to Work Data
R. Abrams, Chief Operating Officer
# CP-18-01, effective 03/1/18
12/23/13; Rev. 05/06/19; 3/1/18; 11/14/16
purpose of this policy is to ensure that MCO and BWC staff appropriately
verify, update and/or maintain return to work (RTW) data in the claims
policy applies to MCO and claims services staff.
Return to Work
confirmed date the injured worker (IW) returns to employment, with or without work
restriction(s). This may include an IW that has returned to the workplace with
restrictions, but is participating in a vocational rehabilitation plan such as:
Return to Work.
Return to Work
anticipated date the IW may be able to return to employment.
The last date the IW reported to work prior to taking time off, regardless of
the length of time the IW worked on that date.
to Work Data:
Data that includes any combination of the dates related to return to work, last
date worked, estimated return to work, released to return to work or actual
return to work.
to Return to Work
date the physician of record releases the IW to return to employment (with or
without restrictions). This may include an IW that is released to return to
work with restrictions, and is participating in a vocational rehabilitation service
or program such as:
Search/Job Seeking Skills Training;
and Stop Dates:
The beginning and end dates of a working period or a period of disability/off
Replacement Compensation: Compensation intended to replace an IW’s earnings. This
includes temporary total, living maintenance, living maintenance wage loss,
wage loss (working and non-working), permanent total disability and salary
is the policy of BWC to rely primarily on the managed care organizations (MCO)
to provide accurate return to work data.
is the policy of BWC to ensure that return to work data is identified,
verified, properly updated and maintained in the claims management system.
staff shall refer to the Standard Claim File Documentation and Altered Documents policy and procedure
for claim-note requirements and shall follow any other specific instructions
included in this procedure.
The MCO shall provide RTW data on medical only claims, which will
systematically update in the claims management system.
1. The MCO shall determine the LDW, RRTW, ERTW, and ARTW
dates based on documentation received and contained in the claim file or as provided by the employer, injured
worker, provider or other reliable source.
a. The MCO shall exercise
due diligence in obtaining the ARTW date for all medical only claims.
b. Before submitting an
ERTW that results in seven (7) or fewer missed days for a particular disability
period in a medical only claim, the MCO shall contact the provider to verify
the provider intended the RTW to be an ERTW and not an RRTW, and shall document
the contact in notes.
c. The MCO shall not
submit an RRTW date as an ERTW. RRTW dates will be captured on the Claims
Maintenance>Claim Dates page in the claims management system.
MCO shall enter detailed
notes reflecting all actions taken to gather RTW data. Every claim note shall include the following:
RTW data was obtained, what those dates are;
the person the
MCO spoke to or the name and date of the document being relied on to determine
the reported dates;
date the MCO spoke to the person who provided the RTW information, if applicable;
details, including when “other” is noted as a reason the IW has not returned to
work, if needed; and
other information relevant to and supporting the RTW data.
Time Claims: For lost time claims, the MCO shall provide the RTW data to claims
services staff via the Electronic Data Interchange (EDI) 148. Claims services
staff shall presume the reliability of the data when accompanied by a detailed
MCO note and enter the data into the claims management system.
MCO has not entered a note containing adequate information, or if for any other reason
further verification is needed, claims services staff shall first contact the MCO, and
then, only if necessary, the employer or employer representative, IW or IW representative,
medical provider, vocational
provider or other reliable resource. Claims services staff may also use
in the claim file
for verification, as appropriate.
ERTW and End of Period Stop
staff shall enter the initial ERTW
date in order to:
a. Calculate days of work
missed and determine if a claim is a medical only or lost time; and
b. Pay any form of
staff shall reflect a subsequent ERTW date (even if there is a RRTW date, or a no RTW
reason) by entering a stop date (the day before an ERTW) on a period of
disability. This occurs when:
c. A future date is
received on a MEDCO-14;
d. When wage continuation
information is received from the employer and there is no estimated date
provided on the MEDCO-14 or other medical documentation.
shall enter an ARTW date when:
a. MCO staff has verified
the IW has actually returned to employment; or
b. BWC staff has verified
the IW has actually returned to employment.
2. When entering ARTW data, claims services staff shall ensure the
following is documented in the
claims management system:
c. Whether the RTW was:
i. Light/modified duty
(i.e., with restrictions); or
ii. Full duty (i.e. with no
d. The RTW job being
returned to was:
i. Same job, same employer;
ii. Different job, same
iii. Same job, different
iv. Different job, different
RTW Information Provided
the IW is no longer receiving wage replacement compensation and claims services staff obtains a
specific reason why the IW will not be returning to work, claims services staff shall update the
claims management system to reflect one of the following reasons:
d. Social Security retirement;
e. Voluntary workforce abandonment;
g. School enrollment;
i. Social Security
shall use the “Other” option as a reason for an IW not returning to work only when no other
listed reason is accurate for the situation.
more than one reason applies, claims services staff shall provide the additional reasons in
staff shall not delete the ERTW
date even when one of the reasons listed above apply.
staff shall enter the RRTW date on the Claim Details>Details>Claim
Dates screen in the claims management system when provided.
staff shall recognize that a release to return to work does not necessarily
indicate that the IW will be immediately returning to work or otherwise that
the ERTW date must be altered.
services staff shall not assume the RRTW date and the ERTW date are the same.
staff shall ensure that all periods of lost time related to the allowed
condition(s) are reflected in the claims management system with appropriately
identified last date(s) worked and return to work date(s), including periods of
lost time when the IW does not receive compensation.
1. Claims services staff shall ensure
that compensation is not paid over periods of ineligibility.
2. Claims services staff
shall not delete periods of lost time from the claims management system unless
the periods are incorrect.
3. Example 1: The IC has
issued an order which states that temporary total disability (TT) is denied
because the IW violated a written work rule and was fired, and thus the IW
voluntarily abandoned the job. In this case, in the disability tracking window
in the claims management system, the disability type selected is “off
work-ineligible for compensation”, medical status is “not released”, work
status is “no RTW” and the “reason” is “voluntary workforce abandonment.”
4. Example 2: The IC has
issued an order which states that TT is not payable because the IW lost time
from work because of some reason other than the allowed conditions in the
claim. In this case, in the disability tracking window in the claims management
system, the disability type selected is “off work-ineligible for compensation”,
medical status is “not released”, work status is “no RTW” and the “reason” is
“no supporting medical documentation.” In addition, if an end date was entered
into the previous working period, the end date should be removed.
3: The MCO approves surgery for an allowed condition, but the IW does not
request compensation for that period of lost time. In this case, on the
disability tracking window in the claims management system, the disability type
selected is “off work-ineligible for compensation”, medical status is “not
released”, work status is “no RTW” and the “reason” is “Other” and then enter a
comment indicating compensation not requested, to prevent payment of
compensation. A second row is created and is sent electronically to the MCO to
reflect the correct status. The new row is largely identical, except the
disability type is “off work”, medical status is “not released”, work status is
“no RTW”, and the “reason” is “other.”
Total Disability (PTD)
1. If the IW is receiving
non-statutory PTD, claims services staff shall remove any ARTW or ERTW date
which is after the most recent last date worked.
2. If an IW is receiving statutory
PTD compensation claims services staff may enter RTW data without affecting
compensation related to the statutory PTD.