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Introduction

The University of Wisconsin System has a long-standing commitment to provide a healthy and safe working environment for faculty, staff and students. The worker's compensation unit of the University of Wisconsin System Administration, Office of Safety and Loss Prevention has the responsibility of effective claim management, when an employee is injured at work. "Return to Work" is the single most important component in Worker's Compensation claim management, while also the most effective means of claim cost containment.

Since FY92 University of Wisconsin System worker's compensation claim costs have increased 31% from $3.3 million to $4.4 million. Approximately 50% of these claim costs are paid as temporary or permanent disability benefits. Reducing lost time days by just 20%, could then result in savings of as much as $450,000. This without any other safety or cost control efforts. Returning an injured worker to modified or transitional work on the 8th day, when full recovery would be reached on the tenth day is an illustration of the 20% savings.

Governor's Executive Order 194 relating to the workplace health and safety of State employees requires that a written health and safety program be established for all State agencies. UW System Administration negotiated with the Department of Administration to accept one overarching written program on behalf of all the UW campuses. This written program was presented to and adopted by the Physical Planning and Development Committee of the Board of Regents at their meeting in October, 1994. Program Element XIII requires early return to work, using transitional work assignments. The following written program is intended as a guide for campuses to use in developing their own Return to Work Program.

Campuses and employees can expect to realize many benefits as a result of implementing an effective Return to Work Program. The American Occupational Medical Association states that early return to work enhances both the psychological and physical recovery of the injured employee. Further, early return to work enables the employee to continue a productive life. Early return to work reduces costs of replacing the employee, overtime costs, loss of production and related costs and improves workplace morale. Early return to work reduces medical costs. The injured worker heals more rapidly, lessening the time medical treatment is needed. Early return to work cost reductions will have a direct impact on Campus Worker's Compensation premiums for the next three years. Premium savings will be returned to campuses for Safety and Loss Control programs.

What This Program Can Do For You

One way to lower worker's compensation costs is to have fewer accidents. Although agencies and campuses have been achieving consistently lower accident rates over the last few years, some accidents causing injury will continue to occur. So when injuries take place, costs can be controlled, by managing the worker's compensation claim.

• Assuring the employee get prompt and appropriate medical treatment.
• Demonstrating genuine concern for the employee's well-being.
• Doing your part to help the employee return to the workplace as quickly as possible.

Initially the injured employee may need to be placed in a modified job rather than be subjected to all of the duties involved in his or her regular assignment. Medical conditions may require work restrictions, therefore, an attitude among managers and supervisors that people need to heal and work back into their jobs will gain long term results. The goal is to return the individual to their original job at the earliest possible time. This program should help you achieve this objective.

University of Wisconsin System Administration, Office of Safety and Loss Prevention can assist you in the development of a Return to Work Program.

The Program

This program is designed to help managers and supervisors minimize the cost of injuries resulting from actual medical and worker's compensation disability costs by:

1. Providing approaches to manage the claim situation to contain costs and return injured employees to work as quickly as possible, and illustrating to managers and supervisors the skills and information they need to play their part in that process;
2. Stressing early return to work, either to regular or transitional productive work activities;
3. Recommending early rehabilitation intervention of possible long-term disability cases for the best approach to case management: early job placement, rehabilitation and/or retraining.

A successful Return to Work Program depends on the ongoing communication between:

• Your campus and the injured employee
• Your campus and the treating physician
• Your campus and the Office of Safety and Loss Prevention

UWSA, Office of Safety and Loss Prevention can assist you to develop a successful Return to Work Program.

Setting up the Program

Develop a Campus Return to Work Policy

Before an injury occurs, it is vital that your campus make the commitment to case management. Plan ahead and assume a quick reaction position if and when a disabling injury occurs. Establishing a Return to Work Policy provides a guide for the actions of all those involved in the program. Policy statements may include the following:

• Employees who are injured will be treated with dignity and respect.
• Employees will be given the best practical medical care to speed recovery and return to work.
• Rapid and efficient return of the worker to his/her original job is the goal of the program.
• All injuries will be treated as legitimate unless investigation reveals otherwise.

