Returning injured workers to their jobs has been a high priority for Managed Care Organizations (MCOs) and the Ohio Bureau of Workers’ Compensation (BWC) since the inception of the Health Partnership Program; however, we can always improve. MCOs, BWC, employers and providers must work collaboratively to advance return-to-work efforts.
Regardless of the greatest intentions and efforts of MCOs, Third Party Administrators (TPAs) and BWC, employers of all sizes and industries should have at least one thing in common — workers’ compensation must be a priority. This may not be a part of your business that welcomes you warmly when you come into the office each morning, but it is one that requires time and attention to keep from growing into an uncontrollable burden.
One approach to handling workers’ compensation is simply to entrust your claims to vendors and allow them to manage on your behalf. MCOs, TPAs, BWC and workers’ compensation attorneys can all help administer this critical segment of your business. But most would agree a more effective approach is for employers to prepare themselves well and become proactive partners in managing workplace injuries. Here are some fundamental key principles employers can utilize to gain significant return for their effort.
Establish Basic Employee Guidelines
A policy for workers’ compensation injury management does not have to be all-encompassing from the start, but begin by addressing basic expectations for employee behavior. Why does this impact workers’ compensation? Two reasons:
Basic guidelines establish a foundation for evaluating and managing employees from the beginning. Challenging employees sometimes create challenging claims.
More importantly, guidelines allow you to specify employee behavior that facilitates transparency and communication throughout the life of a workers’ compensation claim. For example, you should require that injuries and incidents be reported to a supervisor within a specified time (e.g., before the end of the shift, 24 hours, etc.). You can also require employees to return medical documentation regarding their treatment and recovery to you directly (HIPAA laws do not apply to workers’ compensation claims).
Transitional Work
Known by many names — modified duty, light duty, work accommodations — transitional work simply means bringing an employee back to work and adjusting their job requirements while they recover from injury. A multitude of studies show an injured employee will recover more quickly while in their working environment. Transitional work may not be possible in every situation, however, the more creativity used in identifying productive work for an injured employee, the better your chances are of avoiding one of the most costly elements of workers’ compensation claims — lost workdays.
A key point: your employee’s physician decides when they may return to work. Early return-to-work amounts to a reconciliation between the physician’s determination of the employee’s physical capacity and your flexibility to accommodate the employee’s limitations while they recover. Depend heavily on your MCO to assist in informing the physician of modified work options available for the injured employee. It is important for the doctor to understand the actual nature of work you have and that performing those tasks will not put your employee at risk of re-injury.
Injury Reporting Protocols
Establishing a consistent procedure for documenting work-related injuries and initiating the claim-filing process is important in a successful return-to-work program. Timing is critical, as early intervention in a claim from you and your expert resources (MCO, TPA, BWC) helps bring clarity to the claim process. Having the opportunity to discuss return-to-work options with your employee and their treating physician in the early days and hours after an injury helps all parties approach the claim proactively with the goal of early return-to-work.
Many employers maintain a readily available supply of injury reporting forms, contact information and a list of simple instructions. Make sure management and supervisors are familiar with these forms and are prepared to assist injured workers in completing the information and obtaining medical treatment if necessary. The injury-reporting process is an opportunity to build employee trust and confidence by demonstrating a well thought-out game plan for injury management.
Relationships with Local Medical Providers
Remember, the physician has final say regarding return-to-work timing for an injured employee, and your MCO serves all parties by ensuring the physician is as informed as possible when making decisions about your employees’ return-to-work status. Take notice of the medical treatment options available in your area and ask your MCO for recommendations and advice. Build relationships with key physicians. Invite them to tour your facility so they can personally see the types of job duties your employees perform. Their understanding of your business contributes to their decision-making process regarding return-to-work.
Consider other medical services you may need as an organization (pre-employment physicals, drug testing, etc.) and position your organization as a wise consumer. Ohio employers cannot require employees to seek treatment with a specified physician, but you can certainly recommend excellent options and establish relationships with service providers to foster communication and trust.
Culture of Health with Your Employees
It only makes sense that a healthier work force tends to have fewer injuries or, once injured, employees who return to work more quickly. BWC will soon introduce a workplace wellness grant program; take advantage of this to create your own healthier work force and positively impact your workers’ compensation experience.
Putting all the pieces together in your workers’ compensation puzzle will optimize a safe and efficient return-to-work program that ultimately benefits all parties.
Quinn Guist is the President of CompManagement Health Systems. He has been in the workers’ compensation industry for more than 23 years, including 15 years focused on managed care. He can be reached at (614)760-2416 or [email protected].
