1. Return To Work & Transitional Jobs

2. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 Program Goals To lower workers’ comp claim costs To reduce high workers’ comp insurance premiums

3. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 How to Begin Key components: 1. A Written Return to Work Policy 2. Job Analysis for All Problem Jobs 3. Transitional Work Options for Employees Returning with Temporary Restrictions

4. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 Return to Work Policy Statement Put it in writing. Apply it consistently. Use it to guide decision-making.

5. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 RTW and Transitional Job Policy Communicate the policy… –To employees –To supervisors –To healthcare providers –To insurance company or third party administrators

6. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 RTW and Transitional Job Policy Emphasize your commitment to get injured workers back to work as soon as medically safe!

7. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 Job Analysis Provide the treating medical provider with a job analysis of the injured worker’s job. Focus on the physical and environmental requirements of their original job.

8. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 Transitional Work Options Indicate your willingness to provide work that meets the employee’s physical limitations.

9. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 RTW & Transitional Job Policy List some transitional work job options that can be considered.

10. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 Managing Your RTW Costs Report claims immediately. Use quality medical providers who share the company’s philosophy on RTW. Return injured worker as soon as medically safe by providing transitional work options.

11. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 Select Medical Providers According to Local Laws Check your state medical requirements. Inform employees of the company- selected medical providers when they are ill or injured.

12. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 Sample Policy and Forms Return to work (RTW) and Transitional Job Policy RTW Agreement Job Analysis Form RTW Authorization Form

13. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 Focus on RTW Provide the injured worker’s job analysis and Return to Work Authorization Form

14. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 Sample Return-to-Work & Transitional Job Policy If you become ill or injured as a result of a job-related accident, you will be missed by other employees working in your department. Employees have the responsibility to return to work at the earliest possible time, depending upon your physical abilities and/or restrictions. The Company will actively seek to return disabled employees covered by workers' compensation to productive work as quickly as possible, in cooperation with the attending physician or health care provider. If necessary, a temporary transitional job may be provided for you that is within your physical capabilities and consistent with company needs. Even working at a partial capacity will assist your fellow employees in completing the work. Efforts will be made to return you to your previous job, when possible. Owner/Officer Signature_________________________________ Title__________________________________________________ Date__________________________________________________

15. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 Sample Return-to-Work Agreement Employee:__________________________________ The Company agrees that the following represents the restrictions under which you are able, and have agreed, to return to work as of (date). Those restrictions are:___________________________ The Company will not require you to perform any tasks beyond those restrictions. If you are asked to perform such a task by any of our employees or supervisors, please decline. They may not be aware of your restrictions. By signing below, you agree and verify that you will not do anything beyond the noted restrictions either here at work, beyond the work site, at home or at recreation until such time as the doctor has removed the restrictions and The Company has been notified to that effect. Signature - The Company______________________________ Signature - Employee_________________________________ Date - _____________________________________________

16. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 Sample Return-to-Work Authorization Form The Company has a transitional work program which provides temporary jobs that injured employees should be able to safely perform during their recovery periods. Completion of this form will allow us to identify an appropriate assignment for this employee. Thank you for your cooperation and prompt response. EMPLOYEE___________________________ EMPLOYER____________________________ EMPLOYER CONTACT PERSON ___________________________ PHONE______________ DATE ____________________ APPLICABLE SHIFT DURATION ______________________ DIAGNOSIS_________________________________________________________________ WORK-RELATED_____ YES _____ NO NON WORK-RELATED _____ YES _____ NO TREATMENT _______________________________________________________________ DISPOSITION:RETURN-TO-WORK DATE (NO LIMITATIONS) ________________________ RETURN-TO-WORK DATE (WITH LIMITATIONS) __________________________________ UNABLE TO WORK FROM ___________________ TO _____________________________ PROGNOSIS _______________________________________________________________ REFERRAL TO: CONSULTANT -DOCTOR _______________________ DATE__________ PHYSICAL THERAPY__________________________ FREQUENCY___________________

17. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 Sample Return-to-Work Authorization Form (continued) WORK RESTRICTIONS: RESTRICTIONS APPLY TO: WORK______ HOME_______LEISURE______ DURING THE APPLICABLE WORKDAY, THIS EMPLOYEE CAN: ____SIT ____ HOURS;____STAND _____HOURS; _____WALK____HOURS EMPLOYEE CAN:Never ___Occasionally___Frequently___Continuously__ Lift and carry: ___up to 10 pounds; 11 - 25 pounds ; ___26 - 35 pounds ; __36 - 50 pounds ; ___ 51 - 75 pounds ; ___76 - 100 pounds Reach above shoulders Push/Pull Climb Crawl Squat/Kneel Bend/Stoop/Crouch Balance Twist upper body Use hands dexterously

18. Vincent & Vincent Companies (Dept. of Loss Control Engineering) P.O. Box 304 Freeland, PA 18224 For More RTW Ideas & Information… Contact us at 570-636- 3688 or inspections@vvcompanies.com if you have any questions. inspections@vvcompanies.com Speak with your agent.