Establish the Program

After your policy has been developed, it is time to establish your Return to Work Program. This begins by identifying the case management team which is made up of people from inside and outside of your campus. On most campuses, these people, who are responsible for performing the following duties are currently doing some or all of the tasks. Therefore, it will not be necessary to involve additional expenditures. However, in many cases the employees are isolated from each other and arrangements must be made to enable them to interact efficiently. Each member is either assigned a specific task or contributes vital information and support during the course of treatment and rehabilitation of the injured worker. Responsibilities should be clear for each member.

The Worker's Compensation Coordinator is the person on your campus who is the focal point of all case management activity. This person might be a personnel or human resources employee or a safety or risk management person. This person is responsible for:

• Facilitating all case management activity.
• Preparing the required forms.
• Informing the injured worker of his or her benefit options.
• Maintaining Contact with UWSA/OSLP
• Coordinating activities on the campus with outside investigation and rehabilitation vendors.
• Maintaining a thorough knowledge of worker's compensation laws and UWSA reporting procedures.

The Campus Management may include a risk manager, a safety manager, a financial person or specialized human resources personnel. These people may provide specific expertise from their particular area as well as providing support to install effective claim management into the campus organization.

The Supervisor of the injured employee may not be involved in the initial planning of the program, but will be an important part of the process that reviews and manages the individual worker's compensation cases. The supervisor will be responsible for:

• Initiating immediate medical treatment for the injured employee.
• Reporting the injury, investigating its cause and initiating corrective work place measures if necessary.
• Maintaining contact with the employee during the recovery period.
• Establishing a caring attitude toward the employee.
• Identifying the alternative productive work duties.

The UWSA/OSLP Worker's Compensation Claim Examiner is responsible for the mechanics of administering the claim, such as, determining compensability, filing the required forms with the DILHR, paying the appropriate bills and benefits and providing cost containment services, such as medical treatment utilization review, medical bill audit and medical rehabilitation and investigation services. The UWSA/OSLP Worker's Compensation Claim Examiner can also provide:

• A history of past claims and injuries used to pinpoint trends of injuries and accidents.
• Strategies for handling difficult or questionable claims.
• Recommendations for physicians and rehabilitation consultants and other outside support.
• Information on worker's compensation benefits.

It is also recommended that a Physician or Medical Advisor be selected in your area to provide not only primary emergency treatment of injured employees, but also to advise on the treatment and rehabilitation progress of the injured employee. If possible, the selected physician should be a board certified occupational medicine specialist. Regardless of whether or not you select a board certified occupational medicine specialist, the specific background and qualifications to look for in your physician should include:

• An occupational medicine background or an understanding of the types of injuries and illnesses which may result from the work environment.
• A willingness to periodically meet with the campus management and to tour the facilities to view various job tasks.
• Objectivity and a willingness to listen to and relate with the campus and the worker's point of view.
• An ability to build rapport with employees.
• A community reputation as a competent medical practitioner.

Your Employees are the key to setting up the program. Once you develop your program, discuss the program with your employees. The overall policy should include at least the following:

• Employees who are injured will be treated with dignity and respect.
• Employees will receive the best practical medical care in order to speed recovery and return to work.
• Rapid and efficient return of the employee to his/her original job is the goal of the recovery effort.

When an Injury Occurs

The first action when an accident, with injuries, occurs is to provide prompt medical attention. Report the accident to UWSA/OSLP immediately, but always within 72 hours, using form WC-12, Employer's First Report of Injury or Illness, providing the most thorough information you can. The Department of Industry, Labor and Human Relations, Division of Worker's Compensation requires notification of all lost time claims on the fourth day of disability, Ind. 80.02 Wisconsin Administrative Code. As you later learn more about the case, send that information in an update report. Department of Administration forms DOA-6058, Employee Occupational Injury and Illness Report, DOA-6437, Supervisor's Accident Analysis and Prevention Report and DOA-6437, Safety Coordinator's Review and the cumulative trauma and back injuries forms may be used to report additional information. Although UWSA/OSLP asks that these forms be sent with the initial filing, injury reports should not be delayed, while waiting for their completion. If there are outside sources or influences that may have contributed to the accident, make sure that information is also provided to the Claim Examiner. When investigating the accident the focus should be to determine the cause of the accident, not to assess the blame.

