Introduction to Early Return To Work For

Municipalities Presented by John M. Cummings, MBA, Presented by John M. Cummings, MBA,

PHRPHRPersonnel Director &Personnel Director &

Susan Peck, Workers’ Compensation Susan Peck, Workers’ Compensation Claims ManagerClaims Manager

Montana Municipal Interlocal AuthorityMontana Municipal Interlocal Authority

DisclaimerDisclaimer

(Please Note: All materials, (Please Note: All materials, recommendations, and draft recommendations, and draft personnel policy language provided personnel policy language provided in this PowerPoint presentation in this PowerPoint presentation should be reviewed and approved by should be reviewed and approved by a City Attorney prior to utilization or a City Attorney prior to utilization or adoption.)adoption.)

Montana Municipal Interlocal Montana Municipal Interlocal Authority (MMIA)Authority (MMIA)

History:History: Mid 1980’s Liability Insurance Crisis.Mid 1980’s Liability Insurance Crisis. Cities/Towns see dramatic premium increases.Cities/Towns see dramatic premium increases. Many city policies are cancelled.Many city policies are cancelled. League of Cities and Towns forms ad hoc League of Cities and Towns forms ad hoc

committee. committee. Efforts to work with conventional markets fail.Efforts to work with conventional markets fail. Committee looks at self-insurance.Committee looks at self-insurance.

MMIA AdministrationMMIA Administration

Governed by a 13 member Board of Directors.Governed by a 13 member Board of Directors. Board comprised of City/Town Officials.Board comprised of City/Town Officials. Six largest Cities have permanent seats.Six largest Cities have permanent seats. Six seats represent smaller communities.Six seats represent smaller communities. One at-large seat selected by the Board.One at-large seat selected by the Board. Board governs insurance program Board governs insurance program

independently.independently.

MMIA Administration (cont.)MMIA Administration (cont.)

MMIA places emphasis on education.MMIA places emphasis on education. Quarterly newsletters/R.M. Bulletins.Quarterly newsletters/R.M. Bulletins. Training.Training. Policy review and development.Policy review and development. Contract Review.Contract Review. EPLI assistance and training.EPLI assistance and training. Risk Management Evaluations.Risk Management Evaluations.

Workers’ Compensation Workers’ Compensation ProgramProgram

98 Cities/Towns currently enrolled.98 Cities/Towns currently enrolled. Total Annual Premium in excess of $4.6 Total Annual Premium in excess of $4.6

million.million. Rates on average below State Fund.Rates on average below State Fund. Offer coverage to statutory limits.Offer coverage to statutory limits. Exposures are covered by cash reserves Exposures are covered by cash reserves

and excess insurance from conventional and excess insurance from conventional markets.markets.

Workers’ CompensationWorkers’ Compensation

Every employer is required to provide Every employer is required to provide coverage for their employees.coverage for their employees.

Provides remedy for injuries that occur Provides remedy for injuries that occur in the course and scope of employment.in the course and scope of employment.

No fault insurance.No fault insurance. Objective:Objective: To return a worker to work To return a worker to work

as soon as possible after the worker has as soon as possible after the worker has suffered a work-related injury or disease.suffered a work-related injury or disease.

Conditions CoveredConditions Covered

Injury/AccidentInjury/Accident

Occupational DiseaseOccupational Disease

ReportingReporting

Employee:Employee: Has 30 days from the Has 30 days from the

date of injury to report date of injury to report to to employer/supervisor.employer/supervisor.

Must be specific with Must be specific with regard to date, time of regard to date, time of injury, activity and the injury, activity and the nature of the injury.nature of the injury.

Employer:Employer:

Has 6 days to Has 6 days to report to the report to the insurer after insurer after notification of the notification of the injury.injury.

BenefitsBenefits

Medical:Medical:

All expenses directly All expenses directly related to the injury.related to the injury.

No out of pocket costs No out of pocket costs for the employee.for the employee.

Benefits (cont.)Benefits (cont.)

Wage Loss:Wage Loss:

Rate is based on 66 2/3% of employee’s Rate is based on 66 2/3% of employee’s average weekly wage at the time of average weekly wage at the time of injury.injury.

Current Maximum $504 per week.Current Maximum $504 per week. No payment for the first 32 hours or 4 No payment for the first 32 hours or 4

days whichever comes first.days whichever comes first.

