Accommodation MattersThe Art and Science of Linking HR, Workers

Comp and Productivity

Margaret Spence, President/CEO Douglas Claims & Risk Consultants, Inc.

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Why Do We Do

What We Do?

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Absence and Presence Management 54% of HR Professionals Surveyed says they didn’t

know how much absenteeism cost their organization.What is the Organizational Cost to Replace

Employees?Can you quantify the cost right now?

50% of all hourly employees leave their job within 120 days of hire.They may not feel valued

75% of Employee do not feel Valued by their EmployerThese Employees are your next nightmare!

All of this occurs before the “Workers Comp Claim”

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Number of Recordable Injuries in 2011Bureau of Labor and Statistics – 41 States

Actual Injuries 5,000,0005,000,000

A Workplace Injury Occurs Every Six Seconds – 96,000 Each Week

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The Cost of Injuries..The National Safety Council Estimates that injuries

cost US Employers – (National)….$176.9 Billion Annually

$86.6 Billion in lost wages & productivity $43.2 Billion in medical cost $32 Billion in administrative expenses

$1300 – the Cost Per Worker $1300 – the Cost Per Worker (Each Worker in the USA Must Produce $1300 in

Goods or Services to Offset National Cost of Injuries)

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Our Why….

Injury Management

Is

Talent Management™

We see Value….

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We SeeWe See the Employees AbilityAbility to Continue Working – Really We Do!

We Do Not Limit the Employee by Focusing on What They Can’t DoWhat They Can’t Do –

Right?

We Understand that Labels We Understand that Labels Matter…Matter…

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Day 1…Engagement

Return to work is the primary focus of every discussion you have with injured employees starting on the 1st day of the

injury.

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Our Job/Role…….We: Keep the WW in Work Find ways to EngageEngage Injured Employees in their Own

Medical Care and Outcome – we instill Value despite the injury.

Create a “Best in Class” “Best in Class” Medical Treatment Process that is focused on Immediate Care and Measured OutcomeImmediate Care and Measured Outcome

Get our organizations to understand they must prevent instead of manage

Help Supervisors & Managers Understand Value Create a Tribe of People Who Believe in What Create a Tribe of People Who Believe in What

We Do!We Do!Use Data to Enact Change - We must make the We must make the

Business Case for Why Business Case for Why this Process is this Process is Important!Important! 10

We are Return to Work Coordinators….We are here to facilitate the return of injured

employees to work as soon as as soon as they are able to perform meaningfulmeaningful, productiveproductive work within their restrictions. The Key Words:

As soon as possibleMeaningfulProductiveAccommodation Matters

Every member of your organization contributes to the employees successful reintegration to Work…

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We Will Create a Business ModelThat articulates the Financial, Legal and

Procedural Benefit we provide to our organization.

What will your program achieve? What will success look like? and What will you accomplish?Vision MissionGoalProcessResultsAffect/Effect on Bottom-line Cost

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Tribal SWOT – Analysis

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The Negative ArgumentWe don’t need to bring the employee back to

work because…He or She was a bad employee He or She will only get injured againHe or She will sue usWe don’t want that employee here anymoreWe have little tolerance for injured employeesIts too much energy to establish and maintain

a RTW Program.

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The Positive Argument…It’s all about cost…It’s all about cost…

We will mandate return to work Because it saves us money. Because we have a written policy that says so. Because we will not allow our insurance carrier to

pay any lost wage benefits if we can help it.

We value our employees – after the We value our employees – after the injury!injury!

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We Do Not Exist in a Silo…We must be able to articulate

the positive side of Return to Work Programs and

We must be ready to deal with detractors who don’t feel these Programs are viable!

We must learn to speak the CEO’s Language

We must instill Value in every fiber of our program.

We must be willing to Rinse and Repeat

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Business Case…We Must Make a Business Case for the What!

What impact does getting injured employees back to work have on our bottom-line cost and our non-Workers Comp Exposure?

What did we accept, condone, overlook that lead to the employee injury and lack of compliance?

We Must Articulate Our Value “Why should we keep you employed as the RTW Coordinator?” and “Why should we keep the injured employee working?”What do you add to your companies bottom-line?

Justify Your Existence or You will Justify Your Existence or You will be Extinct!be Extinct!

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The ROIWhat is it?What is it?

