It was a discussion worth having for the Disability Management and Return to Work Committee at the recent International Association of Industrial Accident Boards and Commissions (IAIABC) Annual Conference in Madison, WI. With overwhelming evidence pointing to the benefits of effective return to work programs, just how do we go about getting broader adoption of RTW within the industry?

The IAIABC is a representative body for workers’ compensation regulators across the globe, and it regularly addresses important issues facing the industry. THE DM/RTW Committee is merely one of many such groups, toiling in the background to make a more responsive and effective industry for all stakeholders. Peter Federko, CEO of the Saskatchewan Workers' Compensation Board and chairman of this particular committee, along with IAIABC Assistant Director Jennifer Wolf Horejsh, revealed to the members the preliminary results of a jurisdictional survey regarding Disability Management and Return to Work. While not complete by any means, the survey thus far indicated that 68% of jurisdictions had adopted programs to limit or minimize disability, while only 15% had mandated employer accommodations for a Return to Work Program. 26% reported having mandated employee participation in RTW.

So, how to improve the existence of RTW programs across the nation?

Some members discussed the need for doctors to be more engaged in the process, while others felt that carriers should shoulder the burden. Both the employer and claimant certainly must factor into a program designed to return injured workers to a productive role. Some discussed the need for regulators to step up their game, and recognize that they can have tremendous impact in this area. Federko, making an observation not intended as criticism, said that some jurisdictions "don’t see from a regulatory perspective the need to have a focus on Disability Management/Return to Work. They think it is up to the individual employer". He stated, "At the end of the day that is where the responsibility has to reside", and  added that he personally believes "that jurisdictions have to take the lead in somehow encouraging – incenting perhaps" the utilization of RTW programs.

How do we go about ensuring that effective Return to Work programs become the norm, and not the exception? The answer, I believe, has to be a team effort from all the major stakeholders. And yes, I think the regulators have a major role to play in this.

Regulators have the ability to influence and create an environment to promote what they deem important. I am not a fan of excessive regulation, and am not calling for it here. However, the regulators have the reach, the clout and the means to communicate, or incentivize, a proper result. It is being done in Texas at this very moment (more on that in an upcoming post). It has been done with injury prevention, such as the successful Work Safe Montana effort. A proper return to work environment can be created, but it must be driven from a central source that influences all, and the workers’ compensation divisions and bureaus around the country are the place to start. Of course, they can only guide and influence. The other stakeholders need to do their part.

For instance, many look to the medical community, believing they have ultimate authority for a RTW decision.  Simply put, doctors do not make return to work decisions. That is the ultimate responsibility of the employer. Doctors simply diagnose and define a claimant's ability and restrictions. They should work with the carrier/employer to clearly communicate the condition of their patient, and be able to do so using generally accepted medical standards and guidelines. People managing claims need to understand what the claimant is going through, and must be prepared to communicate WHY returning them to work, even in a limited capacity, is so important. These need to be reasons important to the claimant. A claimant frankly does not care that a successful return to work means lower claims costs for their employer. They will care, however, if they can be made to understand that prolonged disability periods can literally ruin their lives, and bring increased depression rates, slower healing and even a shortened life expectancy.

Of course, the claims manager will need to be equally adept when dealing with employers in this process.

To top level managers, the benefits should be obvious. There are clear savings to be had if they can successfully return a good employee to a modified position. They should be willing participants for all of the reasons cited for the claimant, but at the very base they recognize long term savings and an overall happier workforce. But employers need to do more than establish policy. They must also be concerned with the front line supervisor, and make sure they are properly trained to carry out the appropriate modifications and direction required for successful RTW implementations. This is where the rubber hits the road, and often where a RTW program with the best of intentions is given a brutal case of road rash. The front line supervisor – the claimant's immediate boss – MUST be an integral part of the employees' return, if it is to be successful. Through education and accountability this person has to be made aware of why this is being done, and how important it is that the program succeeds. This will make all the difference between an informed, educated boss, and a supervisor who suddenly is "inconvenienced" by a "slacker" who "can’t carry his own weight".

Another major obstacle is the claimants themselves. Injured workers often resist returning to any modified job, and will have a million excuses as to why they cannot perform any function an employer tries to provide. Some of it certainly stems from an increasing entitlement mentality, some from a true lack of understanding of what is actually at stake. Their attorney may try to thwart the move, or they may try to get their doctor to block any placement effort (see the part about doctors using generally accepted medical standards and guidelines). Everyone we’ve discussed thus far needs to be engaged to make the claimant understand that statistically, this is in their interest. It is a discussion most likely not happening today.

Education and information are paramount to any effort in making Return to Work an integral part of workplace injury management. It will require a major effort that can reach all participants, and the regulators indeed hold that key. Regulators must recognize this as a critical part of managing an overall workers’ compensation program. They can define standards and lead the conversation. They can counter weaknesses in an industry where financial incentives for some can overweigh an emphasis on Return to Work.

So my answer to the question, "Are Regulators Responsible For Return To Work?", would be a resounding "yes".



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