moderate (15-45 lbs) ___ ___ ___ Pushing ___ ___
___ Light (up to 15 lbs) ___ ___ ___ Stooping ___
___
___ Reaching above the shoulders ___ ___ ___ Kneeling ___ ___
___ Straight pulling ___ ___ ___ Ability to read ___ ___
___ Pulling hand-over-hand ___ ___ ___ Ability to type ___ ___
___ Dual simultaneous grasping ___ ___ ___ Ability to write ___ ___
___ Operating office equipment ___ ___ ___ Hearing ___ ___
Specify_______________ ___ ___ ___Speaking ___
___
___ Operating a motor vehicle ___ ___ ___ Climbing Stairs ___ ___
___ Other: ____________________ ___ ___ ___ Simple grasp ___ ___
___ Repeated bending ___ ___

Additional Recommendations/Restrictions: (Medical Care Provider: List if applicable)

__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
________________________________________________________________________________________________________

Medical Care Provider Signature: _____________________________________ Date: _______________

Medical Care Provider Printed Name: __________________________________
Approval of Hosting Department: ____________________________________ Date: _______________

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STEP 7 Communicate Policy to Workforce
It is strongly suggested that all employees be notified of every new policy in writing. The policy statement should then be
signed and dated by the employee and filed into the corresponding personnel file. This is not only a good practice for the
Return-to-Work program, but also for every personnel transaction, policy change, or creation. Having all employees sign
and date all changes and additions serves to reinforce that all employees are aware of workplace policies, practices, and
procedures.

Additionally, if you work in a union environment, you must first remember to confer with the union before posting the
new policy. This is another aspect where the importance of having union representation on your Return-to-Work
Committee is so pivotal as to how your policy will be received by the workforce.

Once the policy has been formally introduced, it should be posted in a visible area of the workplace. Posting the policy
will serve not only as a reminder but also as reinforcement of management’s commitment to the program. It will also
allow for the policy to be easily and conveniently referenced should the need arise.

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Step 8 Educate the Workforce
The key to the success of a Return-to-Work program is partnership among workers, employers, and medical care
providers, and a shared commitment to the goal of returning injured workers to employment.

Proper education of your workforce will:

• Make everyone in the workplace aware of the principles and practice of the Return-to-Work program.
• Educate supervisors and workers about the needs of injured co-workers returning to the work
environment.
• Make everyone aware of the benefits of a Return-to-Work program. This can be achieved by:
 Providing employee orientation to introduce the Return-to-Work program and explaining how the
company will respond if a worker is injured;
 Providing ongoing education;
 Displaying posters of the mission statement or policy;
 Putting information about the Return-to-Work program in the employee newsletter;
 Providing sensitivity training to help co-workers generally understand the needs of injured coworkers;
 Providing support and education to the injured worker's family; and finally,
 The Return-to-Work team should educate injured workers on their new tasks or
modified jobs, and explain the importance of staying within the provider's guidelines.

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Step 9 Inform Stakeholders of Responsibilities
The next steps in a Return-to-Work Program take place after an injury has occurred and involve developing and managing
an individual Return-to-Work plan.

After an injury occurs, all the partners in the Return-to-Work process are responsible for the Return-to-Work of the
worker. The breakdown of responsibilities is as follows:

Employer

• Provide immediate support to the injured worker and family;

• Maintain fact finding only – not fault finding – when conducting the accident investigation and documenting
circumstances surrounding the injury;
• Review the accident investigation report and address any job related issues;
• Develop a Return-to-Work plan with the injured worker and the medical care provider;
• Communicate early with the medical care provider and the injured worker about return-to-work opportunities;
• Provide a concise and accurate task list to the medical care provider to assess the worker’s suitability for a
position;
• Maintain communication with the injured worker and the medical care provider about the progress of the
individual;
• Provide detailed job descriptions and make temporary and permanent accommodations for injured workers; and
• Monitor the injured worker’s progress both during treatment and during his or her return to work.

