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CompManagement Health Systems Client Bulletin

Custom-built return-to-work programs     |     February 8, 2013

In business, it is best to establish processes and programs for dealing with challenging employment matters before you have an emergency. When it comes to workers’ compensation management tools, we encourage employers to consider four strategic, custom-built programs: Transitional Work Services, Job Retention Services, Remain at Work, and Vocational Rehabilitation. Your CompManagement Health Systems (CHS) Account Executive and Nurse Case Manager are knowledgeable allies who can help you determine how to incorporate these tools into your existing employee benefit programs to avoid a crisis.

Transitional Work Services (TWS)

The TWS program essentially refers to on-site physical therapy. It can be implemented as soon as your injured employee is ready for therapy and while they are on transitional duty. This is an individualized therapy program created for the employee using their own job tasks. Ultimately, it should cost less than clinical therapy and can have a more aggressive return-to-work goal, which will reduce lost workdays, compensation, and reserve costs. It can be incorporated across the board or on a case-by-case basis. To implement TWS to assist with a claim, contact your CHS Account Executive or Nurse Case Manager. Our team plays a major role in coordinating these services with our clients and their injured employees, and the treating physicians and therapists.

Job Retention Services (JRS)

JRS options are used when an employee is having difficulty progressing to their former position of employment after returning to work on transitional duty. The program requires that a claim be lost time (eight or more calendar days).

JRS can be incorporated whether or not you have used TWS. It dispatches a Qualified Rehab Professional (QRP) to be personally involved in “field case management” with your employee and their physician. There are various services provided through this program, including job analyses, job modification, on-the-job-training, physical therapy, occupational therapy, tools, supplies, etc. The Ohio Bureau of Workers’ Compensation (BWC) must approve JRS, which the MCO will help coordinate.

If approved, most costs associated with the program are not charged to your experience. The benefits include cost containment for the employer and quicker return-to-work outcomes for the employee. This program is a part of CHS’ case management protocol, but never hesitate to ask if it is an appropriate option on a claim.

Remain at Work (RAW)

The RAW program is used when an employee is having difficulty progressing to their former position of employment after returning to work on transitional duty. It is for a medical only claim (where employees return to work in seven calendar days or less.) This option can be incorporated whether or not you have used TWS. It dispatches a QRP, and offers the same benefits and goals as JRS. The MCO, employee and employer, with the cooperation of the physician of record, must approve the program.

Costs associated with RAW services are not covered by BWC like JRS, but are charged to the medical portion of the claim. Because the cost will impact the employer’s experience calculation, the program must be used strategically. It is a part of CHS’ medical case management model. Typically, the Nurse or Case Examiner contacts the employer when this option becomes feasible in a claim.

Vocational Rehabilitation (Voc Rehab)

This is a program designed for the injured worker when the return-to-work efforts described above are exhausted; or when the injury was so severe that the employee will not be able to return to their original position. Voc Rehab involves a QRP meeting personally with your employee to develop a specific plan to accomplish a determined vocational goal, such as return to the same job, return to a different job, same employer, different employer, etc.

A claim may move into Voc Rehab when the employer can no longer accommodate the modified duty requirements. The decision to move to Voc Rehab from transitional duty is agreed upon by all parties (employer, employee, MCO, field case manager, therapist, and physician). A claim may also move to Voc Rehab when an injured employee was never released to transitional duty. The lost time claim is a candidate for Voc Rehab when determined to be “feasible” by the MCO, and the employer, employee, and physician approve the program.

The costs associated with Voc Rehab, including lost-time compensation (living maintenance), are covered by the BWC Surplus Fund and are not charged to the employer’s risk. Voc Rehab can be a powerful recovery strategy when used wisely, but the timing can be sensitive. It is critical to work closely with your Nurse Case Manager and your employee to initiate Voc Rehab at the optimal point in the recovery process to realize its greatest possible value.

Be prepared with helpful strategies

These programs can help employers maintain control over claims by directing their employees to great occupational healthcare. They help build proactive care at the workplace, incorporating treatment into the employees’ original job tasks for continued progress. The programs also help keep you aware of their medical condition and the care they need. In addition, they help maintain employee morale and their confidence in your company’s game plan to help them deal with their injury and preserve their job.

All of these programs are tremendous tools to help organize a return-to-work plan for your employees. The specific utilization will vary widely based on the actual circumstances of each claim. CHS and your third party claims administrator can certainly help you through a thoughtful implementation of these strategies on a claim-by-claim basis. It is never too early to become familiar with these resources and have them available to you as soon as you sense that a claim may be taking an unscripted turn.