Get back to work

A Return to Work (RTW) program is part of a business strategy to retain valued employees and to enhance the productivity of the workforce. There are various definitions of RTW programs, but generally they are designed to return an injured, disabled or temporarily impaired worker to the workplace as soon as medically feasible. The anticipated result of an RTW program is the progressive return of the injured employee to full duty.

RTW programs are historically associated with returning employees from occupational injuries, but many companies are now integrating RTW programs for nonoccupational injuries into their overall disability management strategy.

In smaller businesses, RTW programs are typically managed in-house, while the trend for larger businesses is for third-party vendors to assist in managing the process.
 

Why should employers consider RTW programs?

RTW programs aim to accomplish three important business goals: 1) reduce disability leave costs, 2) maintain productivity of employees and work units and 3) comply with disability-related legislation.

RTW programs reduce costs by minimizing the impact of an employee’s injury or disability, including the cost of lost productivity time, permanent loss of an employee and the use of disability-related leave benefits. RTW programs also may reduce the cost associated with recruiting, on-boarding and training a new employee.

In addition, effective RTW programs help injured or disabled employees maintain productivity while still recuperating, protecting their earning power and boosting an organization’s output, according to the Office of Disability Employment Policy (ODEP). By enabling employees to remain employed, an RTW program provides employees with financial stability. The program also can minimize injured or disabled employees’ loss of skills and workforce value. In addition, an RTW program keeps employees active and engaged, thereby reducing the long-term debilitating effects of disability, such as emotional isolation and depression.

Finally, an RTW program helps ensure compliance with disability-related legislation, such as the Americans with Disabilities Act (ADA), the Family and Medical Leave Act (FMLA), the Occupational Safety and Health Act (OSH Act), workers’ compensation and other state laws.
 

Is research available that supports RTW programs? 

Research shows that RTW programs help reduce workers’ compensation costs and increase productivity by returning employees to work earlier. In a 2007 review of current literature, the Canadian Institute for Work and Health (IWH) concluded that RTW programs “have positive impacts on duration and costs of work disability.”

In addition, the American College of Occupational and Environmental Medicine (ACOEM) reports that “early intervention is the key to preventing disability.” ACOEM recommends that employers “revamp disability benefits systems to reflect the reality that resolving disability episodes is an urgent matter, given the short window of opportunity to renormalize life.” The short window of opportunity to prevent disability refers to research suggesting that the likelihood of an injured worker returning to work drops to 50 percent by the 12th week of leave.

Research conducted by Job Accommodation Network (JAN) with employer customers suggests the cost of retaining an employee is lower than often thought. Employers responding to the ongoing JAN study report that a high percentage (57 percent) of accommodations cost absolutely nothing to make.
 

How does an employer develop an RTW program?

Two initial tasks must be completed when developing an RTW program. The first task is developing a business case to be communicated to senior leadership. The second task is developing the policies and processes that will govern the program and guide its implementation.

As with most, if not all, workplace initiatives, there are costs. Buy-in from senior leadership for startup and long-term support is essential. Support from these leaders can assist in resolving challenges during program implementation. This support can be justified with a cost/benefit analysis. Using the results of this analysis as well as industry specific metrics and benchmarks (if available), a succinct business case can be communicated to senior leadership. A precise internal business case also provides clear measures to evaluate the RTW program once implemented.

As with workplace accommodation programs, an RTW program should have clearly written policies articulating the challenge that has been identified, how the policy addresses the challenge, the role and responsibilities of those involved in the policy implementation as well as time frames for various actions and how the program will be evaluated. Policies also should reflect the values of the organization and guiding principles. For example, if an organization believes that returning to work is the best strategy for keeping injured and disabled employees engaged with the company, then this may be expressed in the value that no employee is expendable.

In addition, processes and supporting materials also need to be developed. In a publication produced by the Florida Partnership for Safety and Health with support from the Public Entity Risk Institute, the authors write that the key components of an RTW process are:

• process flow actions to be followed when an injury occurs;
• an emergency plan that includes directions for reporting an injury and for getting immediate medical help for the employee as well as a list of phone numbers for all contacts involved (from the process flow chart);
• a communication plan, including a regular schedule of communication between all parties involved in the process flow; and
• a transitional employment plan, including modified employment or employment accommodations and/or alternate employment assignment, to enable workers to safely transition back into the work environment after an injury.
   

One of the most practical, process-related resources is produced by Return To Work Matters (RTW Matters, www.RTWmatters.org) in a publication called “Injury and Case Management: A Practical Guide to Dealing With Return to Work After Work Injury,” which outlines specific actions to be taken in various time frames and the challenges that arise if these actions are not carried out.

Crucial elements of an RTW process include viewing the process as a partnership between the employer and employee where both parties’ needs are met. The employee may be very apprehensive about the process initially. As with anyone, the employee’s focus beyond recovery will be on understanding the financial implications of RTW. Providing clear information that includes all the employer and legislatively mandated benefits ready for the employee will help build a trusting partnership.

Another important element in this process involves continuous communication between the employer representative and the employee. From the first few minutes after an injury and through the RTW process, communication may be the difference between successful RTW or litigation. RTW Matters suggests from the first five minutes after employees are injured: “Don’t prejudge or assume what they are feeling—ask them … be mindful of their concerns and take the situation seriously.” If not, the writers remind us, “In most claims that result in litigation, the initial conversation was the starting point for blame and resentment.”

Accurate job descriptions that include the physical demands of particular essential functions also are important. Accurate job descriptions help everyone in the process (e.g., doctors, rehabilitation staff and accommodation specialists) understand the job requirements. A good understanding of the job demands and the employee’s limitations and abilities is the starting point for determining if effective job accommodations will enable the employee to return to or stay at work while still recovering from an injury. Effective job accommodations ensure the employee returns to work as soon as possible without risk to the employee or employer.

Once you have buy-in from upper senior leadership, policies and procedures to implement the RTW program and materials to support the implementation, then you are ready to institutionalize the program. In the Workers Compensation Gazette, the CEO of Douglas Claims and Risk Consultants Inc. suggests these next steps:

• reviewing the policy with new employees during their orientation or with existing employees at their annual review;
• establishing a working relationship with a walk-in clinic or occupational medical center—if your state allows you to select the initial treating facility; and
• assigning a specific person in your organization to be responsible for administering the RTW program. This person should have a thorough knowledge of the ADA, FMLA and the workers’ compensation statutes.
   

JAN also provides a six-step interactive process for engaging the injured employee and negotiating accommodation, which can be found online at http://AskJAN.org/topics/interactive.htm.

Louis Orslene is co-director of the Job Accommodation Network (JAN), Morgantown, West Virginia. JAN is a service of the U.S. Department of Labor’s Office of Disability Employment Policy. More information is available at http://askjan.org.