Medical Care Providers

• Operate from a team approach and treat all the effects of the injury, recognizing the possible psychological
impact of the injury, where related;
• Make an initial diagnosis, identify appropriate treatment strategies and make a realistic prognosis about when the
worker will be able to return to work;
• Focus on the injured worker’s recovery and advise the worker and the employer when a return to work is
medically appropriate;
• Contribute medical knowledge to the Return-to-Work plan;
• Identify other factors that may inhibit the injured worker’s return to work. Communicate any potential work
place risks that may affect the injured employee’s return to work developing and fostering open communication between
all partners. Make certain to follow-up with appropriate and prompt intervention; and
• Tailor each treatment plan so it is medically appropriate.

Injured Worker

• Obtain medical treatment;

• Provide information and influence the design of the individual plan;
• Follow the treatment plan as closely as possible; and
• Keep in regular contact with employer to communicate about progress and needs.

Union or Worker Representative

• Participate with the employer and the injured worker to develop an appropriate work plan. One that is sensitive
to the needs of the injured worker; and
• Represent the injured worker in matters of job security, appropriate treatment, and re-employment assignments.

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In a global economy Heath & Safety and Return-to-Work programs not only help employers to remain competitive, but
also help workers to remain employed.

Return-to-Work Program Samples

A Return-to-Work program may be introduced in large or small organizations. Large companies may be able to devote
more resources to the program, but smaller companies can customize many of the features to meet their needs.

Essential Elements for All Return-to-Work Programs

• Set up a list of clear steps to follow after an injury has occurred;

• Set up lines of communication among medical care providers, management, and the union;
• Set up a contact schedule to monitor the progress and needs of the injured worker;
• Evaluate and enhance the Return-to-Work program on a regular basis;
• Present the Return-to-Work program as part of a benefit package;
• Identify some Return-to-Work opportunities before they are needed;
• Be positive and flexible: focus on capabilities rather than disabilities;
• Use videos in job modification, workplace redesign, rehabilitation efforts, and other reasonable accommodation
procedures;
• Promote a cooperative environment;
• Maintain contact with all partners;
• Make sure the Return-to-Work tasks are appropriate for the injured worker’s capabilities; and
• Have the injured worker assist in identifying suitable work.
• Included in the Return-to-Work model are several sample programs that were generously shared with us by
several employers. These are in-place, working programs from companies large and small and in various types
of businesses and industries. The programs are included as examples that may provide some ideas that may be
appropriate to your company.

See:
Appendix K – Comprehensive Return-to-Work Model
Appendix L– Return to Work Model Program
Appendix M – Return to Work Model Program
Appendix N – Return to Work Model Program

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 Appendix K

Return-to-Work Program
This program is to minimize the production lost by the company and wages lost by the employee as a result of temporary
partial incapacity resulting from on the job injury. It is the express intent to provide modified duty within the employee’s
restrictions whenever possible and to facilitate the employee’s full rehabilitation as rapidly as possible.

The Human Resources Director is primarily responsible for administration of this procedure.

I. Notification of Restriction

A. Human Resources will be notified that an employee has been injured.

B. Copy of completed Treatment Report will be furnished to Human Resources immediately after
treatment; if after office hours, a copy will be left in the Supervisor’s office and furnished to Human Resources the next
business morning.

C. In the event the injured employee cannot return to the facility due to hospitalization or similarly severe
prescribed restriction, Human Resources will obtain required information directly from the medical resources.

D. The Treatment Report is the primary document to capture the treating physician’s restrictions.
Additional clarification or modification of restriction may be provided on other documents; however, a Treatment Report
will be taken by the employee to all medical appointments (except physical therapy).

E. Restrictions addressed by this policy must be identified by a medical doctor or other state licensed
practitioner of the healing arts.

