An injured worker’s early and successful return-to-work benefits everyone.
However, BWC recognizes that each injured worker’s injuries and circumstances
are different. For instance, because of the nature of their jobs, a construction
worker with a broken leg is expected to be off work longer than an office worker
with the same injury. Therefore, an optimal return-to-work date is established
for each claim so the best course of action can be tailored to each injured worker.
Medical providers are critical players in this process. Therefore, they must understand
the basis and goals of return-to-work strategies, including optimal return to work and
establishing an injured worker’s return-to-work expectations. Additionally, providers must
manage return office visits and treatments with optimal return to work in mind and should
release injured workers to work (with restrictions, if necessary) as soon as medically feasible.
Position statement of The American Academy of Orthopaedic Surgeons and the American Association of
Orthopaedic Surgeons (AAOS)
Early return-to-work programs
The American Academy of Orthopaedic Surgeons and the American Association of Orthopaedic Surgeons (AAOS)
support safe early return-to-work programs that help injured workers improve their performance,
regain functionality and enhance their quality of life. The success of an early return-to-work
program is dependent on appropriate planning, as well as attention to a host of physical, psychological
and environmental factors. As patient advocates, physicians realize that early return to work results
in many benefits for the injured worker, including the prevention of de-conditioning and the psychological
sequels of prolonged time off work. Employers also realize benefits through substantial reductions in
disability payments, medical treatment costs, absence from work, insurance premiums and overall workers'
compensation costs. However, improved outcomes are dependent on the communication between and the cooperation
of the employee, employer, insurance company third party administrator, attorney, rehabilitation nurse
and treating physician.
Effective management of the injured worker can include the following:
Providing prompt access to medical care;
Support for the injured worker;
- An injured employee should be seen for early medical evaluation and
appropriately referred for specialty care as medically necessary.
- The employer should communicate with the insurance carrier to expedite care.
- Medical care should be based on a specific diagnosis, when possible.
- Treatment programs should include options for early return to work.
Returning the employee to work;
- A case manager can help begin the process of considering the worker's injury
as it relates to such issues as work and home environment, personal skills and education.
- The employer should make the injured worker feel valued and encourage the worker to return
as soon as possible.
- The employer should maintain a list of modified or alternate work for injured employees.
- An injured worker should be educated about how the workers' compensation system operates.
- An injured worker should be taught the value of being an integral part of his/her own recovery.
- An injured worker should receive prompt and adequate wage replacement.
Preventing chronic pain;
- The injured worker (patient) and the physician should discuss time frames for recovery,
expected duration of pain, the potential need for medication and options for returning to work.
- The worker should resume, if possible, some form of work that meets the restrictions and requirements
outlined by the treating physician. Such modified work is the cornerstone of job rehabilitation.
- The treating physician should be included in determining if the physical demands of a modified job
are appropriate for the recovering worker.
- Workplace guides should be written out and provided to the employee and employer.
- In all cases, the treating physician needs to understand the patient's work environment and occupational tasks.
In difficult cases, a videotape of the job, formal job analysis or an ergonomic report may be helpful to assist
in establishing workplace guides.
- Workplace guides should be considered flexible and should be updated to reflect the improving medical condition.
- Work hardening, functional capacity evaluations and other forms of physical therapy can be used to simulate specific
job demands so that the worker can eventually resume previous work duties without re-injury during the return to work phase.
- An injured worker must be taught to recognize cause and effect related to symptoms and accept responsibility for symptom
control through strategies such as pacing, energy conservation and proper body mechanics.
- If the treating physician and employer believe there are no suitable duties in the present workplace, it may be necessary
to refer the injured worker to a vocational rehabilitation professional.
Encouraging safety and prevention measures.
- Physicians recognize that pain is individually experienced and can sometimes be influenced
by a number of issues, including emotions, cultural differences, family support and social experiences.
Early medical intervention can often limit the period of acute pain and frequently prevent chronic pain.
- Additional intervention may be warranted when a treating physician recognizes that pain is being modified
by the psychological state of the patient.
- Workplace safety requires an understanding of how the physical factors often described
as repetition, force, posture, vibration, contact stress and temperature interact with
the individual's risk factors of age, gender and inherited genetic characteristics.
- Employees should be encouraged to report potentially hazardous conditions or situations for review.
- Prevention requires a commitment from management, physician support and employee understanding.
- Emphasis should be placed on accident reporting, investigation and ergonomic interventions that are
based on scientific data.
The AAOS believes that safe, early return-to-work programs are in the best interest of patients.
Studies have demonstrated that prolonged time away from work makes recovery and return to work
progressively less likely. Return to work in light duty, part-time or modified duty programs
is important in preventing the deconditioning and psychological behavior patterns that inhibit
successful return to work and in improving quality of life for the injured worker.