Handling Difficult Return to Work Scenarios

Achieving a 90% return-to-work rate within 0-4 days is the gold standard for managing workers’ compensation claims, with best-in-class organizations reaching 95%+. However, some cases present challenges that require a more strategic approach.

Consider Psychosocial Factors

Recovery from work injuries is often influenced by psychological and social barriers that go beyond physical healing. Fear, catastrophic thinking, and entrenched disability beliefs can prevent injured employees from re-engaging in work, particularly if they have been away for an extended period. Once separated from their daily routines, employees may struggle with motivation and develop secondary issues such as depression.

Additional Psychosocial Risk Factors Include:

• Depression/anxiety
• History of childhood trauma
• Guarding behavior—extreme fear of re-injury leading to movement avoidance
• Perceived injustice—the belief that they have been wronged by the employer or the system
• Substance abuse history

Employees displaying these risk factors can often benefit from targeted interventions such as telephonic disability coaching, nurse case management, or cognitive behavioral therapy. Employers should take a collaborative approach, engaging adjusters, case managers, and medical advisors to develop a structured plan to help the employee regain functionality.

The Role of Nurse Case Management

Nurse case managers (NCMs) play a critical role in overcoming return-to-work barriers by coordinating medical care, facilitating communication between stakeholders, and ensuring treatment aligns with recovery timelines.

When dealing with complex claims, field nurse case management can provide on-site evaluations, attend medical appointments, and collaborate directly with treating physicians to develop safe, modified duty plans. This hands-on approach prevents unnecessary delays and ensures appropriate care.

When a Doctor Refuses to Release an Employee to Work

One of the most significant barriers to a timely return to work is a treating physician’s reluctance to release the employee, often due to a conservative approach or employee-reported symptoms that don’t align with clinical findings. Employers frequently accept a doctor’s decision without questioning whether an employee is truly unable to work.

How to Overcome This Barrier

• Engage a Medical Advisor for Peer Review
  A peer review physician evaluates whether the treating doctor’s recommendation aligns with best practices for injury recovery. They assess:

  • The appropriateness of care
  • Whether the mechanism of injury matches the extent of time out of work
  • Any inconsistencies in treatment plans

• Use Evidence-Based Guidelines
  Comparing an employee’s work restrictions with industry benchmarks can challenge unnecessary delays in return to work.

• Leverage Nurse Case Management
  An NCM can bridge communication gaps between the employer, claims adjuster, and treating physician to facilitate the release of work restrictions, while medical advisors provide expert recommendations to support return-to-work strategies.

• Communicate with the Treating Physician
  Sometimes, doctors hesitate to release employees due to lack of employer communication about modified duty options. Ensuring the doctor understands what transitional work is available can shift the conversation toward early re-engagement.

The Role of Transitional Duty in Difficult Cases

Transitional duty programs bridge the gap between full disability and full return to work by offering modified tasks tailored to an employee’s restrictions. When dealing with difficult cases:

• Engage the Employee in Solution-Finding – Ask: “What part of your job can you do today?”
• Leverage Part-Time or Task-Based Assignments – If full shifts are too much initially, reduced hours or alternative duties (such as training, auditing, or documentation work) can ease the transition.
• Monitor and Adjust the Plan Regularly – Weekly check-ins ensure that progress is being made, and obstacles are addressed.

Conclusion

Handling difficult return-to-work scenarios requires a proactive, evidence-based approach. Employers who effectively address psychosocial barriers, leverage nurse case management, challenge unnecessary work restrictions, and implement well-structured transitional duty programs will significantly improve return-to-work outcomes and reduce long-term claim costs.

By taking ownership of the process and collaborating with key stakeholders, businesses can ensure injured employees are supported in their recovery while maintaining productivity and controlling costs.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

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