II. Identification of Modified Duty Job Assignment(s)

A.
In cases where an employee’s restrictions preclude performing his pre-injury job (or particular aspect of the
job), every reasonable effort will be made to identify or create a productive job assignment which will
accommodate temporary restrictions as identified by the treating physician.

•
This accommodation may include providing intermittent assistance or relief in dealing with
one or more elements of the employees “regular” (pre-injury) job.

•
Accommodation may also include arrangements for less than an eight hour work day (in such
cases, hours not worked will be accumulated and submitted to the worker’s compensation
insurance carrier).

•
Every effort will be made to place the employee in the most productive assignment available;
direct labor categories will be preferred over indirect.

•
The modified duty job assignment will be made by the Human Resources Director after
consultation with production management.

B.
The modified duty job assignments will be recorded on the Restricted Job Description, to be completed by
Human Resources prior to or coincidental with the employee’s return to work.

• The Description will be acknowledged by the employee, supervisor, union representative and the
Human Resources Director. Each will be provided a copy of the completed document.

• The Description may be revised or reissued based on change in the employee’s restrictions. The
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 Description will expire 90 days after last authorization or when employee is released without
restrictions.

• It is the Supervisor’s explicit responsibility not to assign any work to the employee which is
contrary to the identified restrictions. The employee has an explicit responsibility not to attempt
any task which may exceed his identified restrictions. Any difficulties experienced by the
employee within his restrictions will be reported to Human Resources for review with treating
physician.

• Any questions or controversy as to an employee being restricted from performing specific task(s) will be
brought to the immediate attention of the Human Resources Director for resolution.

• The Human Resources Director will notify all parties when the employee has been fully released for
unrestricted duty.

C. Wages and Related Considerations

• The employee will continue to receive his/her pre-injury wage, plus any general increases, for all hours worked
in a restricted capacity.

• The employee will be paid per C.1 for hours less than his/her scheduled shift lost due to company arranged
examinations, treatment, and therapy.

• The employee may not bid on any posted job openings while in a restricted capacity.

• The employee will be shown on the weekly schedule as “restricted.”

• Since he will “follow the work” within restrictions, normal shift scheduling practices may not be possible.

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 RESTRICTED DUTY JOB DESCRIPTION

Position: Modified Duty

Supervisor:

General Description: Performs restricted duty assignments within the weight and/or physical limitations
prescribed by a provider. Employee must be eligible to receive workers’ compensation benefits and must have
medical release for restricted duty.

Responsibilities/Examples of Work:

Special Limitations: The provider’s release attached is made a part of this light duty job description, and is to
be strictly followed. Failure to follow any portion of these descriptions will be considered a violation of work
rules and may result in disciplinary action. Any questions regarding the appropriateness of a work assignment
must be brought to the immediate attention of Human Resources.

Specific Restrictions:

1. lb. lifting restriction

2.
3.
4.

Time Limit: The Restricted Duty job description is effective until the employee’s next visit to the provider. It
may be extended based on the provider’s report, however extensions may not exceed ninety (90) days without
authorization by Human Resources.

I have read and understand the terms and conditions of the Restricted Duty Job Description. If I have questions
I will ask my Supervisor; any differences in interpretation will be brought to the attention of Human Resources.

Date: Employee:

Date: Supervisor:

Date: Union:

Date: Human Resources:

Dr. Appointment: With:

 Appendix L

Return-to-Work Policy

It is the purpose of this policy to provide guidelines for administering a modified duty program. This program is necessary
to limit the amount of lost workdays an injured or ill employee may incur by providing meaningful work of a restricted or
limited nature. The program objectives should prevent the unnecessary loss of work time for valuable employees and help
maintain continuity of departmental operations to the maximum extent possible.

Definitions:

Restricted Duty: Duties assigned to an injured or industrially ill employee who enables the employee to retain his/her
current status with some limited restrictions and with the company being able to make a reasonable accommodation of full
duties.

