Return To Work

Tammy Roberts, BA, CCM, CDMS, QRP

The Dilemma

Current Trends

NCCI’s latest review indicates

• Overall claim frequency has increased for the first time since 1997 (3 percent)

• Workers’ compensation medical costs per claim average more than $6,000 and soar to nearly $25,000 for lost-time claims

• Prescription drug use is a medical expense that makes up 19 percent of all workers’ compensation medical costs

Impact Of Co-Morbid,Chronic Conditions

Out of the approximate 300 million Americans, 133 have one or more chronic conditions

27 percent of the increase in healthcare costs is due to obesity

The Opportunity

“A well-coordinated education and early activation approach involving primary care physicians, employers and workers’ compensation systems, and targeting workers’ beliefs, perceptions and expectations, would likely be most effective”

Izabela Schultz, et al, Spine Vol. 27, No. 23 pp. 2720-2725, 2002

SAW / RTW Motivation

Two factors of SAW / RTW motivation

1. Lose

versus

2. Gain

Why?

Reduce claims costs up to 70 percent

Injured workers return to workforce 50 percent sooner

Reduce likelihood of malingering and fraudulent claims

Reduce litigation costs

Newton’s Law Of Motion

Things in motion stay in motion

Things at rest stay at rest, unless acted upon by an outside force

Why?

Workers’ compensation costs are reduced when temporary total disability benefits cease or are adjusted when an injured worker returns to work

Decreased loss ratios and experience modifiers help control premium costs

Why?

Productivity is maintained and human resources are used to the maximum extent

Wage costs for substitute employees are saved

When?

The earlier, the better

Return-to-work policy should be in place prior to a work-related injury and clearly communicated to the employees

Employees should understand the purpose and benefits of the return-to-work program

When?

Employees should have an understanding of how work-related injuries impact the company

Employees should be trained on the policy upon hire or implementation with reinforcement throughout the year

When?

Employees should acknowledge an understanding of their responsibilities

Job descriptions and modified job descriptions should be available prior to a work-related injury

How?

What parts of the job can the employee perform

What is not getting done

Pacing, task-sharing options

Skill and knowledge building opportunity

Who?

Who is involved in the process?

• Employer

• Employee

• Medical providers

• BrickStreet claims adjuster

• BrickStreet return-to-work specialist

•BrickStreet nurse case manager

•Field case manager

•Modified duty off-site provider

•BrickStreet underwriter

What?

Return-to-work policy

Job description

Modified job description

What?

Correspondence to employee and provider

Job function evaluation

Physician’s statement of capabilities

Questions?

Thank You!