1. Office of Risk Management Annual Conference TRANSITIONAL DUTY EMPLOYMENT A RETURN-TO-WORK CONCEPT FOR WORKERS’ COMPENSATION COST CONTAINMENT CONTAINMENT

2. Office of Risk Management Annual Conference Transitional Duty Employment A process that facilitates returning injured employees back into the workforce in a safe and timely manner after a work-related injury.

3. Office of Risk Management Annual Conference Transitional Duty Employment Injured employees are returned to work  to perform meaningful, productive work and  within safe parameters of his or her physical capabilities.

4. Office of Risk Management Annual Conference Goal of Transitional Duty Employment Offer temporary transitional employment options that fit the injured employee’s specific capabilities.

5. Office of Risk Management Annual Conference Objectives of Transitional Duty Employment  Manage workplace injuries.  Temporarily modify the employee’s job description to accommodate physical restrictions identified by the treating physician.  Reduce workers’ compensation costs.  Make workers’ compensation more effective.

6. Office of Risk Management Annual Conference State of Louisiana  Approximately 89,000 employees.  4400 active workers’ compensation claims.  960 of these paid compensation benefits on regular basis.  $55 mil spent on workers’ compensation.  Money comes directly from agency budgets.

7. Office of Risk Management Annual Conference State of Louisiana Prior to 1999 Injured workers cannot return to work unless they can perform full duty. Civil Service won’t allow injured workers to return to work unless they are at 100% full duty.

8. Office of Risk Management Annual Conference State of Louisiana ORM had to get legislative authority just to write a policy on return to work.

9. Office of Risk Management Annual Conference State of Louisiana To make the legislative argument, ORM first worked a pilot program of Transitional Duty Employment at Pinecrest Developmental Center. A vocational rehabilitation counselor helped Pinecrest develop a transitional duty employment policy. The pilot was worked for one year.

10. Office of Risk Management Annual Conference State of Louisiana Pinecrest was selected for the pilot program because:  They had the highest volume of workers’ compensation lost time claims. compensation lost time claims.  They had the highest workers’ compensation premiums.

11. Office of Risk Management Annual Conference State of Louisiana Before the pilot program… Pinecrest employees accepted the fact that they would not be allowed to return to work on any type of modified duty once released by the treating physician.

12. Office of Risk Management Annual Conference State of Louisiana After the pilot was worked, Pinecrest employees were allowed to return to work, limited duty.

13. Office of Risk Management Annual Conference State of Louisiana In the first six (6) months of the transitional duty pilot, Pinecrest saw a 15% reduction of its monthly indemnity pay-out.

14. Office of Risk Management Annual Conference State of Louisiana At the end of one year of the transitional duty pilot, Pinecrest saw a 36% reduction of its indemnity pay-out.

15. Office of Risk Management Annual Conference Statutory Authority for TDE R. S. 23:1547 In 1999, the legislature passed Senate bill 689 which gives ORM the authority to develop and administer a transitional duty program for State employees.

16. Office of Risk Management Annual Conference Case Study INJURED WORKER

17. Office of Risk Management Annual Conference Case Study Injured Worker got hurt on the job.  She received conservative treatment with Dr. Mild for 2 months.  Now Dr. Mild feels like Injured Worker can do something.  Dr. Mild releases Injured Worker to return to work except… she can’t lift over 25 pounds.

18. Office of Risk Management Annual Conference Case Study Injured Worker is so happy she can go back to work.

19. Office of Risk Management Annual Conference Case Study Injured Worker’s supervisor does not allow her to return to work because she is not released to return to work full duty.

20. Office of Risk Management Annual Conference Case Study Injured Worker just doesn’t know what to do…

21. Office of Risk Management Annual Conference Case Study Injured Worker gives the bad news to her adjuster: “Keep sending me my checks!” Develops renewed interest in: Dr. Phil The Biggest Loser Casino Gaming

22. Office of Risk Management Annual Conference Case Study Because Injured Worker is not allowed to work, restricted duty -- Compensation benefits continue to be paid.