Alternate Duty: Duties assigned to an injured or industrially ill employee which require the employee to transfer to another
job position or department on a temporary basis.

Work Related: Any injury or illness which occurs while performing assigned job duties.

Responsibilities:

Injured Employee

• Have any or all specific job-related restrictions approved by company designated physicians, as
necessary.
• Report all job-related restrictions to the Safety Director and your immediate Supervisor.
• Keep both the Safety Director and immediate Supervisor informed of any change in job-related
restrictions.
• Adhere to all medical advice and directives as prescribed by your treating physician, nurse, or other
medically qualified professional.
• Question any medical directives which you may not understand.
• Do NOT perform any activity which is not in accord with your job-related restrictions, both on and off
the job.
• Employees must be re-evaluated by a company designated physician within 30 days of their last
examination to determine whether their modified duty status should be continued. NOTE: Failure to adhere
to any work-related restrictions may result in disciplinary action.
Supervisors

• Insure all employees with job-related restrictions are adhering to their restrictions as noted on the
modified duty form.
• Assign employees with job-related restrictions to jobs which can accommodate their restrictions. If no
jobs are available within your department, contact the Human Resources Department and/or the Safety
Director to discuss options or arrange for departmental transfer.
• Compile and maintain a list of departmental job duties that meet light duty requirements. List to be
given to Human Resource/Safety Department.

Human Resources/ Safety Department

• Arrange for temporary work assignment of modified duty employees where no work is available within the
employee’s regular department.
• Contact all Company designated physicians and inform them of our modified duty policy. Provide periodic
updates and any change of status relating to the modified duty program.
• Schedule all employees’ re-evaluations as noted in the “Injured Employees Responsibilities” number seven.
Guidelines

• Restricted duty employees will be compensated at their designated base rate for a period not to exceed 4 weeks for
work-related injuries. For non-work related injuries, the employee will be compensated at the rate of pay, by contract, for
the job he/she is performing. After 4 weeks, the Human Resources/Safety Department will determine the rate of pay for
the job being performed. At no time will the rate of pay be less than labor rate per contract.

• Alternate duty employees, with a work related injury, will be compensated at their designated base rate for a period
not to exceed 4 weeks. For non-work related injury, the employee will be compensating at labor rate per contract. After 4
weeks, the Human Resources/ Safety Department will determine the rate of pay for the job being performed. At no time
will the rate of pay be less than labor rate per contract.

• Job availability for work related injuries will take precedence over non-work related injuries.

• The company shall make every effort to bring people back to work as long as this person can not cause any harm to
themselves, others, or company property.

• A non-work related injured employee may continue on a modified duty job for a period 4 weeks. After this time, they
may be placed on or returned to sick leave at the company’s discretion.

• Whether an employee should be continued on modified duty due to a work related injury or illness shall be at the
discretion of the company.

• NO alternate duty employee will be permitted to work overtime.

• People on modified duty may be assigned to work on any shift at the discretion of the company.
• Any person who is unable to report for work due to an injury or industrial illness must check in with the company at
least once per week. This person shall contact the Human Resources/Safety Department to verify there has or has not been
a change in their status as to coming back to work.

• Non Work related injury/illness - Human Resources Work related injury/illness - Safety Director

• The company maintains the right to assign employees on modified duty to any job, within the plant, that will not
exceed their restrictions and they are capable of doing.
 Appendix M

Return-to-Work Policy

ABC Company has implemented a Return-to-Work Modified Duty Work Program for employees injured at work. The
purpose of this program is to return an injured employee to work as soon as possible following an injury. This keeps the
employee in their normal routine of working and allows the employee to be productive in some manner. Ideally an injured
employee can gradually progress back to their full time position.

Modified duty job tasks are determined by the restrictions placed on an employee by their physician. To avoid re-injury
only those tasks within the limitations must be performed by the injured employee.

