Which of the two parts of your workers’ compensation program costs the most: the medical treatment for work-related injuries or lost wage replacement (or indemnity). Historically, the indemnity payments accounted for most costs, but recently, the steady rise in medical costs has driven your workers’ compensation costs.
The discussion may be academic in that the two are often interdependent: if employees are under active medical treatment, it is much harder to bring them back to work. This, in turn, causes indemnity costs to continue. While a good safety program will lower the frequency and severity of claims, accidents will occur. How your risk manager responds to the resulting injuries defines the maturity of your risk model.
A well designed Return-to-Work (RTW) program is the cornerstone to a successful workers’ compensation (WC) program. Unfortunately, the success of RTW programs are, too often, hamstrung by myths born of skepticism. A successful RTW program can only be achieved by identifying the myths surrounding RTW programs and replacing them with a more mature approach to returning your workforce to productive employment.
MYTH #1 Most injured workers are malingerers and fakers. With the amount of the risk management issues that risk managers and administrators have to juggle every day, they lack the leisure to look at every claim. The only workers’ compensation claims that make it to my desk each month are the problem children: the catastrophic or suspicious claims. This focus skews the perspective of everyone from the financial officer who must budget for the losses to the risk manager who must develop and run the district’s program down to the claims adjuster who must manage the file. Of the 2,300 workers’ compensation claims that my district handles each year, about 21 percent are serious enough that the district has to pay lost wage replacement benefits. And roughly 5-7 percent of the lost wage claims rise to the level of probable fraud. Your RTW program should focus on returning your skilled employees to work. Develop a separate “red-flag” system for dealing with the fraudulent few.
MYTH #2 Bringing someone back on light duty is too expensive. Try the math: A teacher making $1,326 per week in Pennsylvania breaks her ankle. Under Pennsylvania law, she is entitled to the maximum $888 every week for 15 weeks that she will be out. If the teacher is not working, the district must pay for a substitute. The difference between what employees get paid to work versus what they get paid to not work is $43.
MYTH #3 Bringing someone back on light duty undermines the coworkers. This is simply not true. My experience has been that good workers will get the support of coworkers, and will not slack off, to not let the team down. On the other hand, weak link employees will face peer pressure. Your risk manager needs to take a “hands on” approach by working with the injured employee, the physician and the employee’s supervisor to ensure the transitional duty is appropriate. A cafeteria worker with limitations on lifting, pulling and pushing cannot move tables, but can clean tables and counters thereby freeing others to do strenuous work.
TALKING THE TALK
Common Terms Used in Return-to- Work Programs
Although people often use such terms interchangeably, they have meanings:
- Modified Duty—implies that the job is modified, temporarily or permanently to accommodate the employee.
- Alternate Duty—implies that other tasks are offered to the employee for a temporary period.
- Light Duty—implies that the work is either of a sedentary nature or for a limited amount of time each day.
- Transactional Duty—implies the work is a stepping stone to their original job.
MYTH #4 You lack the resources for a personalized program; therefore, you must rely on the one-size-fits-all approach. The consistency that should be practiced is consistency of opportunity. No two injuries are the same, so blind application of some formulas ensure inherent unfairness. As a former litigating attorney in New Jersey, I know the time to train and guide supervisors on the RTW program or work with the injured employee in getting them back to work is a fraction of the time that is spent in litigation. Fairness is designing a program for the real claims.
A successful RTW will reduce the number of days an employee is out of work and will reduce what your district pays in medical expenses and in wage replacement.
The most impressive result of a well-crafted RTW program is your ability to return your teachers to classrooms and the professionals that keep your schools operating with less interruption to services and less stress on your budget. DA
Jeff Marshall is director of the Office of Risk Management for the School District of Philadelphia.