Wage Loss Benefits (cont.)Wage Loss Benefits (cont.)

Temporary Total DisabilityTemporary Total Disability: Total loss of : Total loss of wages that exists until the worker reaches wages that exists until the worker reaches maximum medical healingmaximum medical healing

Temporary Partial Disability: Temporary Partial Disability: Partial loss of Partial loss of wages that exists prior to the worker wages that exists prior to the worker reaching maximum medical healing (return reaching maximum medical healing (return to work in modified or alternative to work in modified or alternative employment).employment).

Wage Loss Benefits (cont.)Wage Loss Benefits (cont.)

Permanent Partial Disability:Permanent Partial Disability: wage loss wage loss benefits after maximum medical healing benefits after maximum medical healing is reached - worker is precluded from is reached - worker is precluded from returning to time of injury position but is returning to time of injury position but is physically capable of returning to work in physically capable of returning to work in alternative employment. Based on 5 alternative employment. Based on 5 criteria: age, education, wage loss, criteria: age, education, wage loss, impairment.impairment.

Wage Loss Benefits (cont.)Wage Loss Benefits (cont.)

Impairment Award:Impairment Award: Benefits paid to Benefits paid to worker after maximum medical healing is worker after maximum medical healing is reached at the permanent partial reached at the permanent partial disability rate; medical determination disability rate; medical determination established by objective medical findings established by objective medical findings pursuant to the Guides to Evaluation of pursuant to the Guides to Evaluation of Permanent Impairment published by the Permanent Impairment published by the AMA.AMA.

Wage Loss Benefits (cont.)Wage Loss Benefits (cont.)

Permanent Total Disability: Permanent Total Disability: Physical Physical condition after maximum medical healing condition after maximum medical healing in which a worker does not have a in which a worker does not have a reasonable prospect of physically reasonable prospect of physically performing regular employment.performing regular employment.

DeathDeath

Vocational RehabilitationVocational Rehabilitation

Referral made when medical Referral made when medical documentation indicates a possibility the documentation indicates a possibility the injured worker will be precluded from injured worker will be precluded from returning to the time of injury position.returning to the time of injury position.

General Workers’ Comp General Workers’ Comp Questions Questions

What are your questions, thoughts, What are your questions, thoughts, concerns regarding Workers’ concerns regarding Workers’ Compensation?Compensation?

The Many Faces of ERTWThe Many Faces of ERTW

Own Occupation/Any Occupation

AccommodationsLight Duty

Part-time

ProductivityTransitional Duty

Modified Duty

Alternative Work

Functional Capacity

Employer Benefits of ERTWEmployer Benefits of ERTW

Reduce Medical CostsReduce Medical CostsEmployees who return to work early typically recover Employees who return to work early typically recover faster, resulting in medical cost reductions up to 70%. faster, resulting in medical cost reductions up to 70%.    

Improve ProductivityImprove ProductivityEmployees working at a transitional assignment is Employees working at a transitional assignment is more productive than hiring a temporary employee. more productive than hiring a temporary employee.    

Improve Employee MoraleImprove Employee MoraleImplementing an ERTW program tells employees their Implementing an ERTW program tells employees their employer is concerned about their well-being. employer is concerned about their well-being.    

Employer Benefits of ERTWEmployer Benefits of ERTW Reduce Potential Fraud ClaimsReduce Potential Fraud Claims

An ERTW program that returns injured employees to An ERTW program that returns injured employees to work immediately following an injury reduces the work immediately following an injury reduces the incentive to file a false claim in order to take time off incentive to file a false claim in order to take time off work. work.    

Decrease Attorney InvolvementDecrease Attorney InvolvementEmployers who do their best to return employees to Employers who do their best to return employees to their job show they care. Employees who know their their job show they care. Employees who know their employer values them generally will not hire an attorneyemployer values them generally will not hire an attorney

Reduces Workers Compensation Premiums Reduces Workers Compensation Premiums InvolvementInvolvementImproves employers WC experience ratingImproves employers WC experience rating

Employee Benefits of ERTWEmployee Benefits of ERTW Reduce Financial ImpactReduce Financial Impact

Many injured employees experience reduced wages due Many injured employees experience reduced wages due to an injury while they are away from work.to an injury while they are away from work.   

