Read UPGRADE YOUR RISK MANAGEMENT PROGRAM WITH RETURN TO WORK text version

BAILOUT YOUR DISTRICT WITH RETURN TO WORK!

A MEMBERS PERSPECTIVE

Presented by Patricia Guidry, Aldine ISD Director of Risk Management and Sarita Shipe, TASB Risk Management Compliance Coordinator

OBJECTIVES

You will be able to determine the best course for you with respect to modified duty by understanding:

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Advantages of having a Return to Work Program The elements of an effective Return to Work Program A member's successful implementation

BUT FIRST . . . . . . . . . . .

Some things you didn't know about claims costs in Texas and why.

TEXAS CLAIM COSTS HIGHEST IN 12-STATE STUDY

Texas Claim Costs Highest in 12-State Study

$6,000.00 $5,000.00

Average Cost Per Claim

$4,000.00 $3,000.00 $2,000.00 $1,000.00 $0.00 IN WI NC PA CT MA TN FL LA IL CA TX

WHY ARE TEXAS COSTS HIGHER?

Higher number of "lost time claims" Highest medical payments per claim for all health care providers and more visits per claim More medical and disability payments = more cost containment expenses

IN ADDITION . . . . .

More treatment leads to:

Longer duration of TIBs Higher frequency of Impairment (60% of TX claims) Injured employees less likely to RTW

IS THERE AN ANTIDOTE TO ESCALATING COSTS?

ITS YOU!

The individual employer has the greatest opportunity to reduce losses in the WC system and to return the injured employee back to work. A SINGLE PHONE CALL IS ALL IT TAKES

POLITICAL PRESSURE TO HAVE A PROGRAM

Texas Legislature Wants It (HB2600 in 01)

Employer required, upon written request, to notify employee, doctor and carrier of availability of Return to Work Carrier required, with agreement of the employer, to provide RTW coordination service

POLITICAL PRESSURE TO HAVE A PROGRAM

Texas Legislature Wants It (HB7 in ,,05)

Networks Disability Management Proposed Legislation This Session

REASONS TO HAVE A PROGRAM

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Improved chances of returning employee to work sooner/employee assists in recovery Lost work days are decreased and claims resolved more quickly Retain employee's expertise Employee retains mental/physical work conditioning ­ "Wounded Worker" Is a "Win-Win" for the employee and the district

"WOUNDED WORKER"

Employees' attitudes are affected by the reaction of supervisors/managers (that single phone call) Focus on inabilities rather than abilities Employee's self-perception can turn into a disabling condition; he defines himself by his impairment Psychosocial issues set in motion Prolonged "pain" ­ prolonged disability ­ prolonged treatment ­ unnecessary procedures eventually make the employee truly wounded. A process is set up that enables the behavior that keeps them ill.

Sorry, we just can't take you back. You're not at 100%.

DISPEL THE MYTH!

"If I bring him back, he'll get re-injured."

o This situation is rare o Symptoms are not harm o Automatic assumption that time away from work after an injury is necessary o Per treatment guidelines the best treatment is to return the employee to physical activity This position is a costly mistake $$$

OTHER REASONS TO HAVE A PROGRAM

· Uniform response to all work-related injuries · Studies show early RTW with some symptoms does not increase risk of re-injury · Actually reduces recurrences and sickness absences over the following year · Reduction in overall claim costs up to 30-40% $$$$$

CLAIMS COSTS RTW DISTRICTS (Aldines)

DOI Year

2004-05

(RTW)

Avg TTL Cost

$2,207,411

$1,823,074 $1,978,505 $1,470,962

Avg/Claim

$2,920

$2,299 $2,620 $1,935

# of Claims

756

793 755 760

2005-06 2006-07 2007-08

Great to see you! Please return to work tomorrow.

For Employees of Aldine ISD

REASONS FOR UNNECESSARY TIME OFF WORK

According to physicians surveyed: · Treating doc is unwilling to force a reluctant patient back to work (most common) · Treating doc is not equipped to determine the right restrictions on work activity · Employer has a policy against modified duty work · Employer can't find a way to temporarily modify a job

REASONS FOR UNNECESSARY TIME OFF WORK, continued

· Treating doc feels caught between the employer and the employee's version of events · Treating doc has too little information about the physical demands of the job · Conflict exists between two docs · Employer wants to get rid of the employee

ELEMENTS OF RETURN TO WORK

Management Commitment!