Panel physicians are made aware of our programs and are encouraged to cooperate with ABC Company, for a smooth and
safe return to work. Non-panel physicians treating employees with work related injuries shall be notified by mail to define
our Return to Work Modified Duty Policy.

Upon returning to work a conference should be held with the Safety Manager, the employee’s immediate supervisor, and
the injured employee. The purpose of this conference is to ensure all parties involved are aware and understand the
modified duties to be performed. A “Modified Duty Job Description” form shall be signed by all attending the conference
and posted as a result. Also a daily “Modified Duty Sign-off” form will be provided to the employee. The injured
employee shall be asked to sign the form following their daily shift in order to ensure ABC Company has provided a
modified duty job and the employee has followed his/her physician’s restrictions.
 Modified Duty Job Description

Position: Modified Duty ____________________

Location: _________________________________

Supervisor: _______________________________

General Description

Perform modified duty assignments within the weight and/or physical limitations prescribed by a physician, for a limited
period of time. Employee must be eligible to receive Workers Compensation and must have a medical release for light
duty work.

Responsibility/Examples of Work

Special Limitations

The Physician’s Return to Work Evaluation, attached, is made a part of this light duty job description, and is to be strictly
followed. Failure to follow any portion of this light duty job description will be considered a violation of work rules and
may result in disciplinary action.

Special Restrictions

1. _____lb. Lifting restriction

2.
3.
4.

Time Limit

This Modified Duty job description is effective until the employee’s next visit to the physician. It may be extended based
on the physician’s report, however, extensions may not exceed ninety (90) days without authorization by
_______________ Upon expiration of the time limit, and the employee must have a medical release before returning to
regular duties.

I have read and understand the terms and conditions of this Light Duty Job Description. If I have questions I will ask my

Light Duty Approved until Next Doctor’s Examination:

Next Dr. Appointment: _______________________ With: ______________________ Next Dr. Appointment:

_______________________ With: ______________________ Next Dr. Appointment: _______________________

With: ______________________

Modified Duty Sign off Sheet

My signature acknowledges that all restrictions concerning the modified duty job I have been working have been adhered
to by me and ABC Company.
Name: _________________________ Modified duty job: ____________________________________

Date Signature Date Signature

 Appendix N

Return-to-Work Program

Purpose: To provide temporary, modified-duty for members who are partially disabled due to work-related injuries.
Every effort will be made to assist the member to return to his/her former position. We will cooperate with the member,
the physician, the therapist and any rehabilitation personnel involved in the case.

Scope: XYZ Company will provide temporary transitional duty whenever possible for a period of 120 calendar days to
determine the degree of improvement. An extension in excess of 120 days may be allowed on a case-by-case basis, when
recovery is incomplete. Such extensions will be reviewed every 30 calendar days thereafter and modified work may
continue to be provided in cases where improvement continues.

If a member does not demonstrate progress in their recovery through the modified duty program, the program will be
reevaluated utilizing the team approach and possibly discontinued as with any other ineffective medical treatment.

Program Coordinator: The Medical/Safety Manager will coordinate the return-to-work modified duties with the injured
worker, the supervisor, and other team members.

OBJECTIVES

1 To allow the member to remain in the work force and resume productive employment as soon as possible in
his/her normal classification.
2 To enable the worker to gradually overcome his/her limitations through a transitional period of modified-duty,
work reconditioning assignments.

