Safely Returning Employees to Work

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Now an industry standard in post accident control, return-to-work programs provide benefits to employees and employers following an on-the-job injury. Basic elements of the process are important to understand when seeking to minimize time lost by injured employees while providing them with a productive, safe work environment until they reach their full medical work potential. This is true, whether the County chooses a more formal County-wide program or whether an individual official chooses to implement these measures in their his/her office.

Contents:
Why should we consider a return-to-work program?
In basic terms, what is a RTW program?
How much can we expect to save with a successful RTW program?
What is changing attitudes by employers toward implementing RTW?
How can a smaller entity implement a RTW initiative?
Why would employees want to participate in a RTW program?
Who all is involved in the communication process dealing with RTW?
Claim Management and Coordination Procedures
Accident Reporting
Internal Reporting Procedures
ACCIDENT REPORTING AND INVESTIGATION - XYZ COUNTY
WITNESS STATEMENT
Communication with the Injured Employee
Communication with Adjuster
Return-to-work Programs
RETURN-TO-WORK PROCESS STATEMENT
RETURN-TO-WORK POLICY and PROCEDURES
Sample Letter to Treating Physician

Safely Returning Employees to Work

Why should we consider a return-to-work program?
Most employers have found that return-to-work (RTW) programs have found that they are a key ingredient in controlling Workers' Compensation claims costs, but have also discovered they are generally good for employee morale and productivity. Rather than throwing their hands in the air and saying, "It's too late now!" following an accident, employers have found their actions following an accident can impact that actual outcome significantly. This impact is not only a measurable difference on the bottom line of Workers' Compensation claims, but may also be tracked by lost work days, occasional improved impairment ratings on serious accident victims, and employee satisfaction.

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In basic terms, what is a RTW program?
Following an on-the-job injury, an employee may be injured to the degree that they are not medically able to carry out the duties of their current job while healing. In simple terms, a return-to-work plan sets in motion a plan to:

1. Reduce Workers' Compensation claim cost.
2. Provide safe, temporary work for the employee during the healing process
3. Prevent alienation from the workplace and decline in morale of an employee by allowing the worker some choices about their recovery.
4. Get workers' back to their normal duties quicker, which can help with morale of other employees having to cover their duties while they're gone.

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How much can we expect to save with a successful RTW program?

Workers' Comp Cost Reductions
Estimates from private and public sector employers who have implemented RTW programs range from 15% to 40% savings on claims when implemented. This, of course, depends on the seriousness of the injuries; the type of work available, and cooperation from those involved from the claims adjusters, medical providers and naturally the employee.

By controlling Workers' Compensation claim costs, employers control insurance costs through their experience modifiers and discounts through their insurance carrier. These savings are generally more pronounced in self-insured entities, or those who participate in governmental self-insurance pools. Generally pools are able to provide better discounts to entities having favorable loss experience.

Quotes from Counties interviewed regarding their RTW programs reveal that this is a viable part of a risk management program.

We think that the limited duty practice provides two advantages. First, we are led by psychologists to believe that the longer an employee stays away from work, the more difficult it is to get that employee to return-to-work, at all. Second, we think that by limiting the duties of the employee until the recovery is complete, we reduce the risk of a second injury. We also think that if the employee is working while he is recovering, there is a likelihood that the permanent impairment will be less. -Elmer Russell, Denton County Loss Control Coordinator

Reduced risk of TWCC Extra Hazardous Employer Program
One of the few safety regulations that affect public employers in Texas is the TWCC's Extra Hazardous Employer program. Employers with lost time accidents (those that are at least eight (8) lost work days that substantially exceed the average for their industry are subject to the sanctions of TWCC, which may require formal safety program elements and inspections based on OSHA criteria. A good RTW significantly reduces the odds of having injuries that result in more than eight (8) lost work days, thereby reducing the opportunity to be included in this regulatory sanction.

Other names for RTW
These efforts come in many forms and go by many names, and there has been a lot of discussion and argument among risk management professionals about which name is correct and best explains the process and doesn't unduly offend their workers. While open for debate, we'll stick with RTW for purposes of this workshop.

Some other terms you may have heard include the following:

• Light Duty
• Modified Duty
• Modified Work
• Alternative Work
• Temporary Alternative Work

And the list goes on; however, they are all basically devised for the same purposes outlined earlier. Feel free to adopt the terminology you feel will work best for you.

Getting Productivity for Your $$
While most of the focus on RTW program is on the Workers' Comp savings, another aspect, possibly even more important, is that of production from employees who are medically capable while they are still on your payroll.

Entities, who are self-insured, they are paying money out directly to the injured worker. The same is true, to some degree, for entities that pool together in self-insurance, as these losses are reflected in future Workers' Compensation costs.

Temporary Income Benefits payments
Weekly Temporary Income Benefits (TIBs) checks pay 70% of the difference between an employee's Average Weekly Wage* and the employee's post-injury earnings, after he/she lost all wages for more than 1 week (or earned lower wages for more than 1 week).

If an employee earned less than $8.50 per hour before his/her injury, the first 26 weeks of weekly TIBs checks pay 75% of the difference between the employee's Average Weekly Wage* and his/her post-injury earnings - after he/she lost all his/her wages for more than 1 week (or earned lower wages for more than 1 week). The amount CANNOT exceed his/her previous year's earnings.

If that employee is not at work, he or she is basically being compensated for time he is not productive. A $10 per hour employee will receive approximately $7.00/hour (tax-free) in TIBs for zero production. Under alternative work, production could resume (as limited by the treating physician) for the additional $3.00/hour it costs to bring the employee back to work at full pay.