In Wisconsin, the employee has the right to select his/her own physician. When the employee selects the physician, it is important for the Campus Coordinator or other designee, to develop a rapport and to make sure the physician is aware of your campus' early return to work program.

The treating physician can have a great deal of influence over the length of disability. Understand that it is the physician's responsibility to make certain the employee is not put in a situation where there is a risk of re-injury. When an injured employee is not released to return to work on a timely basis, it is perhaps because the physician does not understand job requirements or how the job can be modified to accommodate the temporary limitations of the employee. Clear communication is essential.The Program at Work

Maintaining Employee Contact

During the recovery period, it is important to maintain at least weekly contact with the employee, and get medical updates from both the employee and the physician as often as possible. This can be done by telephone or by personal visit.

Try not to make this seem as though you are checking up on the employee. Demonstrate that you genuinely care about his or her well-being, and that you are naturally anxious to see the employee back to work as soon as he or she is able.

Identify a Target Return to Work Date

Once an injury occurs, helping the employee get back to work becomes the objective of the entire team. It is important to maintain contact with the employee during the at-home recovery period. This contact should be made, at least, on a weekly basis. Every time the employee is contacted, he or she should be asked when he or she and the treating doctor feel they will be ready to return to work.

It might feel awkward, but everyone should go out of their way to demonstrate to the employee that they care, and that they are anxious to have the employee back to work. Frequent contact with the employee and treating physician, focused on a return to work date is critical to a successful program.

Rehabilitation Nurse

Another area where your UWSA/OSLP Claim Examiner can help you is in assigning a rehabilitation nurse, in your area, to work with the injured employee and the physician to ensure that the employee is receiving the appropriate treatment and progressing at the optimum rate. Rehabilitation Nurse expenses are charged to the claim file. Studies have shown a 4 to 1 savings of claim costs for every dollar spent on rehabilitation services. In serious cases or extended disability claims, the rehabilitation nurse can play a key role in helping the employee during that at-home recovery period, both in providing encouragement and in demonstrating or explaining specifics that can assist in the recuperation and helping the employee get back to the job. Rehabilitation nurses meet directly with the employee's supervisor to better understand the physical requirements of the employee's job. They further relate that information to the treating physician. Together they work to structure the employee's job considering the physical requirements and the employee's temporary or permanent restrictions. Rehabilitation nurses should focus on returning the employee to work activities which are based on physical limitations and transferable skills. Work directed rehabilitation is the objective.

Alternative Work Assignments

The responsibility for developing the alternative or modified job is generally the injured employee's immediate supervisor. This responsibility can vary from campus to campus. In identifying tasks to be included in an alternative work assignment, things to keep in mind include:

• The value of the alternative work to the total work unit and to other employees.
• Whether or not the alternative assignment is meaningful to the injured worker.
• Take a positive approach.
• Focus on what the employee can do rather than those tasks he or she can not perform.

Alternative work can be full or part-time, one-time or on-going, but it is generally better to avoid make-work or menial tasks, both for the injured employee's sense of worth and for the morale of the work unit.

Consider:

• Tasks not being done by anyone now.
• Jobs being done only occasionally.
• Tasks now being done, which if assigned to someone else, would free other employees to do other work.

Work with the UWSA/OSLP Claim Examiner to obtain an agreement from the physician stating that the employee is capable of performing the tasks designated in the alternative work assignment. Make sure the doctor completely understands the alternative work assignment. One effective tool is to video tape the tasks involved. Video taping the job is not expensive to produce and will certainly be less costly than having the physician visit the job site. The UWSA/OSLP Safety Staff can assist you in reviewing jobs and evaluating any associated safety hazards.