OTHER ELEMENTS OF RETURN TO WORK

Written procedures Statement of responsibilities Program coordinator Known consequences for non-compliance with Bona Fide Offer Member guidelines for maximum length of any modified position Communication with adjuster/Loss Prevention

Physicians - the unwillingness of employers to accept employees less than 100% You - knowing when doctor has given restricted RTW Identification of tasks Determining pay

­ Wages modified, insurance carrier pays difference ­ Full pre-injury wage

ISSUES IN IMPLEMENTATION

COMMUNICATE RTW BEFORE AN INJURY OCCURS

Solicit employee/management buy-in Make sure employees know what to expect when injury occurs Create a Return to Work expectation Maintain contact with the off-work employee Clearly explain the purpose of modified productive work Consistent application *Remember: A Return to Work assignment is only a temporary placement

WHEN SHOULD THE DWC-73 BE FILED?

· The treating doctor must fax or send no later than 2 days after the exam

­ Initial visit regardless of work status ­ Change in work status or restrictions ­ Request from insurance carrier

· Receipt of job description from employer or carrier

­ Report must be faxed or sent no later than 7 days after receipt (See DWC-73 in handout)

IMPORTANCE OF A FUNCTIONAL JOB DESCRIPTION

· The treating doctor needs an accurate description of specific work activities to determine limitations. · Some injured employees may not always convey job duties as they really are. · Assists you in accommodating job tasks in line with doctor's restrictions. (Task Analysis in

Handout)

EXAMPLES OF MODIFIED DUTY

Transportation ­ Bus Monitor/Aide ­ Pumping fuel ­ Perform filing and clerical tasks ­ Parking lot Security

ANOTHER EXAMPLE

Food Service: · · · · Serve as cashier Monitor lunchrooms Inventory food supplies and chemicals Perform filing and clerical tasks

ELEMENTS OF A BONA FIDE OFFER OF EMPLOYMENT

· · · · · · In writing Copy of DWC-73 Location and schedule employee will work Wages to be paid Description of physical and time requirements Statement that only tasks consistent with abilities and knowledge will be assigned and training will be provided, if necessary.

(Sample Letter in handout)

(DWC RULE 129.6)

FILING THE DWC-6

· Must be filed with the carrier within 3 days after return to full or modified duty · If less wages earned, modified duty amount paid ($) must be on DWC-6 (box 7) · Every time there is a change in earnings or the employee elects paid leave, the actual paid amount ($) and hours worked must be posted on the DWC-6.

PROCESS IN A NUTSHELL

· Employee reports an injury · Direct the employee to prompt medical treatment · Inform the doc that your district has a RTW program

­ Letter to the treating doctor ­ Functional job description ­ Blank DWC-73

PROCESS IN A NUTSHELL

· Employee is released to work with restrictions · Identify modified duty position · Extend Bona Fide Offer of Employment · Monitor employee at work for compliance with restrictions · File DWC-6 for RTW or rejection of Bona Fide Offer

SUMMARY

Modified duty ­

· Results in significant savings for your district · Allows you to assist in your employees' recovery · Is for a temporary disability · Is a "Win-Win" for the employee and you

MODEL PLANS AVAILABLE

· http://www.tasb.org/services/risk/training _and_resources/fund_member_library/ret urn_to_work.aspx

· http://www.tdi.state.tx.us/wc/rtw/docume nts/rtwguide.pdf

QUESTIONS?

Don't forget:

Complete your session evaluation

Course # 17OU

AND

THANK YOU FOR ATTENDING!

BONA FIDE OFFER OF EMPLOYMENT

(District Letterhead) Date: (Employee name and mailing address) Dear :

We have been informed that Dr. _______________ has released you to return to modified duty with restrictions as outlined in the attached Work Status Report dated _______. We are pleased to offer you the following temporary modified work assignment that we believe is within those restrictions. To do this assignment, you will be required to (describe physical and time requirements): 1. 2. 3. You will be working at ____________ campus and have the following work schedule: _______________ through _______________ from ___________ to ____________. You will be paid $ __________ per _________. Please be assured that we are sympathetic to your injury, and we will only assign tasks consistent with your physical abilities, knowledge and skills. Your supervisor will work with you to ensure that you receive the proper training necessary to do this work. The duration of this assignment will be _________ weeks. At the end of this period, we will review the district's needs to determine if an extension can be made, or if other suitable work is available. This offer will remain open for five days from your receipt of this letter. If we do not hear from you within five workdays, we will assume you have refused this offer, which may impact your Temporary Income Benefits. We are looking forward to your return. If you have any questions regarding this offer, please contact me at ( ) - . Sincerely, (Signature and Title) I, _______________________________, acknowledge receipt of this offer and accept/reject the provisions. _______________________________ Date

