Minimizing Lost Time: Defining Key Stakeholder Roles and Interaction

It is not the accident severity or the injured body part that always determines the length of time an injured worker spends away from work. It is how the injury is managed by the patient, doctor, employer and claims administrator. This session at the 2018 National Workers’ Compensation & Disability Conference highlighted strategies for defining key stakeholders’ roles and the interaction needed for a successful return-to-work environment.

Speakers included:

• Kathy Schroeder, Senior Director, Global Risk Management, Office Depot
• William Zachry, Senior Fellow, Sedgwick Institute

There are many exposures driving loss time. Factors like an aging workforce, co-morbidities and opioid addiction have increased exposure to disability. Loss time drives workers’ compensation costs, including total indemnity and disability. Reducing the total loss time can reduce up to 30% of claims costs.

To create a successful program, you need to remove potential barriers that may exist and inhibit return to work. Claims administrators are not always aware of comorbidities or psychosocial issues, do not always have the correct employer contacts or knowledge of available light/modified duties, or could be dealing with complex legal issues on the claim. In the medical providers’ case, they may not be given inaccurate information about the injury, there is poor communication from the employer with return-to-work expectations, or can prescribe medications or perform a treatment that inhibits return to full duty. Finally, employees can be inhibited by a confusing or intimidating claims process that may encourage them to hire an attorney. Psychosocial issues or a bad relationship with the employer can influence their behavior in addition to fear of reinjury.

AVAILABLE SOLUTIONS

One of the best solutions to ensure no permanent loss of a job is to provide transitional return to work. There are several behaviors and solutions that can contribute to a successful program.

Employers:

• Create a culture that incentivizes immediate injury reporting with no negative repercussions.
• Offer light duty. Align financial incentives to encourage willingness for light and or modified duties. This can be a percentage or full pay. Financial incentives drive behaviors.
• Show care and concern. Be empathetic. Avoid the disconnect with care calls, cards, invite them to visit and keep them engaged.
• Provide prompt medical care.
• Investigate the accident to use info in prevention programs.
• Ensure claims professionals understand the light duty program and meet regularly with claims examiners to discuss return-to-work programs and progress.
• Explain your light duty program to the physician.
• Collect analytics to determine impact of reduced lost time on workers’ compensation overall costs.

Claims Administrators:

• Promptly investigate questionable claims.
• Make timely compensability decisions. You want the right decisions quickly to get employee buy in for the treatment plan.
• Demonstrate empathy and urgency. Be compassionate to calm employee fears.
• Explain their benefits, including workers obligations, employer expectations and the claims role. Always be available.
• Answer questions honestly and directly. Set expectations.
• Pay all benefits accurately and timely.
• Communicate and regularly keep in touch. Does the employee understand the medical treatment and protocols? Are they happy with the medical provider? Are they motivated to get back to work (i.e. worried about re-injury or healing)?
• Understand the relationship between employee and employer. Do they speak negatively about the employer? Bad relationships drive litigation.
• If a claim in not compensable, communicate promptly with the employer and obtain concurrence. In addition, promptly advise the employee.

Medical Providers:

• Visit employer to understand the type of work employees perform. Job descriptions do not explain physical work. Job analysis helps to understand these requirements.
• Obtain a complete copy of all the job descriptions that are available.
• Understand the employer’s provision of light or modified duties.
• Spend time with the employee to understand potential psychosocial barriers inhibiting return to work.
• Follow published disability guidelines when dispensing time off.
• Set expectations.
• Severely limit prescribing of any opioids or drugs that can hinder return to work to full duties.
• Set timely follow-up evaluations to determine if the treatment is working and if the modified duties are appropriate.
• Look for employee reluctance to returning to work.