Defines the Cost of Leaving Employees at Home

Evaluates the HR vs. Workers Compensation exposure

Defines What Successful Return to Work Programs Should Look Like

The Roadmap to building an Effective Team Approach to Getting Injured Employees Back to Work and Keeping Them There.

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The Engagement

Leading with Cost and Cost Drivers

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Prove Me Wrong…How do you gather

the data to prove the ROI?Premium PaymentLoss Data – 1 YearOSHA Log Average Hourly

Rate of PayCompanies Profit

Margin – Assume 2%

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Data Number of Lost Work Days Number of Restricted Days Add Lost Work Days and Restricted Days/ 365 = Year(s) of Lost Productivity

Average number of Hours Worked Each Day Average Hourly Rate of Pay

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Cost Calculation Worksheet Policy Year - 2007

Data/Calculation Results

Lost Productivity Number of Lost Workday (A) 368 Number of Restricted Days (B) 249 Lost Productivity Total - (C-) 617 (A+B)/365 - Years of Lost Productivity 1.69

How many years did we loose?

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Lost Productivity Calculation Add the Lost Work Days + Restricted Days Enter Total Here

Multiply by Hours Worked Each Day Multiply by Hourly Rate of Pay Lost Productivity or Replacement Staffing Cost

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Lost Productivity Totals (C) 617 Average Hours Worked Each Day (D) 8 Average Hourly Rate of Pay (E) $9.50

Multiply (C*D*E) 46,892

Replacement Staffing Cost (F) $46,892

Calculation = Number of Lost Work Days (Productivity)x Average hours worked each day x Average Hourly Rate of

Pay

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Pull out the Loss Runs/Claims Statistics How much did the insurance carrier pay for claims cost? Enter – Reserves + Paid Amounts = Total Incurred

What is the Annual Premium Payment Add Total Incurred + Annual Premiums Total Insurance Cost

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Insurance Cost Annual Incurred Cost (G)*** (paid+incurred) $332,648 Annual Premiums (H) *estimated $482,835

Total Incurred + Premiums (I) $815,483

Total Insurance Cost (J) $815,483

Raw Data from Loss Runs – Statistical Data Used to Calculate the Experience Modification

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True Workers Compensation Cost Add Lost Productivity Cost + Insurance Cost = Total Cost of Risk

What is your profit margin? It’s Your Money! Additional Sales Required to Cover My Company’s Cost of RISK? Calculation: Multiply the Total Cost of Risk by 100 then divide it by the Profit Margin Example: 500 x 100/2.5

Total Cost of Risk

Multiply by 100

Divide by Profit Margin

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Profitability Total Cost of Risk (K) $862,375 Profit Margin (Estimate 5%**) (L) 5% Sales Required to Cover Loss (Kx100/5%) $8,623,750

Additional Sales Required to Cover Cost $8,623,750

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Simple Math…Linking Productivity with Accommodation

(Any Company USA) – Lost 155 days 155 days x 8 hour work day = 1240 hoursMedian Hourly wage = $15.95 ($15.95 x Hours = Lost Productivity)Lost Productivity: 1240 x $15.95 = $19,778 The Salary of 1 full time employee for (X) year(s)

Now add: Replacement Cost, Unemployment Insurance, delays in meeting deadlines……..Do not allow the blame game to set in.

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Along Comes Johnny…

When you When you speak speak what does he what does he hear?hear?

• You’re disabled• You don’t count• You’re not capable• You’re not wanted here anymore• We don’t need you…you were bad news….you are

ineffective30

Pre-Injury - The Cycle of EngagementPre-Injury - The Cycle of Engagement

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The Engaged – Disengaged • 9% Benchwarmers• 50% Disengaged• 7% Free Agents• 34% Star Employees

Now Add the Injury

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Your Injured Worker….Injured “Johnny”49 Years old Simple but Complex

Back InjurySurgical PossibilityStrategically EducatedLong-term employeeDislikes his SupervisorReally wants to continue

working….maybe!Someone in your

organization is plotting ways to get rid of Johnny – and he knows it.