Frequently Asked Questions Early Return to Work: Injured Workers

What is an Early Return-to-Work Program? It is a plan set up by an employer so injured workers can return to work more quickly and safely while they heal ­ either with changes to their regular job or in a temporary, alternate work assignment. Why would my employer want me back at work before I am released to full duty? In most cases, some work is better than no work. Your employer will benefit from your being able to help the company in some way, even if it is not in your regular job. My doctor filled out a form DWC 73 at my last appointment. What is that? The DWC 73, also called the work status report, is the form your doctor fills out to tell about the parts of your job you can safely do - such as lifting, standing, and driving. A copy is given to you, your employer and insurance carrier. What happens to my benefits if my doctor releases me to work with restrictions, but my employer does not have any modified or alternate work for me? You will keep receiving Temporary Income Benefits (as long as you are qualified*) if your doctor releases you to return to work with restrictions, but your employer doesn't have a job that meets your medical restrictions. What if my doctor says I can go back to work, but I don't think I can? If your employer makes you a bona fide offer of employment, and you choose not to take the offer, you may lose your Temporary Income Benefits. What exactly is a bona fide offer of employment? It is an employer's letter offering modified or alternate work to an employee within his/her medical restrictions. What must be included in the bona fide offer? · · A copy of work status report (DWC 73) that the offer is based upon. · · The location, schedule and pay for the job. · · The physical and time requirements of the position. · · A statement that the employer will only give tasks within the employee's physical abilities, knowledge and skill, and will provide training if necessary. What happens to my benefits if I go back to work? If you are receiving Temporary Income Benefits, your weekly benefit check may be suspended while you are working, or reduced, depending on what actual wages you earn. If you return to work and later your doctor takes you back off work, your checks may be restored, if you are still eligible.* Your medical benefits continue, as long as it is for reasonable and necessary treatment that is related to the injury.

My doctor told me that I will never be able to do my regular job again, because it requires very heavy lifting. I don't know how to do anything else. Is there somewhere that can help me learn a new job? Yes, the Texas Rehabilitation Commission is a state agency that can help in certain situations. *You are eligible for Temporary Income Benefits as long as you have disability and have not reached Maximum Medical Improvement.

TO: FROM:

NADINE KUJAWA, SUPERINTENDENT OF SCHOOLS KEITH CLARK, ASSISTANT SUPERINTENDENT OF FINANCE PATRICIA GUIDRY, DIRECTOR OF RISK MANAGEMENT APRIL 2, 2004 MODIFIED DUTY RETURN TO WORK PROGRAM

DATE: Re:

During the March study session a modified duty return to work program for injured employees was presented. The board members asked for one month to consider the program before accepting or rejecting its implementation. Following is a summary that was presented in March which highlights current practices and the recommended modified duty return to work program. The pilot program mentioned was not started. If approved, the Child Nutrition and Buildings and Properties departments have graciously agreed to pilot the program. Information presented at the March Study Session: Currently, Aldine does not have a uniform response to employees who have had a work related injury and have been released to return to work with medically dictated restrictions. Auxiliary departments typically do not return employees to work unless they are fully recovered. Professional employees return to work in varying capacities with varying capabilities. It would be advantageous for the district to create a modified duty return to work program as such a program would benefit both the employee and the district. Injured employees would recognize the benefit of being able to return for temporary periods of time. In doing so they would receive district wages in lieu of reduced workers' compensation wages, assist in their recovery by performing medically approved tasks and reduce the number of lost work days. The district would benefit by maintaining the employee's expertise, reducing workers' compensation costs, reducing substitute costs and reducing the number of lost workdays. A successful program would include visible support from top administration and a communication campaign that promotes the program as a benefit. This program will take creativity and effort by our supervisory staff and co-workers. Co-workers may have to adjust to the injured employee's job modifications and rotate duties. The efforts made should be communicated as a sign that Aldine cares about our employees. Other districts that have implemented this program have found that most employees are satisfied and that workers' compensation claims have been reduced. A nationwide study indicates that a modified duty return to work program could reduce claims by an estimated of 30%-40%. If this program is accepted, a pilot program will be implemented with the Child Nutrition department in April/May. The implementation of the district-wide program would occur on July 1, 2004.