Increase Self-EsteemIncrease Self-Esteem Employees feel like productive members of society and Employees feel like productive members of society and it promotes wellness through contact with fellow it promotes wellness through contact with fellow employees.employees.       

Contribute to a Speedier Recovery Contribute to a Speedier Recovery Keeping the injured employee physically active and on a Keeping the injured employee physically active and on a normal work schedule contributes to a faster the healing normal work schedule contributes to a faster the healing process. process.

Employee Benefits of ERTWEmployee Benefits of ERTW Reduced chance of a “permanent” disabilityReduced chance of a “permanent” disability Loss of physical fitness and muscle tone are preventedLoss of physical fitness and muscle tone are prevented Job skills are maintainedJob skills are maintained Employee benefits such as vacation and sick leave are Employee benefits such as vacation and sick leave are

preservedpreserved Workplace seniority maintainedWorkplace seniority maintained Less disruption to the employee’s (and his or her Less disruption to the employee’s (and his or her

family’s) daily lifefamily’s) daily life Stress, boredom, anxiety, and depression are lessenedStress, boredom, anxiety, and depression are lessened

Elements of a Successful Elements of a Successful ERTWERTW

Incorporating these basic elements Incorporating these basic elements can maximize the opportunity for a can maximize the opportunity for a

successful early return to work successful early return to work program. program.

Successful ERTWSuccessful ERTW

Develop ERTW cultureDevelop ERTW culture Commitment to the program by all Commitment to the program by all

managers and supervisors; managers and supervisors; Consistent application of the program; Consistent application of the program; Emphasis on safety and prevention; Emphasis on safety and prevention; Prompt medical care following an injury; Prompt medical care following an injury; Periodic evaluation of the program.Periodic evaluation of the program.

Successful ERTWSuccessful ERTW

Continuous education and dissemination Continuous education and dissemination of information about the return to work of information about the return to work program beginning before injuries occur; program beginning before injuries occur;

Review of accident and injury history; Review of accident and injury history; Development of job descriptions for most Development of job descriptions for most

jobs that clearly explain essential job jobs that clearly explain essential job functions and tasks required; functions and tasks required;

Successful ERTWSuccessful ERTW

Information to help doctors understand the Information to help doctors understand the employee’s regular job, the return to work employee’s regular job, the return to work program, and available alternative program, and available alternative assignments; assignments;

Designated person to coordinate the early Designated person to coordinate the early return to work program, monitor assignments, return to work program, monitor assignments, be responsible for reporting and record be responsible for reporting and record keeping, and communications with the treating keeping, and communications with the treating doctor and injured worker; doctor and injured worker;

Compliance with ADA and FMLA, and state or Compliance with ADA and FMLA, and state or federal law that might apply; and federal law that might apply; and

SUMMARY: Successful ERTW SUMMARY: Successful ERTW Programs…Programs…

Involves the Employee, their Supervisor, and Involves the Employee, their Supervisor, and their Health Care Provider, early on and their Health Care Provider, early on and throughout the processthroughout the process

Requires special consideration and coordination Requires special consideration and coordination between the Employee and the Employerbetween the Employee and the Employer

Utilizes key management activities such as Early Utilizes key management activities such as Early Notification, Clinical Management, Notification, Clinical Management, Administrative Controls and Return to Work Administrative Controls and Return to Work PoliciesPolicies

Summary: Successful ERTW Summary: Successful ERTW Programs…Programs…

Allow Employers to consistently see a return on Allow Employers to consistently see a return on their investment in ERTW for their Employeestheir investment in ERTW for their Employees

Focuses on the Employee’s abilities and job Focuses on the Employee’s abilities and job “activities” versus their illness or injury“activities” versus their illness or injury

Fosters flexibility in the workplaceFosters flexibility in the workplace

Barriers to Accommodating Barriers to Accommodating ERTWERTW

Condition is too serious for Early RTW (i.e. Condition is too serious for Early RTW (i.e. Alzheimer’s disease, cancer, post-surgery)Alzheimer’s disease, cancer, post-surgery)

Supervisor and/or Agency MotivationSupervisor and/or Agency Motivation– lack of budget driverslack of budget drivers– perception of “problem employee” perception of “problem employee” – immediate staffing needsimmediate staffing needs