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What Does He Hear?….I have a Simple but Complex

Surgical Back I have to have Lumbar SurgeryI will be Off work for 16 weeksI may be Released to Return to

Work Modified DutyI will have Restriction: Limited

Standing, Walking, Must sit, has difficulty managing daily chores, no lifting over 10lbs, no bending – The Restrictions may be permanent

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Typical Workers Comp Restrictions:No lifting over 25lbsLimited sitting or

standingNo use of the right

handNo walkingNo bendingNo pushing or pullingNo drivingNo workNo full time work….

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The Double “O” ChallengeObesity

Cost Employers $73.1 billion each year13 Times as many Lost Work Days Medical and Indemnity Cost: 7 – 11 times higher 30% Suffer from Two or More Co-morbidities

OpioidsRx Accounts for 19% of Claims CostWorking While “High”Using heavy narcotics to treat chronic pain conditions Epidemic

Can We Add Wellness as a Key Component of Injury Management?36

Every Workers’ Comp Claim Starts With An HR Decision….

Old Exposure New Reality

Lost WagesIndemnity or Lost

Wage PaymentsMedical CostAncillary ProvidersLitigationSettlementsIncreased Premiums

ADA – ADAAAFMLAAge DiscriminationWage and HourGINA Obesity & OpioidsRetaliatory DischargeMedicareWorkers’

Compensation and the associated cost.

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What are the ADA Qualifiers?Major life activities:

In general – major life activities include but not limited to – caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating and working

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Typical Workers Comp Restrictions:No lifting over 25lbsLimited sitting or

standingNo use of the right

handNo walkingNo bendingNo pushing or pullingNo drivingNo workNo full time work….

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Well Defined Return to Work Procedures…What do you want me to do when I am

released to return to work…Who do I notify that I am able to come back to

work?What is your company or organizations

requirement?What will accommodation look like for the

employee?

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Return to Work Policy…This policy should define your return to work

program…By addressing how you will accommodate the

injured employee. Outline your expectations for accepting light or

modified duty positions. It should explain that the position is temporary

and based on the restrictions imposed by the treating physician.

You should explain how permanent restrictions are handled.

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Along Comes the Injured Employee Your Next Step…

Job DescriptionJob AnalysisLetters to the injured workerEffective Communication with

Supervisors & ManagersEffective Communication with

other employees Proactive communication with the treating

physicians

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Case Study….Nancy Brown is a Home Health Aide. She has a

back injury and goes to the doctor. Her restriction is: Limited lifting – nothing over 5lbs.

Treatment Plan Physical Therapy – 3x per weekAble to return to work light duty…

RTW Coordinator Toolkit:Employee’s Post Accident GuideEmployee Pre-Injury Job DescriptionEvaluate FMLA Exposure

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Step 1: Pre-injury Job CheckThe employee is released to return to work light

duty:Identify the light duty restrictions and decide where

you will assign the employee. Evaluate the pre-injury job to determine if the

employee is able to perform all or only specific parts of the position.

Question: Can the employee return to the pre-injury job?

Yes or NoEvaluate and Reviwe the:

Pre-injury Job Description

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Step 2: Light Duty AssignmentIf the restriction prohibits or limits the

employee’s ability to do their regular job:Evaluate the restrictions and determine the exact

tasks that will be assigned to the injured worker. Complete a Job Demand Evaluation for the pre-

injury position and the post accident position.

Toolkit:Job Demand Evaluation

Physicians Approval of Light Duty JobAssignment Form

Supervisor Meeting

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Step 3: ComplianceTwo areas Employee and Supervisor

Compliance:Employee:

Is the employee showing up for light duty work? Did the employee respond to your request to return to

work light duty? How do you document that you relayed the job to the

injured employee?

Toolkit:Letters to the EmployeeCommunication with the Adjuster

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Step 4: DocumentationEmployee Non-Compliance

I’m in too much pain to work?I’m taking medication that is making me sleepy –

this is a real issue! Working while totally ill – “Working While Sick” or “Too

Sick to Work”My supervisors is making me do things I shouldn’t My attorney told me I don’t have to do what you

said! The answer: I really don’t care what your attorney said –

We are the employer we set the rules. We are offering you a job within the stated restrictions – these are our rules.

Toolkit:Document! Document! Document!No Intimidation Zone

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Toolkit – Tricks of the TradeImmediate and Prompt Referrals for

Specialty CareFunctional Capacity EvaluationPhysical Therapy Progress ReportsPhysicians approval of the light duty jobVideo tape of the job Physician visit to your facility

Malingering – Non-Compliance!