TYPE OF WORK

1. All departments at XYZ Company will cooperate in every way possible to provide regular duties on a limited basis,
modified duty, and/or special assignments for the disabled member. Whenever possible, attempts will be made to allow
the member to remain in his/her classification with modified duties.
2. Some of the following special assignments and/or modified duties in addition to regular duties might include:
• Rework (sort rejected parts)
• Clerical work
• Visitor escort
• Label and file samples
• Errands in company vehicle
• Light janitorial duties
• Engage in physical reconditioning program
• Inventory recorder
• Log and maintain quality records
• Painting tools
• Library filing
• Operate photocopy machine
3. The XYZ Company Occupational Health Nurse will supervise all members undergoing rehabilitation and/or modified
duty. When these members are assigned to their regular departments, they will report to the supervisor in that department
under the direction of the Occupational Health Nurse. Members undergoing rehabilitation who are not working in their
regular departments will be given assignments by the Occupational Nurse.
4. On evening, night shifts, and weekends, modification of job duties may be made at any time by the supervisor of a
member who has reported an injury, until the member sees the Occupational Health Nurse or sees a practitioner on the
Workers Compensation panel of providers.

SUPERVISION unless on a specific errand, members undergoing rehabilitation will have the same obligation to remain at
their designated work stations as any other member.
DOCTOR’S APPOINTMENTS

1. The XYZ Company notification policy regarding doctor’s appointments will also apply to members
undergoing rehabilitation. If the member requires follow-up treatment or a doctor’s appointment which cannot be
scheduled during his/her non-working time, the Company shall compensate the member for any straight-time lost from
work due to said treatment or appointment; provided that the member must have given the Company prompt prior notice
that such treatment or appointment could not be scheduled during non-working time, in which case the Company shall
have the right to attempt to change the member’s treatment or appointment to non-working time and, if able to do so, the
member shall not be entitled to compensation if the employee chooses nevertheless to keep the treatment or appointment
on working time.
2. The provisions of the agreement between I.U.E. Local 631 and XYZ Company apply to all modified duty
and/or rehabilitation assignments.
 Suggestions for Effective Communication with the Medical Community

Communication is Crucial
Your ability to communicate effectively with your medical community is crucial to the success of the Return-To-Work
Program. For your program to be successful, the following goals must be achieved:

• Immediate Return of Injured Employees to Transitional or Regular Employment: Nationally, millions of dollars
each year are wasted by employers paying time lost to employees who could actually go back to transitional or even
regular duty within 24 hours of injury. This money could be saved if, at the time of injury, the medical provider was given
a detailed description of the injured employee's job, or alternate tasks the employee could perform while recovering.

• Rapid Progression from Transitional to Regular or Other Permanent Employment: Time-lost and related
expenses can be dramatically reduced when frequent, ongoing provider contact moves injured employees as quickly as
possible through transitional employment to regular or permanently modified employment.

• Efficient Determination of Reasonable Accommodation Alternatives: If an employee will not be able to return to
regular employment due to permanent or long-lasting limitations, significant dollars can be saved by quickly evaluating
and (when appropriate) implementing permanent job accommodations, including internal transfers when feasible.

The Key to Working with the Medical Community

To achieve good communication with providers and to ensure the rapid return to work of your employees, you need to
provide providers with good information about your Transitional Employment work assignments.

How Can You Get Your Medical Community To Cooperate With Your Return-To-Work
Program?
The success of your Return-To-Work Program can only be ensured when your medical community:

• Understands your commitment to facilitating rapid return of injured employees to transitional and/or permanent
employment;

• Understands that your commitment is to your employees, not just to dollar savings;

• Anticipates your active participation in the recovery and return to work of each of your injured employees.

• Understands exactly how each step of your plan works; and

The Key Elements To Provider Cooperation Are:

1. Education of the medical community; and

2. Frequent contact with its members.

See: Appendix O: Steps for Obtaining Cooperation from the Employee’s Medical Provider
Appendix P: Troubleshooting Guide
 Appendix O

STEPS FOR OBTAINING COOPERATION FROM THE EMPLOYEE’S

MEDICAL PROVIDER
STEP 1 Create and prioritize a list of all key providers in your medical community:

• List all providers who have treated your employees over the past 3 to 5 years.
• Prioritize this list according to the total number of employees treated by each provider during this time.
• Utilize your Workers’ Compensation Provider Panel.

