Choices Solution Center

Speeding Return to Work

Overview
Addressing return to work is critical for both the claims examiner and the employer. Why? The claims examiner is issuing temporary disability payments to workers that are off work. If they don't receive the correct work status information from the physician in a timely manner, it could result in the injured worker receiving payments when they are actually back at work.

The State of California states that if the claims person makes a mistake, then the injured worker does not have to pay back the money. In addition, and much more costly, is the cost to an employer who has an injured worker out of work. They need to plan appropriately for the worker's return. They need to know so that they can arrange for temporary help, etc., if the injured worker will be out long. Also, the employer may have light duty positions available, and needs to know what the injured worker can do. Many times this information is not communicated to the treatment team.

The nurse is able to dialog with the physician and with the employer and communicate what the injured worker can do and explore if a light duty job is available. This expedient and reliable information speeds the return of the injured worker back to work, allows employers to appropriately plan for return or extended absence of an employee, minimizes over payment of temporary disability payments, and reduces costs a of claim when an injured worker returns to work quicker due to the communication and intervention of a Choices nurse.

Case Study Example #1
An employee sustained an injury to their knee. The employee had surgery and was off work for an extended amount of time. A Choices nurse received a referral for case management. The nurse met with treating physician to discuss medical progress and return to work as the physician was keeping the injured worker off work completely. The nurse asked physician to provide a list of things that the injured worker could do (not what they could not do). When the nurse communicated with physician that employer had light duty jobs that fit within those restrictions, the physician stated that the employee had told him that there were no light duty jobs available. The physician changed the return to work order to reflect what the injured worker could do. The employer found a light duty position available for the injured worker and the injured worker returned to work.

Result: Speedy return to work, cost savings in temporary disability payments, improved communication between employer and physician.

Case Study Example #2
A nurse was assigned to a case with injured worker. The nurse took the time to communicate and explore with employer their modified (light duty) program. The nurse communicated with the physician about the employer's flexible, modified return to work program and provided a job analysis. The physician returned the injured worker to work in a temporary modified position with employer.

Result: Excellent communication with employer and bridge the gap between employer and physician, cost savings with early return to work.

Case Study Example #3
A chiropractor refused to release a carpal tunnel patient to modified (light duty) prior to having a 2nd opinion with a surgeon. Surgeon could not see the patient for two weeks. The Choices nurse contacted the employer and obtained specific modified job duties that only required the patient (injured worker) to be able to speak and sit. The nurse then contacted the chiropractor and specifically ask him if patient was able to talk. "Yes, she can talk." "Is she able to sit and watch T.V?" "Yes, she is able to sit and watch T.V." The nurse told him "good, because the employer has a modified job that only requires the injured worker to talk and sit. The chiropractor released the injured worker to return to work modified and the injured worker returned to work.

Result: Speedy return to work and cost savings in Temp. disability payments and loss work time.

Case Study Example #4
An injured worker had a two-level anterior disectomy fusion. A Choices nurse is assigned case to manage the medical case and set up surgery and discharge for successful return to work. The injured worker returns to work full duty 19 days post injury. (This compared to other injured workers without nurse case manager intervention off work for 6 months and as long as 1 year). In a similar scenario, a teacher returned to work (light duty) 6 weeks post surgery and full duty 12 weeks post surgery with a nurse on the file from the date of surgery. Early intervention pays off.

Services we provide to TPAs, insurers and other claims professionals include:

  • Workers’ Compensation Case Reviews
  • Field & Telephonic Case Management
  • Catastrophic Case Management
  • Utilization Review
  • Task / Limited Assignments
  • Early Return-to-Work Assessments & Programs
  • Early Intervention Programs
  • Ergonomic Evaluations & Prevention
  • Job Descriptions & Analysis
  • In Service Training for Employers, Physicians and Treatment Teams
  • CEU Program for Nursing Staff

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