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Multiple Physicians….Rinse and RepeatEnlist the help of the adjuster

Send the job description to new doctor

Ask if the employee can returnto the pre-injury job

Ask if the employee cancontinue in the light duty position

Challenge off work status from “New” treating doctors

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Follow-upYou must create a plan or diary system to follow-

up with all the players in the RTW processEmployee:

When is your next appointment? Did you go to the appointment? Are you feeling any better? Any problems accessing

medical treatmentAdjuster:

What is the status of the claim? What information did you get from the last appointment? What is the anticipated full duty release date? Are there any issue I need to know about?

Supervisor: How is the employee adjusting to work? Any issues, challenges, problems?

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Step 5: Final Release – Now or NeverLong-term light duty

How long is too long?ADA Compliance – is the restriction permanent and

does it qualify the employee for ADA protection?MMI with Permanent Restrictions

Can you continue to offer employee a job if they have a permanent restriction?

What are your options?

ToolkitSee Legal advise – from an Employment Attorney in

your State

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Advocate + Enforce + Liaison + Advocate + Enforce + Liaison + Customer Service Customer Service

Primary DutyAdvocate

Secondary DutyEnforcer

Tertiary DutyLiaisonCustomer

Service

What would your program look like if you focused on being a Customer Service Advocate for the Injured Employee?

How would we impact the outcome of the claim if we added Wellness as a component of our Talent Retention Strategy?

Litigation triangle: People hire attorneys because they think someone is out to take something away that they are entitled to… or

They saw your prior pattern and they anticipated the outcome and that outcome requires legal representation.

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12 Steps to Re-introduce Your Employee to Work

Contact the employee notify them that you have light duty job

Contact the adjuster or case manager and let them know you are offering the employee a light duty job

Send offer letter to the employee or schedule an appointment to meet with the employee

Create your form that list the restrictions and light duty job Get the supervisor to understand the restrictions

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12 Steps to Re-introduce Your Employee to Work

Before the employee returns to work, sit down with him/her and review the job description, duties and restrictionsExplain that his is temporary and will be evaluated

weekly to determine if the job is fitting the employeeStep back and recognize that you are not a

babysitterThe employee is either going to comply or not – do not

over manage or micro-manage the injured employee. Become an advocate

Track all medical appointments – You must have a method to track appointments and compliance with attending appointments

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12 Steps to Re-introduce Your Employee to Work

Contact the adjuster after the employee returns to work and provide them with the return to work date, work schedule and rate of pay

Follow any State rules on Return to Work and workers comp payments

Continue to send letters to the treating physician to determine if and when the employee can return to work full dutyMonitor for FMLA and ADA compliance with HR

Department oversight. 55

12 Steps to Re-introduce Your Employee to Work Monitor each appointment for signs of progress

Is the employee getting better?Red Flag for permanency

Make sure the employee returns for the final appointment and gets either a full duty release or final release with permanent restrictionsMonitor for ADA exposuresDetermine if your insurance carrier intends to

settle claim file – What’s allowed in your State?Transition the employee back to regular job

gradually Determine the Accommodation (Temporary or

Permanent)

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What’s Next…Create and Add policies to your Employee

Handbook…Add Return to Work Policy as a poster in your

break-room. Get everyone on board…Education can

change the heart and the mind. Coordinate, Advocate, EnforceCreate checklist, forms and

procedures that work in your organization

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Change the Lingo…Re-Onboarding – How do we bring the employee

back to work?Talent Management – How do we determine

what they can do? Or How do we create pathways to work? How do we extract the talents the employee has if they can’t do their regular job?

Retention – How do we keep the employee here after the injury?

Value – Do we continue to value the employee after they have an injury? How do we EliminateEliminate the “De-Valued” Employee Syndrome? How do we get others to understand that the employee has value? 58

Job Accommodation Network…

www.AskJAN.org Most Accommodations Cost Less then $500 59

Contact Information…

Blog – www.WorkersCompGazette.com

LinkedIn – Margaret SpenceTwitter – @MargaretSpence

@WorkCompGazetteTraining…www.WorkCompSeminars.com

Phone: 561-795-3036Email: Margaret@MargaretSpence.com

Speaker: www.MargaretSpence.com60

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