Return to Work Program Guide

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1) Introduction

While you always try to provide the safest working environment for your staff, even the most proactive injury prevention program cannot entirely eliminate illness and injury. The establishment of a return to work (RTW) program is critical to successfully managing your Workers’ Compensation claim and injury management costs. Likewise, it is extremely important that your YMCA have a successful RTW program to help maintain the quality of services you provide for your community.

The primary benefit of a return to work program is to facilitate the earliest possible return of injured workers to the workplace to perform meaningful, productive work within their physical capabilities. An effective RTW program requires the involvement and cooperation of a number of parties, including your employees, health care providers, and YMCA leadership.

The information presented in this Guide outlines our goal at The Redwoods Group to assist you with maintaining a healthy and safe environment for your employees.


2) Sample Return to Work Policy Statement:

To All Employees:

The health and welfare of all employees is a top priority of this organization. When one of our employees is injured on the job, we are committed to returning that employee to productive work and full wages as soon as possible.

Our Return to Work program incorporates temporary, transitional duty jobs, which consist of some type of modification to your original job, a different job or several part-time tasks combined into one job. The transitional job will be provided until the treating physician releases you to your full, regular work or until you reach maximum medical improvement. This program has proven effective in returning injured employees back to production work quickly and also aid in the healing process.

The success of this program is the responsibility of everyone, from senior management to each individual employee. Only by working together can we provide a safe and secure workplace.

We all should be alert for potential accidents and strive to prevent them. If they occur, let us work together to minimize the effects. These efforts will be a benefit to us all.


3) Return to Work Team

A successful return to work program utilizes a team approach. This team includes your Return to Work (RTW) Coordinator, your management personnel, Redwoods’ Case Management Specialist, the claims team, and medical providers.

The first step is to designate a RTW Coordinator – someone who is enthusiastic – to oversee the program and to assist supervisors and the injured employee in returning to work. (The coordinator position does not have to be full time, but oversight of this program does need to be a person within your organization). The Coordinator must be methodical in applying the program and must maintain thorough documentation of all actions. Information such as the result of an injury may be confidential and should be handled accordingly. The Return to Work Coordinator will work closely with The Redwoods Group Case Management Specialist, the employees, and the supervisors.

Return to Work Coordinator duties include:

  • Address and respond to RTW policy issues
  • Insure job analyses are completed and updated
  • Maintain regular contact with Redwoods’ Case Management Specialist
  • Maintain weekly contact with injured employees (it may be wise to include the Supervisor on at least initial phone contact)
  • Update the program as needed (with Redwoods’ assistance)
  • Address and respond to RTW policy issues
  • Train supervisors, monitor adherence to the RTW Program, and document the training
  • Maintain contact with the injured employee’s supervisor to ensure the information provided to the employee is accurate and does not conflict with other guidance.

Supervisors should:

  • Report the injury to the Return to Work Coordinator
  • Conduct investigation and correct hazard
  • Complete all paperwork as outlined in the RTW program
  • Inform employees about work rules/practices
  • Maintain documented contact with the injured worker
  • Assist the RTW Coordinator in developing transitional duty work.
  • Assist the RTW Coordinator in monitoring recovery and continued need for transitional duty.

4) Who Does What…Before an Injury Occurs

YMCA:

  • Implement the Return to Work (RTW) Program:
    1. Prepare/distribute policy statement
    2. Identify RTW Coordinator
    3. Select medical providers (where allowed)
    4. Prepare physical job-demand descriptions
    5. Identify modified work tasks
    6. Implement RTW procedures
  • Communicate Return to Work Program to supervisors, employees, and medical providers

Maintain a safe work environment!

Employee:

  • Know when and to whom to report an injury
  • Know where to obtain medical treatment
  • Be familiar with the RTW program
  • Follow all job safety procedures and use required personal protective equipment

Report unsafe conditions!

Medical Provider:

  • Meet with Y management
  • Be familiar with Y facilities

Understand the Y’s modified duty/RTW commitment!

Risk Management

  • Assist with:
    1. RTW program development
    2. Establishing safety and health programs
    3. Physical job demand descriptions

Participate in injury review process!

Case Management Specialist:

  1. Serve as liaison on all workers’ compensation claims
  2. Assist Y with implementing a Return To Work Program
  3. Assist in developing physical job demand descriptions
  4. Help to identify modified work tasks
  5. Who Does What…After an Injury Occurs

5) Who Does What…After an Injury Occurs

YMCA:

  • Provide First Aid as needed
  • Refer to preferred medical provider/facility (where allowed)
  • Report injuries to Redwoods in a timely manner
  • Actively communicate with:
    1. Treating physician
    2. Employee
    3. Redwoods Case Management Specialist and claims adjuster
  • Accommodate work restrictions
  • Monitor disability status until full duty return to work

Employee:

  • Report injury promptly
  • Follow prescribed medical treatment plan
  • Comply with work restrictions
  • Communicate medical disability status to employer and Redwoods’ Case Management Specialist

Medical Provider:

  • Provide appropriate medical treatment
  • Evaluate whether employee can return to work
  • Establish target return to work date (modified/full duty)
  • Complete RTW form
  • Communicate with:
    1. Employee
    2. Employer
    3. Redwoods’ Case Management Specialist
    4. Claims Adjuster

Risk Management:

  • Assist in:
    1. Injury Review Process
    2. Job Modification
    3. Monitoring and evaluating effectiveness of RTW Program

Claims:

  • Investigate promptly to determine compensability
  • Pay medical/disability benefits promptly
  • Actively manage claim to aggressive resolution
  • Bring claim to conclusion

Redwoods Case Management Specialist:

  • Discuss medical treatment plan and disability status with injured employee
  • Facilitate early RTW by matching employees’ functional capabilities with physical demands of modified/regular jobs
  • Assist employer in developing modified job duties for employees
  • Coordinate medical and disability information

Attending Physician’s Return to Work Recommendations Record

Physician: Please fill out this form and fax it to 800-478-6068, attention: Angela McGarity
Employee: Completed form must be returned to your employer following each examination.
YMCA: When received, route this form to The Redwoods Group immediately.