23. Office of Risk Management Annual Conference Case Study Injured Worker’s doctor doesn’t see what the big deal is. As her doctor, he knows Injured Worker can work.

24. Office of Risk Management Annual Conference Case Study Injured Worker doesn’t see what the big deal is either, she knows she can work. She can do everything her job requires her to do except the lifting.

25. Office of Risk Management Annual Conference Case Study Sadly enough, Injured Worker’s supervisor doesn’t see what the big deal is, either. After all, Injured Worker is being paid workers’ comp benefits anyway, right? What’s the big deal?!

26. Office of Risk Management Annual Conference Case Study The big deal is:  Workers’ compensation benefits continue until the injured worker returns to work, or  The injured worker is released to return to work regular duties by a treating physician.

27. Office of Risk Management Annual Conference THE ECONOMICS OF RETURN TO WORK

28. Office of Risk Management Annual Conference The Economics of Return to Work A claim for a health care worker who hurts her back lifting a patient will cost the employer $5,150 with a return to work program. Without a return to work program the same claim will cost $29,250. This is a 72% difference.

29. Office of Risk Management Annual Conference The Economics of Return to Work  If Injured Worker is unable to return to her previous work earning the same wages or  If she is unable to earn 90% or greater of her pre-injury wage... R. S. 23:1226 requires Injured Worker’s employer to provide rehabilitative services: Job placement Retraining Job placement Retraining

30. Office of Risk Management Annual Conference The Economics of Return to Work Rehabilitation of injured workers automatically adds $5,000 - $7,500 to value of a claim. Benefits continue to be paid during the rehabilitation process.

31. Office of Risk Management Annual Conference The Economics of Return to Work At the end of the rehabilitation process, if the injured worker is unable to earn wages equal to 90% or greater of pre-injury wage, she is entitled to supplemental earnings benefits or SEB.

32. Office of Risk Management Annual Conference The Economics of Return to Work SEB is based on 66 2/3% of the difference between:  the pre-injury wage and  what the employee is now capable of earning.

33. Office of Risk Management Annual Conference The Economics of Return to Work While this reduces benefits, benefits are still being paid.

34. Office of Risk Management Annual Conference The Economics of Return to Work As long as an injured worker is off work, indemnity and medical benefits continue to be paid. These affect premiums.

35. Office of Risk Management Annual Conference The Economics of Return to Work If the claim is settled, another $30,000 – $50,000 is added to value of the claim.

36. Office of Risk Management Annual Conference The Economics of Return to Work If a claim is settled, in most cases, consideration must now to be given to a Medicare Set Aside which will significantly increase the settlement amount.

37. Office of Risk Management Annual Conference Transitional Duty Employment The only way to stop indemnity payments altogether …

38. Office of Risk Management Annual Conference Transitional Duty Employment Return injured workers to work with the employer of injury on transitional duty.

39. Office of Risk Management Annual Conference BENEFITS OF RETURN TO WORK To the Employer

40. Office of Risk Management Annual Conference Benefits of Return to Work  Keep workers’ compensation costs down.  Productivity increases and human resources are used to the maximum extent.  Manage impact of workers’ compensation claims on premiums.  Reduce the fiscal impact of workplace absences.

41. Office of Risk Management Annual Conference Benefits of Return to Work  Wage costs for substitute employees are saved.  Work delays and business interruption are eliminated when an experienced employee returns to work.  Creates goodwill and positive image with the public and employees.

42. Office of Risk Management Annual Conference Benefits of Return to Work When an injured worker is sitting home watching Dr. Phil …

43. Office of Risk Management Annual Conference Benefits of Return to Work A commercial comes on that says: “Have you been hurt on the job? Call me, I’m a lawyer, I can help. I can get you top $$ for your claim.”

44. Office of Risk Management Annual Conference Benefits of Return to Work This is how he does it and employers help the injured worker’s attorney by not returning injured workers back to work light duty.

