A body in motion stays in motion. The old adage applies not just to physics, but also to the quest to ensure that injured workers, regardless of the severity of their injury, are restored to function in body and mind. 

A body that keeps moving, one that returns to work, is more likely to heal. Less than half of injured workers will ever return to work if they’re out more than six months, according to the National Conference of State Legislatures. 

“The key to a successful return-to-work program is to keep employees working or doing something. This is the best way to keep them from adopting a ‘disability mindset.’ Keeping an employee focused on their ability to work in any capacity versus inability or incapacity will get employees back to full functional recovery sooner,” Concentra’s Dr. Kathy Le said. She is the company’s vice president of medical operations for the Pacific region.  

For those companies with stellar examples of return-to-work programs, several factors are key to their success: communication, a clear destination and timetable for light duty, and a focus on social determinants of health. Le noted that the design of the program needs to help support that goal to render the results for the injured worker, and that this means focusing on function and support rather than pain.  

A Whole-Person Approach to Care 

Clinicians in the workers’ comp industry have embraced this approach in recent years, as the need to heal the whole person has gained traction — to the extent that the American College of Occupational and Environmental Medicine issued a position paper stating that the physician’s role is to keep patients with medical conditions at work or help them return.  

For practitioners, this includes engaging with the right experts across the care plan for transitioning back to work.  

“By placing the priority on bonding with the patient, aligning with the right providers, ensuring quality medical and mental health care, including the family, communicating promptly with all stakeholders and routinely measuring progress to outcomes via subjective and objective patient and provider reports, time and the associated claims costs are not wasted,” said David Vittoria, chief behavioral health officer with Carisk.  

Specialists will work together, and facilitating that process means communication is key to driving results: “Communication is number one. There has to be a calibration of expectations for all of the stakeholders to realize what the limitations are and what the opportunities are to integrate return to work,” said Brian Peers, vice president of Clinical Services at MedRisk.  

To start that process, return-to-work programmatic leads ramp up the injured worker. “We want to screen for fear avoidance or malingering very early on in the claim; you don’t want to find that out when you’re right on the doorstep of return to work,” Peers said. “The plan itself usually involves professionals engaged that are adept at addressing these psychosocial barriers. Sometimes, it’s just a matter of having the right conversation or the right motivation strategies to convince them that these are the next steps and that they’re safe.” 

A Mix of New Tech and Old-School Best Practices 

In some cases, safety can be established with the injured worker and the employer through technology. FIGUR8, a company focused on biomechanics data for musculoskeletal injuries “has brought biomechanics-lab-grade data into the clinic setting, allowing for much greater trust and certainty in an injured worker’s recovery progress and their return-to-work capabilities,” said Scott Sexton, president and chief business officer at FIGUR8.  

“In some cases, the injured worker is much more confident in their capabilities, allowing for an earlier return to work. In other cases, the data more effectively supports the injured worker’s limitations, reducing the chance of reinjury, exacerbation and prolonging the recovery.” 

In other cases, it’s old-school interviewing skills that can turn the tide. Motivation makes the difference, and with an understanding of social determinants of health, those can be varied. 

“If you consider that anywhere between 55 and 63% of the U.S. population lives paycheck to paycheck, you would think that that would be a motivation to get back to work. When you create that transitional duty, what are you going to pay them? Are you going to pay the comp rate, more, or full salary? Knowing that most people are struggling financially, you have to consider that aspect,” said Tammy Bradly, senior director of clinical product marketing, Enlyte.

“Also, [there’s] the simple things; someone who has been on workers’ comp for two to three months, I’ve seen examples of folks who lost their car insurance or the car is broken and they can’t afford to get it repaired.” In that case, Bradly’s team was able to work with the employer to arrange a carpool for the injured worker until they were able to make the payment for insurance to be restored. 

Clear Return-to-Work Benefits 

Karen Thomas, vice president, clinical solutions, CorVel

The benefits of return to work for employers and employees are clear. The RAND Institute found that an employer with a clear return-to-work policy can expect to reduce time out on disability by an average of 3.6 weeks. This is also true for those workers with very serious injuries that could become permanent, reducing that average by 12.6 weeks. On the employee side, in addition to increased financial security, reintegration into the workplace retains the employee’s social network and ties to the outside world.  

“It’s all about educating that employer,” said Karen Thomas, vice president, clinical solutions with CorVel. “Historically in our industry, we have shied away from social determinants of health. But what’s exciting to me is that employers are starting to understand that humans don’t exist in a vacuum. If I’m stressed out about my paycheck or my next meal or my kid’s daycare, that all affects my recovery.” 

Modified and light-duty positions are a hallmark of a good return-to-work policy, and for workers’ comp professionals this might mean convincing the employer that the effort to implement such accommodations is worthy of their time and attention. For Mike Milidonis, national manager of ergonomics and employer services with Enlyte, one success story started exactly that way. The employer had a “no return-to-work until you’re a hundred percent” policy, but his team was able to convince them to change course for the sake of the employees and their business.   

“We’ve found that we have to combat against past experience with some employers because they’ve had employees on light duty for two years,” Milidonis said. In the end, Milidonis was able to radically alter the company’s perspective, to the extent that the union wrote return to work into their policies as well. To achieve that 180, time frames carried the day. 

“Distinct entry and exit requirements are essential. If the employee is still recovering at those time limits, then it’s time to take a look at that claim and figure out what to do with that employee and job. The other extremely vital piece is the physical demand requirements for the job. If we don’t know what those are, it’s difficult to return to them. We have to understand the discrepancies between the job tasks and the employee’s abilities. What’s typically in a job description is not enough for return to work, and a lot of times that’s all we have, or something from the dictionary of occupational titles.” 

Peers echoed that last element, quipping that “rehabbing without a formal job description is like traveling somewhere new without your phone. If you stumble upon your destination, it’s unlikely you did so efficiently.” 

Even after the employee returns, the work is not done for anyone in the orbit of the policy, but commitment to the plan will bear fruit. 

“When employees are treated like valued members of the organization, the process of returning someone to work is much easier,” said Peers. “Stakeholders often underestimate the power an injured employee has during return to work. Injured employees choose how much effort to put into getting better and how much discomfort to tolerate when getting back to work.”  

That agency is not just powerful — it can be transformative for individuals, underscoring the enduring impact of a quality return-to-work program. &