STEP 2 Develop and Implement an Education Strategy for Each Key Medical Care Provider:

At this point you should, if possible, devise a specific strategy to develop a relationship with and educate each medical
care provider. You may use the same strategy for all practitioners or you may develop different strategies for each key
medical care provider. Consider the following:

• Face-To-Face Meetings: Schedule individual face-to-face meetings with practitioners to (a) develop
relationships, (b) dispel any previous negative impressions, and (c) discuss and/or drop off materials summarizing your
company’s Return-To-Work Program.

• Professional Meetings: Address Professional Association meetings that key practitioners may attend. Use the
same basic strategy for individual meetings. Explain the mechanics of your Return-To-Work Program. Remember, it is
most important to clearly communicate the philosophy of the program.

• Personal Correspondence: If you cannot arrange to meet practitioners, try a personal letter (not a form letter).
The letter should communicate your interest in meeting with the practitioner personally. As an attachment, be sure to
provide a brief description of your company’s Return-To-Work Program, or at least a statement of philosophy. Ensure
that the practitioner knows that your company’s Return-To-Work Program is not "business as usual."

• Follow-Up Calls and Thank-You Letters: Part of your education strategy could include a brief phone call
preceding important letters sent to a practitioner. This phone call builds rapport, and may provide the necessary context
for an important letter requiring the provider's response. Practitioners also generally appreciate a brief call or a thank-you
note at the conclusion of a difficult case.

STEP 3 Develop Sample Documents Explaining Your Company’s Return-To-Work Program:

There are numerous occasions when a concise and professional description of the Return-To-Work Program will be of
value. Rather than developing an intimidating all-inclusive document, it would be preferable to create a series of
freestanding one-page documents, each briefly describing a key concept.

STEP 4 Develop Sample Letters for Communicating with Doctors:

Unfortunately, many letters written to medical practitioners ask the wrong questions.
 Appendix P
TROUBLESHOOTING GUIDE

There will be times when you have difficulty dealing with specific members of your local medical community. What
follows are some common problems and some approaches to dealing with those providers.

1. The provider refuses to talk with your Company about an injured employee’s ability to perform regular or
transitional employment. What do you do now?

It is difficult to understand why some providers will refuse to discuss releases to regular or transitional employment.
It may be that the provider is harboring some anger about a past conflict, or perhaps simply misunderstands your
intention. There is a basic process to go through when dealing with providers who seem uncooperative. The general
process is as follows:

• Call the provider directly and talk with him or her about your concerns and about what your goals are for
injured/ill employees.
• If you cannot reach the provider directly, contact the provider’s nurse, case manager, or assistant to arrange
either a telephone conference or a meeting with the doctor to discuss a case.
• If you are still unsuccessful, contact the Clinic Administrator or someone else who is connected with your Posted
Panel of Providers and arrange a telephone conference or direct meeting with provider.
• While awaiting a response, you may also want to send information to the provider about your company’s Return-
To-Work Program.
• Enlist the assistance of your dedicated Claims’ Specialist.

2. The provider refuses to release your employee to any kind of work until he or she has fully recovered from the
injury. What do you do now?

There may be any number of reasons for a provider to react this way, including a fear of employee re-injury or
perhaps a long-term paternal relationship with the employee. Whatever the reason, the proper response is to follow
the steps described above under No. 1, and to call or meet with the provider directly. The goal is to be sure that the
provider knows you mean the worker no harm and view gradual return to work as therapeutic.

3. The provider appears to ask the injured employee what he or she can do physically, rather than making an independent
decision about physical capacities. What do you do now?
Frequently, providers are at a loss to determine what an employee actually can do physically. Sometimes they have
no idea what the employee’s job involves, or the providers may simply feel they have no way to objectively measure
a worker’s physical capabilities. One potential solution:

• Contact the provider personally and arrange an in-person meeting if possible.