Early Return to Work General Implementation Outline Aldine ISD

1. Aldine ISD and TASB met regarding implementation of an Early Return to Work Program 2. Risk Manager proposed Program to Assistant Superintendent of Finance 3. TASB and Risk Management presented program to Superintendent and Cabinet 4. Program was proposed to, and approved by, Board of Trustees 5. Pilot program initiated two months prior to district-wide implementation in the Child Nutrition and Buildings and Properties (custodial) departments 6. Program was presented to Principals and operations directors at area meetings (vital groups that make program successful) 7. Various training sessions were held regarding administration of the early return to work program (principal and operations departments' secretaries) 8. All employees were to be made aware of the new program by their director or principal 9. Program policy statements were made into laminated posters so that all employees are knowledgeable of program 10. Program was implemented district-wide July 1, 2004

Additional information: 1. Employees may be reluctant to pick up the additional work that an injured co-worker may not be able to do. Aldine emphasized that co-workers are a team and that we help one another when in need. We also tried to emphasize that an unexpected moment any one of us may be the "employee in need." We tried to create team spirit with the introduction of the ERTW program. This topic became particularly important at the head custodians meeting. 2. Aldine has 5 vertical teams made up of regional principals and the corresponding area superintendent. In the initial meetings four vertical teams were very receptive but the fifth group was not. They were insistent that their scores would go down by returning employees who were not at full capacity. They said that they were responsible for performing at a certain level and that they needed employees who were "whole" to

educate and monitor 20+ students. This could not be done from a chair w/ a knee injury. Or, they did not want to bring employees back w/ reduced hours because they can only get a full day substitute. I listened to their concerns and validated their worries but insisted that studies showed that by returning injured individuals to work their employee would return to work in a full capacity more quickly and that studies confirm that employees heal more fully. Then I proposed ideas such as the district paying for a full day substitute which could be used in conjunction w/ a reduced schedule teacher or in another capacity while the teacher was there (the deputy superintendent was in agreement). Principals were asked to review their performance concern and whether they would prefer having a substitute in the classroom that could walk around or a teacher who knew the lesson plan and could teach w/out being able to walk around. Additionally, it was mentioned that when substitutes are in classrooms, many students feel that it is a semi-holiday. 3. The program truly is a win-win situation for the district and the employee. Employees do not experience financial problems, lose sick leave benefits, or receive reduced income benefits and they do heal more quickly and fully. The district has reduced lost work days, maintains expertise in positions and reduces workers' compensation costs. This is another big point of emphasis during our communication. The program was not being implemented just for Aldine but for our employees well-being too! These statements were made at the beginning of all presentations. 4. Aldine's board was very receptive. Board members wanted to be 100% certain that professional employees would be returned to work in professional capacities. In research, Aldine had been advised by another district that any employee could be returned as a bus aide if modified duty was not available at the original place of employment. Aldine returns employees to a modified position within an injured employee's original department or campus. 5. Do not create permanent light duty positions. The intent of the early return to work program is to provide temporary modified duty. Aldine offers up to four weeks of modified duty. 6. Aldine implemented the program July 2004. At the onset I was told that it takes about 3 years to fully experience the affects of the program. Five years later, Aldine ISD's work related expenses continue to decline. 7. Sources for additional information 1. Texas Assocaition of School Boards ­ Sarita Shipe 2. Texas Department of Insurance, Division of Workers' Compensation, Return to Work Section http://www.tdi.state.tx.us/wc/rtw/index.html 3. Internet ­ contains countless examples of early return to work programs from which ideas can be gathered

Policy Statement for Early Return to Work

Aldine ISD is committed to providing a safe workplace for our employees. Preventing work related injuries and illnesses is a fundamental goal. Aldine ISD will make every reasonable effort to provide suitable return to work opportunities for every employee who is unable to perform his/her regular duties following a work related injury/illness. This may include temporarily modifying the employee's regular job or, if available, providing temporary alternate work depending on the employee's physical capabilities. Only work that is meaningful and productive will be considered. The support and participation of management and all employees are essential for the success of the district's Early Return to Work Program.

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UPGRADE YOUR RISK MANAGEMENT PROGRAM WITH RETURN TO WORK

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