Do not overlook the importance of making certain your entire work unit understands the alternative productive work approach and the specific assignment. Each time it becomes necessary, make certain that the employee's co-workers understand the situation and the purpose of the alternative productive work assignment. Emphasize that the injured employee is not receiving treatment different from what they would also receive.

The supervisor should also be responsible for monitoring the injured employee's progress and working with the worker's compensation coordinator on your campus to see that the employee returns to his or her original job as quickly as possible. Remember that recovery periods will vary with individuals. Stay flexible and do not force the situation. It defeats the purpose if the employee tries to return to his or her regular job before he or she is ready. If an employee, that you and the physician feel is ready to work at their original job, resists returning to that job, use the resources at your campus and UWSA/OSLP to resolve the problem.

Throughout the recovery period, positive interaction concerning the progress the employee is making is vital. Emphasize the abilities the employee is displaying, rather than dwelling on any remaining limitations. In addition to the supervisor, members of the campus management team should demonstrate their interest and concern as they come in contact with the employee. Remember, the goal is to get the employee back to his or her regular job and feeling good about their recovery.

If the employee is represented by a Union, it is advisable to involve the Union in assessing and identifying alternative assignments. At the same time, it will be beneficial to communicate your philosophy and plan for alternative productive work to all employees.

Situations to Avoid

The following situations are those that should either be avoided or may be indicative of problems that may exist at your campus and may be a source of increased claim frequency, length of disability or legal involvement.

1. Bringing an employee back to work before they are ready.

   By bringing an employee back to work before being ready (not utilizing an early return program which identifies Alternative Productive Work), the length of the disability will increase substantially.

   For example, when physical restrictions are not followed, there may be a worsening of the injury or a re-injury resulting in more medical treatment. Physicians then become reluctant to allow a second job trial. Also, the worker loses motivation due to fear of additional injury and may not even want to attempt a modified work assignment.

2. Establishing a confrontational environment to worker's compensation claims.

   It is important to remember, in Wisconsin, the law provides that workers compensation is a "no-fault" program. All worker's compensation claims should be treated as legitimate unless proven otherwise by careful investigation. If an injured worker feels that they are being denied what they are entitled, the employee may seek legal representation. Attorney representation will not only complicate, but will likely increase the cost of the claim. If employees know that all cases will be investigated, and if a few questionable claims are uncovered, the number of questionable claims will often be reduced.

3. Keeping employees in the dark about their benefits or the claim process.

   Most employees do not understand the Worker's Compensation System. If it is not clear to the injured employee what benefits will be provided, in terms of wage replacement, medical cost coverage, rehabilitation and return to work efforts, the employee is likely to seek outside legal counsel. Questions about benefits should be referred directly to your UWSA/OSLP Claim Examiner.

4. Not contacting employees on a regular and frequent basis during extended disability.

   Take an active interest in their recovery. Make them feel that you truly care about their rapid return to work. don't let the employee feel cut off from the events at the campus. Keep them informed as to what is being done to modify a position for them.

5. Establishing a negative attitude towards a worker's compensation claimant.

   Even though you have an active safety program some injuries will occur. Don't blame an employee for their injury. Instead, take the opportunity to involve the injured worker in making changes to prevent future similar injuries. Try to head off negative attitudes by co-workers who may assume worker's compensation claimants are only after a few days off. Work to maintain a positive environment in the department to speed a successful and complete return to work.

6. Not willing to make concessions for a permanently partially disabled employee.

   Employees who know that the employer is making a good faith effort to modify a job to meet work capabilities tend to maintain a better attitude about returning to work. Such efforts by the employer go a long way to improve department morale and productivity when all employees know that if they have the misfortune to be hurt, the campus will look out for their interests.

7. Pushing an employee beyond work restrictions or allowing them to perform tasks which may complicate or delay recovery.

   The restrictions set forth by the treating physician are important in the recovery process. If either the supervisor or the employee ignore them, recovery could be delayed or additional related complications could develop. For example, favoring an injured shoulder during regular work activities may require unusual body mechanics and thereby introduce the likelihood of an additional injury to the body. (Return to top.)

Last Updated: 04/27/00