• When contact is achieved with the provider, make every attempt to understand the provider’s perspective. Your
Claims Specialist may be able to suggest where an Independent Medical Examination can be obtained or where an
employee may be sent for a Functional Capacities Evaluation. In many cases, this will address the provider’s concerns,
while providing you with the needed information to proceed.
4. The provider believes your Company is not working in the injured employee’s best interest. What do you
do now?
There are many situations that can result in a provider being skeptical about the intentions of an employer. For
example, a provider may be suspicious of an employer’s actions if his or her previous experience was negative.
Frequently, a provider has had no direct contact with an employer for many years. The proper response is to follow
the basic contact process described in No. 1, and then sit down with the provider and discuss at some length the
intentions of your company relative to the injured employee. It is very important that you meet face-to-face so that
the provider has a real person to visualize when he or she is thinking about you as an employer.
 FREQUENTLY ASKED QUESTIONS (FAQs)
1. What are the financial benefits to an employee for early return to work after an injury?

For many injured workers, workers’ compensation benefits alone are insufficient to replace lost wages.
Returning to work in sustained employment, therefore, is probably the best way for injured workers to avoid
significant financial losses. In addition, scientific evidence shows that returning to medically suitable modified-
duty work aids healing and recovery. Many obstacles, however, hinder successful and sustained returning to
work, including communication problems and financial disincentives of important stakeholders in the workers’
compensation system.

2. What strategies are suggested for ensuring the high quality of modified-duty jobs?

To ensure that jobs for injured workers are rewarding and fulfilling, the following recommendations are
suggested:

• Increase information and resources for employers and employees about these positions and how to
design them.
• Include the injured worker in the negotiations.
• Develop written job descriptions that include worker input.
• Allow enough time for discussion, interaction, and negotiation.
• Develop methods for following up on individual plans and avenues of recourse if a plan is not followed.
• Create a position for a “worker advocate” (possibly a nurse or nurse practitioner), who would have
early involvement in the case.

3. What efforts are recommended for employers to assist injured workers to return to sustained
employment?

Efforts to help injured workers return to sustained employment include the following steps:

• Injured worker’s signs and symptoms: The injured worker describes his or her experience with the injury,
including subjective symptoms such as pain, and sometimes shows objective signs of injury.
• Treating provider’s diagnosis, treatment plan, and work restrictions: The treating provider interviews and
examines the injured worker, makes a diagnosis, determines necessary treatment, and specifies work restrictions.
• Employer’s efforts to correct hazards and accommodate injured workers: The employer encourages
reporting of injuries, corrects safety problems, and provides accommodations to allow the injured worker to work safely
while recovering and to work with accommodations permanently if necessary.
• Claims administrator paying for necessary medical care services: The claims administrator promptly
authorizes and pays for necessary health and medical evaluation services.

4. There are many parties involved in what is often a complex workers’ compensation system. How can we
better sort out the responsibilities of these various parties, eliminating some of the confusion and/or distrust that
seem to exist?

There are many perceptions, viewpoints, beliefs, and disagreements that often contribute to some level of
confusion and/or misinformation in the workers’ compensation system. A proven way to help dispel
misunderstandings and to clarify roles and responsibilities is to develop and disseminate informational materials
that define procedures, roles and expectations of the various persons involved. Parties most frequently involved
in the workers’ compensation system include:

Claims Administrators Third-Party Administrators

Self-Insured Employers Self-Administered Employers
Treating Physicians Panel/non-panel Medical Care Providers
Qualified Medical Evaluators Rehabilitation Counselors
Case Managers Injured Workers
Developing and distributing communications which describe the roles of these and other parties, and, where appropriate
the contact information can greatly help employees and injured workers understand what a particular individual or group’s
duties and responsibilities are.

For a Return-to-Work program to be successful, it is important that, prior to being injured, an employee know the process
that will be initiated, the roles of those within the process, and his or her responsibilities within the process. This
structured and planned process allows the injured worker to concentrate on his/her rehabilitation.