45. Office of Risk Management Annual Conference Benefits of Return to Work Transitional Duty Light Duty Restricted Duty Modified Duty Temporary Assignment of Duties.

46. Office of Risk Management Annual Conference Benefits of Return to Work Whatever you call it, just get ‘em back to work!

47. Office of Risk Management Annual Conference Benefits of Return to Work Transitional Duty Employment is an absolute must for keeping workers’ compensation costs down.

48. Office of Risk Management Annual Conference Think About It Would you like for your employee to sit here?

49. Office of Risk Management Annual Conference Think About It Or here?

50. Office of Risk Management Annual Conference Benefits of Return to Work When an employee is sitting home collecting a comp check -

51. Office of Risk Management Annual Conference Benefits of Return to Work The work piles up!!! Somebody’s gotta do it or it doesn’t get done.

52. Office of Risk Management Annual Conference Benefits of Return to Work To the Employee….

53. Office of Risk Management Annual Conference Benefits of Return to Work  Return to work is an employee benefit.  Employees will see workplace involvement in their recovery as an indication that the employer cares about their well-being and wants them back at work.  Transitional Duty speeds up recovery time and helps to boost the injured employee’s self-esteem.

54. Office of Risk Management Annual Conference Benefits of Return to Work  Injured workers receive their regular pay instead of 2/3% of their average weekly wage.  Return to work programs help reduce depression and alleviate emotional stress.  Employees are able to maintain physical conditioning through work life discipline.  Most employees want to be a part of the productivity process of the employer they work for.

55. Office of Risk Management Annual Conference Successful Transitional Duty

56. Office of Risk Management Annual Conference Successful Transitional Duty Focus on what the injured worker CAN do.

57. Office of Risk Management Annual Conference Successful Transitional Duty Do not focus on what the injured worker cannot do.

58. Office of Risk Management Annual Conference Successful Transitional Duty Transitional Duty Employment doesn’t have to be nicest, coolest, best job you have to offer. Transitional Duty Employment doesn’t have to be nicest, coolest, best job you have to offer.

59. Office of Risk Management Annual Conference Successful Transitional Duty Create a return to work policy.  Announce the policy.  Sell the policy as an employee benefit.  Include return to work policy in personnel manuals and new employee orientations.  Make policy accessible to employees through newsletters, etc.

60. Office of Risk Management Annual Conference Successful Transitional Duty Designate one person to manage the program.  Injured employees need to know that someone is in charge of return to work at the employer.  Give the return to work coordinator the appropriate authority to administer job duties.

61. Office of Risk Management Annual Conference Successful Transitional Duty Adopt an Empathy Program.  Frequent contact with the injured worker helps to facilitate early return to work.  Contact them within 24 hours of the injury and once a week.  Assure your employees they are missed and explain their benefits so they will know they will be taken care of. These courtesies promote rapid return to work and counter negative feelings.

62. Office of Risk Management Annual Conference Successful Transitional Duty Establish a guaranteed transitional duty period.  Guarantee transitional duty for a set period of time based on the injury.  Alter the length of time for transitional duty employment to conform to average diagnostic recovery time.

63. Office of Risk Management Annual Conference Successful Transitional Duty Establish a guaranteed transitional duty period.  The job should be open and available when the injured employee returns to work.  Make sure ADA and FMLA guidelines are met if the injured employee is unable to return to work.

64. Office of Risk Management Annual Conference Successful Transitional Duty Stipulate the goals of the transitional duty.  Transitional duty should have therapeutic goals that have been agreed upon by the treating physician, the employer and the injured worker.  Treating physician can help define the employee’s abilities to make sure transitional duty tasks are meaningful and promote recovery.

65. Office of Risk Management Annual Conference Successful Transitional Duty Stipulate the goals of the transitional duty.  Both the employer and the employee must adhere to physical restrictions identified by the treating physician.  The return to work program is an employee benefit. It is a privilege. Employees are expected to be productive.