Lack of cooperation by the EmployeeLack of cooperation by the Employee

Barriers to Accommodating Barriers to Accommodating ERTWERTW

Relapse - inadequate recovery can result in Relapse - inadequate recovery can result in subsequent disability and lost work dayssubsequent disability and lost work days

Increased need to modify the work Increased need to modify the work environmentenvironment

Need for higher levels of emotional support for Need for higher levels of emotional support for the Employee in the work environmentthe Employee in the work environment

More complexity in payroll administrationMore complexity in payroll administration

Workers Compensation Workers Compensation & ERTW& ERTW

EXAMPLEEXAMPLE

Steps to Implementing Steps to Implementing ERTWERTW

These steps will assist in These steps will assist in implementing a successful early implementing a successful early

return to work program.return to work program.

Steps to Implementing ERTWSteps to Implementing ERTW EMPLOYEE INVOLVEMENT IN ERTW PROGRAM EMPLOYEE INVOLVEMENT IN ERTW PROGRAM

DEVELOPMENTDEVELOPMENT Involving employees in developing and Involving employees in developing and

implementing an ERTW encourages a feeling of implementing an ERTW encourages a feeling of ownership in the program and maximizes the ownership in the program and maximizes the opportunities for success.opportunities for success.

Involved employees will be more likely to Involved employees will be more likely to encourage and accept ERTW efforts on their own encourage and accept ERTW efforts on their own behalf and on behalf of their co-workers.behalf and on behalf of their co-workers.

Steps to Implementing ERTWSteps to Implementing ERTW ERTW POLICY & FORM(S) DEVELOPMENT ERTW POLICY & FORM(S) DEVELOPMENT This serves notice and explains your ERTW policy to This serves notice and explains your ERTW policy to

employees and establish necessary forms. We employees and establish necessary forms. We recommend presenting this to new employees upon recommend presenting this to new employees upon orientation and redistributing this on a regular basis to orientation and redistributing this on a regular basis to all employees. Employees should know what to expect all employees. Employees should know what to expect if they are injured on the job, and that their healthy if they are injured on the job, and that their healthy recovery is a top priority that involves them, their recovery is a top priority that involves them, their doctors and their supervisors.doctors and their supervisors.

ACCURATE JOB DESCRIPTIONS ACCURATE JOB DESCRIPTIONS Ensure all employee JD’s are up to date and include Ensure all employee JD’s are up to date and include

accurate depiction of physical requirementsaccurate depiction of physical requirements

Steps to Implementing ERTWSteps to Implementing ERTW DESIGNATE AN ERTW PROGRAM COORDINATOR - DESIGNATE AN ERTW PROGRAM COORDINATOR -

This helps ensure consistency and accountability This helps ensure consistency and accountability

Communicates program information to supervisors and Communicates program information to supervisors and workers. workers.

Monitors the recovery status of injured workers. Monitors the recovery status of injured workers. Manages correspondence from injured workers, medical Manages correspondence from injured workers, medical

providers and MMIA. providers and MMIA. Works with supervisors to ensure that consistent and Works with supervisors to ensure that consistent and

appropriate communication with injured workers is appropriate communication with injured workers is ongoing and documented ongoing and documented

Steps to Implementing ERTWSteps to Implementing ERTW IDENTIFY TRANSITIONAL DUTY IDENTIFY TRANSITIONAL DUTY

An important first step is performing job analyses on the An important first step is performing job analyses on the various positions in your organization. The actual various positions in your organization. The actual demands and essential elements of each position must demands and essential elements of each position must be identified. This can be used for developing individual be identified. This can be used for developing individual modified assignments. The key is to find ways to make modified assignments. The key is to find ways to make use of the worker's skills and knowledge, rather than use of the worker's skills and knowledge, rather than "make-work" assignments."make-work" assignments.

Steps to Implementing ERTWSteps to Implementing ERTW IDENTIFY TRANSITIONAL DUTYIDENTIFY TRANSITIONAL DUTY

Be creative in developing modified assignments. This Be creative in developing modified assignments. This enables the employee to be productive while meeting enables the employee to be productive while meeting medical guidelines.medical guidelines.

