Early Return to Work Programs Reduce Work Comp Costs By Barry S. Rosenblum, D.O.

Workers Compensation costs are increasing faster than non-work related medical costs that translate into higher work comp insurance premiums for employers. This year some businesses will be facing premiums that are fifty percent higher than last year’s premiums! This is due in part to the complexity of our workers compensation system and to increasing fraud and litigation in our society. Employers therefore must continue to push for more legislative reforms and promote health and safety programs in the workplace. Nevertheless, occupational injuries will continue to occur and these workers must be accommodated by their employers. Establishment of an Early Return to Work Program for the injured worker has been an effective way to minimize lost time days and thereby help control work comp costs.

An early return to work program (ERWP) was initiated at Johns Hopkins Hospital and Associated Schools of Medicine, Baltimore, Maryland, in 1992, which demonstrated a significant reduction (55%) in lost work day cases after the program was instituted. To be effective, an ERWP should incorporate a team approach involving the participation and cooperation of a qualified and cost effective Occupational Medical Services Provider (physician), the injured worker, and human resources individuals including supervisors, safety professionals and the workers compensation insurance company. Involvement of nurse case managers, industrial hygienists and individuals trained in ergonomics, further facilitate the return to work process.

Components of the ERWP include careful team planning, training of all supervisors and accommodation of the injured employee. After examination and treatment of the injured or ill employee, the occupational physician reviews the employee job task description and completes a Return to Work Form, which specifically describes any work restrictions. This form is then reviewed with the employee and subsequently with a pre-designated employer team representative, such as a store manager or department supervisor, and when available, a nurse case manager.

The goal is to return the individual to work without risking any adverse health effects. Of course some injuries may be too severe to allow for an early return to work, which then initiates either a temporary total or permanent disability status. Human resource individuals attempt to develop alternative work assignments in order to accommodate the restrictions set forth by the physician. This may include physical modification of the employee’s original job, such as limiting bending, lifting, standing, etc., or merely modification of the number of hours per shift that the individual may work. At times temporary transfer within the company to a new job is required.

Obstacles that may impede an early return to work and accommodation of the employee include a supervisor’s unwillingness to modify a job, or fear that the assignment may exceed the physical limitations outlined by the physician. Workers may be skeptical that the supervisor will adhere to these recommended work limitations. At times ridicule by co-workers who observe the injured individual working at a less physically demanding job for an extended period of time, while receiving the same pay rate as theirs, creates additional social pressures at the work site. This is why teams members must work together to facilitate this whole process, which in turn gives credence to the program and reaffirms to the injured worker that all attempts are being made to allow him or her to remain a valued and productive member of the work force.

In summary, a well-structured early return to work program is only one component of a company’s comprehensive effort to control the rising workers compensation costs, but it undoubtedly has an overall positive effect.