66. Office of Risk Management Annual Conference Successful Transitional Duty Evaluate and Improve the program.  Once the employee returns to work full duty, have an open discussion with the employee, supervisor, and physician.  Find out how well the program worked.  Solicit feedback on ways to improve the program.  Ensure executive management has a “buy in” to return to work.

67. Office of Risk Management Annual Conference Transitional Duty Works  Effective in both public and private sector.  Nationally, there is an 18% decrease in disability costs.  23% effective for ORM.  Keep productivity and employee moral up.

68. Office of Risk Management Annual Conference Transitional Duty Works  Transitional Duty Employment is economical.  Injured workers are returned to a productive lifestyle.  Return-to-work makes good business sense.  IT’S A WIN – WIN SITUATION.

69. Office of Risk Management Annual Conference How the Transitional Duty Process Works

70. Office of Risk Management Annual Conference How the Transitional Duty Process Works A copy of the injured worker’s job description is presented to the treating physician.

71. Office of Risk Management Annual Conference How the Transitional Duty Process Works If the treating physician releases the injured worker to return to work at the job of injury, lost time benefits are stopped.

72. Office of Risk Management Annual Conference How the Transitional Duty Process Works If the treating physician places restrictions on the injured worker based on the job description provided,  The employer is contacted to determine if accommodations can be made to the injured worker’s current position.

73. Office of Risk Management Annual Conference How the Transitional Duty Process Works If accommodations can be made to the injured worker’s current position…  The employer notifies the injured worker of the transitional duty position in writing.  Utilize return receipt mail notification.  Specify a return to work date.

74. Office of Risk Management Annual Conference How the Transitional Duty Process Works The OFFER of employment is the most important part of the transitional duty process:  If the injured worker refuses the transitional duty employment offered by the employer  Or if the injured worker does not return to work on the specified date,  Lost time benefits stop.

75. Office of Risk Management Annual Conference How the Transitional Duty Process Works Once the injured worker returns to work, transitional duty, lost time benefits can be stopped. If the injured worker’s current job description cannot be modified, lost time benefits continue.

76. Office of Risk Management Annual Conference How the Transitional Duty Process Works If the treating physician will not release the injured worker to return to work, restricted duty to the job of injury but –  The injured worker can return to work, other employment, employment,  Vocational rehabilitation services will conduct a labor market survey to identify other employment.

77. Office of Risk Management Annual Conference The Object of Vocational Rehabilitation If the injured worker cannot return to the job of injury at full duty or transitional duty employment, the objective of Vocational Rehabilitation is to:  Assist the injured worker in returning to work in a related occupation with another employer in the same field or to another field of employment.  Or if necessary, on–the–job training.

78. Office of Risk Management Annual Conference The Object of Vocational Rehabilitation Vocational Rehabilitation should return the injured worker to work –  As soon as medically feasible after the injury occurs and  With a minimum of retraining. Transitional Duty Employment is how this is done.

79. Office of Risk Management Annual Conference Link to ORM’s Transitional Duty Policy http://www.doa.louisiana.gov/orm/pdf/tranduty.pdf

80. Office of Risk Management Annual Conference Contact Information Karen C. Jackson State Risk Claims Manager P. O. Box 91106 Baton Rouge, LA 70821-9106 225-219-0168 (p) 225-219-0516 (f)

81. Office of Risk Management Annual Conference Contact Information Debi Patt Cindy Macaluso Amanda Major State Risk Claims Supervisors P. O. Box 91106 Baton Rouge, LA 70821-9106 225-219-0168 (p) 225-219-0516 (f)

82. Office of Risk Management Annual Conference References  www.sorm.state.tx.us www.sorm.state.tx.us  www.returnetoworkmt.com www.returnetoworkmt.com  Treating the Whole Elephant: A Holistic Approach to Reducing Workers’ Compensation Costs by Rebecca Shafer

83. Office of Risk Management Annual Conference