and Procedure Name:
to Work Data
Percy, Chief of Operational Policy, Analytics & Compliance (Signature on
# CP-18-01, effective 12/23/13
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 Field Operations staff.
Return to Work: The
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
Return to Work.
Return to Work: The
anticipated date the IW may be able to return to employment.
The last date the IW reported to work prior to taking time off due to the work-related
injury or illness, 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: The
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 continuation..
A. It is the policy of BWC
to rely primarily on the managed care organizations (MCO) to provide accurate
return to work data.
B. It is the policy of BWC
to ensure that return to work data is identified, verified, properly updated
and maintained in the claims management system.
A. BWC staff shall refer
to the Standard Claim File Documentation policy and procedure for
claim-note requirements and shall follow any other specific instructions included
in this procedure.
B. The MCO shall provide
RTW data on medical only claims, which will systematically update in the claim
C. For lost time claims,
Field Operations staff shall presume the reliability of RTW data provided by
the MCO when accompanied by a detailed MCO note which contains the following
1. The estimated or
release to RTW date, and the verified actual (i.e., employee physically reports
to work) return to work date;
2. The name of the person
who provided the RTW information;
3. The date the MCO spoke
to the person who provided the RTW information;
4. Clarifying details,
including when “other” is noted as a reason the IW has not returned to work, if
5. Any other information
relevant to the RTW data.
D. If the MCO has not
entered a note containing the above-listed information, or if for any other
reason further verification is needed, Field Operations staff shall first
contact the MCO, and then, only if necessary, the employer or employer
representative, IW or IW representative, medical provider, rehabilitation
provider or other reliable resource. Staff may also use documentation for
verification, as appropriate.
E. Estimated RTW and End
of Period Stop Dates
Operations staff shall enter the initial estimated RTW 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
Operations staff shall reflect a subsequent estimated RTW date (even if there
is a release to RTW date, or a no RTW reason pursuant to V.G) by entering a
stop date (the day before an estimated RTW) on a period of disability. This
a. A future date is
received on a MEDCO-14;
b. When wage continuation
information is received from the employer and there is no estimated date
provided on the MEDCO-14 or other medical documentation.
F. Actual RTW
Operations staff shall enter an actual RTW 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 actual
RTW data, Field Operations staff shall ensure the following are documented in
the claims management system:
a. Whether the RTW was:
duty (i.e., with restrictions); or
(i.e. with no restrictions); and
b. The RTW job being
returned to was:
same employer; or,
job, same employer; or
iii. Same job, different
iv. Different job,
G. No RTW Information
IW is no longer receiving wage replacement compensation and Field Operations staff
obtains a specific reason why the IW will not be returning to work, Field
Operations staff shall update the claims management system to reflect one of
the following reasons:
d. Social Security
e. Voluntary workforce
g. School enrollment;
i. Social Security
Operations staff shall use the “Other” option as a reason for IW not returning
to work only when no other listed reason is accurate for the situation.
than one reason applies, Field Operations staff shall provide the additional
reasons in comments.
staff shall not delete the estimated RTW date even when one of the reasons
listed in E.1 above, apply.
H. Released to Return to
Operations staff shall enter the released to return to work date when provided.
Field Operations 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 estimated RTW date must be altered.
I. Field Operations 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. Field Operations staff shall ensure
that compensation is not paid over periods of ineligibility. Field Operations
staff shall not delete periods of lost time from the claims management system
unless the periods are incorrect.
1. 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 management
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.”
2. 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 management 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.”
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
management 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 comment
indicating compensation not requested.
J. Permanent Total
1. If the IW is receiving
non-statutory PTD, Field Operations staff shall remove any actual or estimated
RTW date, which is after the most recent last date worked.
2. If an IW is receiving statutory
PTD compensation Field Operations staff may enter RTW data without affecting
compensation related to the statutory PTD.