Consider the following: Consider the following: Part-time employment Part-time employment Temporary jobs Temporary jobs Alternative tasks Alternative tasks Job sharing Job sharing Jobs in other departments Jobs in other departments Transitioning through different jobs Transitioning through different jobs Job modificationJob modification

Steps to Implementing ERTWSteps to Implementing ERTW

NOTICE TO MMIA OF AN ERTW CASE - NOTICE TO MMIA OF AN ERTW CASE - This alerts MMIA that you This alerts MMIA that you have identified an injured employee as a possible participant in have identified an injured employee as a possible participant in your ERTW program. In some cases, MMIA will notify your company your ERTW program. In some cases, MMIA will notify your company to a claim potentially appropriate for ERTW.to a claim potentially appropriate for ERTW.

DOCTOR NOTIFICATION LETTER DOCTOR NOTIFICATION LETTER - This advises the doctor of your - This advises the doctor of your

company's ERTW Program, directs the physician's attention to company's ERTW Program, directs the physician's attention to information about the employee's job demands, and asks the information about the employee's job demands, and asks the doctor to fill in, sign and return information concerning the doctor to fill in, sign and return information concerning the employee's physical capabilities. This should be provided to the employee's physical capabilities. This should be provided to the injured worker to give to the physician or sent to the physician injured worker to give to the physician or sent to the physician directly by you. Copy MMIA after the doctor completes the form.directly by you. Copy MMIA after the doctor completes the form.

Steps to Implementing ERTWSteps to Implementing ERTW JOB REQUIREMENTS ANALYSIS - JOB REQUIREMENTS ANALYSIS - This is filled in by the employer This is filled in by the employer

and accompanies the Doctor Notification Letter. It summarizes the and accompanies the Doctor Notification Letter. It summarizes the employee's current job duties and physical requirements of that employee's current job duties and physical requirements of that job. You can also use this form to identify transitional duty job. You can also use this form to identify transitional duty throughout your company and present the doctor with a transitional throughout your company and present the doctor with a transitional position for your employee. Copy MMIAposition for your employee. Copy MMIA

PHYSICAL CAPABILITIES WORKSHEET PHYSICAL CAPABILITIES WORKSHEET - This form accompanies - This form accompanies the Doctor Notification Letter to be completed by the doctor upon the Doctor Notification Letter to be completed by the doctor upon examination of the injured worker. It should be provided to your examination of the injured worker. It should be provided to your employee to start the ERTW process once an injury is reported. You employee to start the ERTW process once an injury is reported. You should also send it to the treating physician on a regular basis, so should also send it to the treating physician on a regular basis, so that work restrictions can be addressed at each examination. Copy that work restrictions can be addressed at each examination. Copy MMIAMMIA

Steps to Implementing ERTWSteps to Implementing ERTW

RETURN-TO-WORK AVAILABILITY LETTER RETURN-TO-WORK AVAILABILITY LETTER - This - This should be sent to the injured worker by certified mail as should be sent to the injured worker by certified mail as a documented offer of a transitional duty position; a a documented offer of a transitional duty position; a copy should be kept on file by the employer, and a third copy should be kept on file by the employer, and a third copy sent to MMIA. This letter is an important document copy sent to MMIA. This letter is an important document if transitional duty is refusedif transitional duty is refused

The Basics of Early RTW

• Early Return Return to Work prior to full recovery from disabling condition

•Light DutyReturn to less physically or mentally demanding level of work

•Modified duty Temporary modification of work environment or job requirements that allow Employee to work productively given current condition

•Part-Time DutyReturn to one’s own job on a part-time basis

Communicating With Your StaffCommunicating With Your Staff

It is everyone’s responsibility to It is everyone’s responsibility to communicate with staff off due to injury communicate with staff off due to injury and/or staff coming back on ERTW.and/or staff coming back on ERTW.

Don’t let them forget to……Don’t let them forget to……

Don’t Let Them Forget To..Don’t Let Them Forget To..

Focus on getting wellFocus on getting well

Talk with their doctorTalk with their doctor

Keep in touch with their employer: Keep in touch with their employer: – Supervisor,Supervisor,– Human Resource Department, orHuman Resource Department, or– Other point of contact with your employerOther point of contact with your employer

Work toward returning to their regular job, full-Work toward returning to their regular job, full-timetime

DonDon’’t give up!t give up!

Questions?Questions?