Promptly returning injured employees to work is a major factor for reducing workers compensation exposure and excess cost. The longer the employee remains off duty chances develop that may lead to exaggeration of symptoms, excessive disability, additional medical pathologies, the ability to live on weekly benefits, and potential fraud.
Employee Incentives to Delay Return to Work:
1. Most jurisdictions have weekly benefits established at sixty six and two thirds to seventy percent of the employee’s average weekly wage with an annualized cap on benefits.
The majority of benefit caps are high enough for better than survivorship living. Most states do not discount the average weekly wage for taxes and other wage deductions. All workers compensation benefits are free from federal and state income taxes.
2. Supplemental benefits from social security may be available to the employee after certain periods of disability or due to disabilities. Eligibility for food stamps, rent subsidies, utility subsidies, family health coverage under Medicaid or Medicare, possible transportation subsidies and or other numerous welfare programs may also be added benefits.
3. Medical providers may have tendency to extend time off work. This is especially probable where the employee has free choice of medical care, legal representation, union support, and a weak or poor moral or work ethic.
4. Not keeping in touch with the employee may lead to, feelings of alienation, lack of caring, self-pity, over indulgence of symptoms and attitude deterioration.
5. Lack of attention to the claim’s progression may allow a deterioration that might never be able to be recovered.
6. High income employees often do not receive enough in compensation benefits due to the benefit caps. Therefore, they are not prone to fall prey to these incentives.
1. Establish a program for injury disability management, and return to work options. Outline responsibilities of the employer and employee as required by both federal and state statutes. Post the policy in employee hand books, contracts and on bulletin boards.
2. Include some alternate or light duty jobs that can be performed by the employee during recovery. Point out that every effort will be made to accommodate the employee in a job suited to physical capacity during recovery. This will allow new jobs to be developed. Seek the help of Foremen, Supervisors, Union Shop Stewarts and Legal Counsel for jobs that might be developed.
3. Make unions a part of the program through negotiation and contractual commitment.
4. When the injury occurs, give the employee written highlights of the disability program. Include any authorizations as necessary. Send copies to the attending medical provider. Contact or direct the employee to review the full program in the employee handbook as a reminder and for compliance.
If the employee’s injury is such as to void his capacities have a family member or responsible person made aware of the policy until such time as the employee can again act on their own behalf.
5. Send the attending medical provider the requirements for job modifications and capacities required. Jobs can also be developed from the medical provider’s restrictions.
6. Move for Independent Medical Examinations as soon as medical disabilities extend beyond normal healing periods. Use the independent medical exam to establish job functional capacities.
7. Keep weekly contact with the employee. Ask how healing is progressing and what activities can be performed. Emphasize a strong upbeat attitude with the employee. Show definitive concerns for the employee’s recovery. Inquire as to how the injury might be impacting the employee’s family. Verify that benefits are correct and being paid timely. Be pro-active in addressing any employee concerns.
Ask the employee for alternate work ideas. Keep the employee aware of any workplace changes that occur during disability. Discuss how the employee’s absence is affecting fellow employees and work friends. Let the employee know of fellow employee well wishes and concerns.
Discuss information learned from employee with foremen and supervisors to form a plan of action for return to work.
8. Review need for medical and vocational rehabilitation. If needed, ascertain that the program has specific goals, time frames and a definitive resolution period.
9. Review the medical provider visits and recovery correlation. When they do not meet accepted standards, seek an Independent Medical Examination, a Consultation or a Utilization Review. Move for resolution through controversy if necessary.
10. Adjust job site environments for physical accommodation where necessary.
11. Document all offers for employment, functional capacity evaluations, independent medical examinations, and controversy issues in writing. It may be necessary to send these letters by regular and registered mail. If any are done electronically, they must be securely backed up for evidentiary purposes. Hard copies should also be part of the claim file.
12. Move to contest any situation where the employee becomes non-compliant, appears to be extending disability or develops pathologies that were not presented at the time of injury. This requires proper investigations, medical examinations, and documentation.
13. Utilize field investigators in the event suspicion arises for possible fraud or cheating. Make sure the findings are strong enough to withstand litigation and possible SIU prosecution.
The average employee who receives a worker’s compensation benefit that is equal to or greater than take home pay, and other possible social welfare benefits, to survive without returning to work.
This requires employers to be pro-active, innovative and vigilant in efforts to return the employee to work. For further thoughts and assistance in this area, it is suggested outside consultation be considered.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.
Editor Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: firstname.lastname@example.org.
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.