Employee name:
Claim number:
Date of injury/illness:
Examination/treatment date:
Brief diagnosis of injury (indicate clinical manifestation of condition to what body part or surface):

Patient has been advised of the following regarding return to work:

  • Return to work immediately, with no restrictions.
  • No return to work until:
  • Return to work with the following temporary restrictions beginning: __ / __ / ____ and ending: __ / __ / ____
  • Sedentary Work. Lifting 10 pounds maximum and occasionally lifting and/or carrying such articles as files, desk supplies, and small tools. Although a sedentary job is defined as one that involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.
  • Light Work. Lifting 20 pounds maximum with frequent lifting and/or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be only a negligible amount, a job is in this category when it requires walking or standing to a significant degree or when it involves sitting most of the time with a degree of pushing and pulling of arm and/or leg controls.
  • Light Medium Work. Lifting 30 pounds maximum with frequent lifting and/or carrying of objects weighing up to 20 pounds.
  • Medium Work. Lifting 50 pounds maximum with frequent lifting and/or carrying of objects weighing up to 25 pounds.
  • Light Heavy Work. Lifting 75 pounds maximum with frequent lifting and/or carrying of objects weighing up to 40 pounds.
  • Heavy Work. Lifting 100 pounds maximum with frequent lifting and/or carrying of objects weighing up to 50 pounds.
Number of consecutive hours the patient can perform the specified activity during an 8-hour work period 6-8 4-5 1-3 0
Sitting _ _ _ _
Standing _ _ _ _
Walking _ _ _ _
Pushing _ _ _ _
Pulling _ _ _ _
Climbing _ _ _ _
Bending _ _ _ _
Kneeling _ _ _ _
Reaching _ _ _ _
Grasping _ _ _ _
Weight-handling frequencies per hour 15 or more 10-14 1-9 0
Lifting/carrying less than 10 pounds _ _ _ _
Lifting/carrying 10-20 pounds _ _ _ _
Lifting/carrying 20-50 pounds _ _ _ _
Lifting/carrying 50-100 pounds _ _ _ _

Patient discharged? Yes / No
Next scheduled examination/treatment date:

Attending physician’s signature:
Print name:
Address:


Job Analysis

(For YMCA and Redwoods’ Case Management Specialist Use)

Employee name:
Claim number:
YMCA:
Employee job title:
Supervisor interviewed? Yes / No
If yes, list supervisor name:

Was the employee hired with any restrictions? Yes / No
If yes, explain the restrictions:

Typical work hours per week:
Overtime? Yes / No
Breaks? Yes / No
If yes, list frequency:

Body movements at work Rarely Occasionally (1/3 or less) Frequently (1/3 to 2/3) Continuously (2/3 or more)
Sitting _ _ _ _
Standing _ _ _ _
Walking _ _ _ _
Vertical reaching at or above shoulder height _ _ _ _
Bending/stooping/squatting _ _ _ _
Crawling/kneeling _ _ _ _
Close-distance hearing _ _ _ _
Near/far vision _ _ _ _
Driving _ _ _ _

Describe the driving involved:

Body movements at work Weights handled (lbs.) Item Alone or assisted? Push/pull/lift? Times per day Distance moved
1-10 _ _ _ _ _ _
11-20 _ _ _ _ _ _
21-50 _ _ _ _ _ _
More than 50 _ _ _ _ _ _
Hand coordination Movement required Tool/machine Left Right Both
Fine manipulation _ _ _ _ _
Hand twisting _ _ _ _ _
Power gripping _ _ _ _ _
Simple grasping _ _ _ _ _

Physical surroundings:
Inside Work - Percentage performed inside:
Outside Work - Percentage performed outside:

Work around moving machinery? Yes / No
If yes, describe:

Check each of the following that the employee comes in contact with:

  • Strong Odor
  • Steam
  • Air conditioning
  • Dust
  • Mist / Vapor
  • Fumes
  • Describe mist/vapor/fumes:
  • Additional comments or observations:

Signature:
Date:


Transitional Return to Work Log

For YMCA and Redwoods’ Case Management Specialist Use

Employee name:
Supervisor:

Date Hours Worked Tasks performed Comments regarding injured worker’s tolerance of modified-duty tasks Initials
Sunday _ _ _ Injured Worker: / Supervisor:
Monday _ _ _ Injured Worker: / Supervisor:
Tuesday _ _ _ Injured Worker: / Supervisor:
Wednesday _ _ _ Injured Worker: / Supervisor:
Thursday _ _ _ Injured Worker: / Supervisor:
Friday _ _ _ Injured Worker: / Supervisor:
Saturday _ _ _ Injured Worker: / Supervisor:

I clearly understand, take responsibility for, and acknowledge the limitations my physician has placed on me while participating in this temporary transitional work program.

Employee’s signature:
Date:
Physician’s name:

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