Many risk managers and Workers' Compensation specialists recommend putting the employee into alternative or light duty at full pay. Others believe you can pay only what that job is worth and Workers' Compensation pays the difference to make up to 70% of their normal wages. Generally, if it is financially better for the employee to be at work, it helps in returning them to work successfully and safely.

Salary Continuation
By state law, many positions (not all) in law enforcement are entitled to receive their full pay, if they must be off work due to Workers' Compensation covered injuries. Some entities still provide salary continuation programs voluntarily for all their employees. This is not generally recommended as it hampers the ability to control Workers' Compensation claims, since there is no monetary incentive to return to their position. Workers' who are able to return to limited duty may be paid their full wage.

For detailed information on all Workers' Compensation Benefit details, TAC provides a Worker's Compensation Claims Handbook that nicely details this information.

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What is changing attitudes by employers toward implementing RTW?
Risk managers have had difficulty getting management to "buy in" to the idea of providing RTW efforts in the past, although that is changing rapidly as organizations, large and small, have seen excellent results from these initiatives.

In the past, management used several reasons for not exploring RTW as an option. Here are just a few of the more common ones.

• "There is no light duty available in this organization - everybody here has to work at full capability."
• "It will slow operations down to do this."
• "It will hurt morale if someone is here not pulling their weight."

Counties, who have implemented some type of RTW initiative, whether formal or informal, have reported, without exception, that they have found their program to be very helpful and providing effective results for them. RTW programs are becoming a standard element to risk management programs throughout the nation and Texas.

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How can a smaller entity implement a RTW initiative?
For many years, smaller organizations have not initiated RTW plans because they believe there are no "light duty jobs" available. Each position was viewed as needing to be filled by someone at 100% of his or her ability.

While there are some cases when this is true, most of the time temporary adjustments can be made in workload, as long as all employees understand it is temporary. With the acceptance of the benefits of RTW, both for employers and employees, these views are changing.

Businessman Bo Pilgrim, has been quoted as saying, "If you don't have light duty, you have too many workers!" His point is that there is usually always some little things that need doing around the workplace that the regular employees never quite get around to doing. Take a moment to think of all the little projects around the workplace that need taking care of - possibly by your injured employee. Many entities where RTW program exist keep a list of such projects and are happy when the Risk Manager calls with someone qualified to take care of those odd jobs.

Smaller employers need not have formal programs and paid risk managers to implement some of the basic ideas of this workshop. Many times, even in small shops there are actually many temporary, light duty projects available. Occasionally, it might work better to cross department lines and budget lines with light duty employees, which is certainly possible if officials are committed to support this initiative.

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Why would employees want to participate in a RTW program?

Most employees want to work!
There is generally a misconception by some employers that employees are generally looking to get out of work, when in most cases, the employee enjoys his work (whether he admits it or not!) and misses the work environment when sitting at home. Employers who have implemented RTW programs generally attest to the fact that most employees actually prefer to be at work.

Psychological Aspects
Experience has shown that employees who have no contact from people in the workplace begin to think that they're not needed or wanted. While this is probably not the case, these feelings may affect the employee's attitudes toward coming back. Employees may begin to actually feel fearful and/or angry about returning to the workplace after extended periods of time. It's really difficult to know what's going through the employee's mind while at home watching television (which is sometimes teeming with attorney ads!).

Separating Safety/Injury Problems from Personnel Problems
On occasion, there are those who want to take full advantage of their Workers' Comp claim/injury by staying off longer than necessary, making it an extended leave or vacation, but generally this is rare. In these cases, there generally may be more of a personnel problem, than an actual injury healing process we're dealing with. Dealing with personnel termination issues always carries some risk and must be done with great care to avoid legal problems. Counties generally have only a budgeted number of positions and must fill those positions at some point in order to handle the workload.

Employment Policies - "Neutral Termination"
Many organizations have opted for a "Neutral Termination" policy, which automatically terminates employment for someone whom, after a specified time period (within legal limits), cannot perform the essential functions of their job without reasonable accommodation. (Remember those ADA laws). Generally the time period involved is no less than 90 days, and is sometimes more, depending on the County policy. 120 days is a generally acceptable time period in nearly all cases. The employer has the opportunity to fill that position if necessary, or re-hire a good employee when he is able to return to his position. Problem employees need not be re-hired, but keep in mind if they are off work on Workers' Compensation, this would limit your ability to bring them back to work under a light duty, or modified duty program. In most situations, however, an employee can return-to-work in some capacity within the time limits set up.

Reminder - Always check with qualified labor attorney, personnel consultants, or your County Attorney when developing these policies to ensure they are legal and fairly administered.

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Who all is involved in the communication process dealing with RTW?
The actual group involved may differ from case to case, but generally the program will involve some degree of communication and teamwork from the following people:

• Adjuster
• Claims Coordinator
• Loss Control Coordinator
• Doctor
• Claimant
• County Department Heads or Supervisors

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Claim Management and Coordination Procedures Background & Purpose
Claim coordination and management is a key to reducing Workers' Compensation costs in conjunction with accident reduction and employee safety awareness. The following information is recommended for use by the County's claims administrator. The purpose of the following flow chart is to:

• Provide guidance to the Administrator during the early stages of the claim, through the closing of the claim.
• To facilitate communication between the County, claims adjuster, and employee.
• To assist the employee to re-enter the work force.
• To assist the County in reducing the cost incurred by the WC claim.

The following guidelines should always be used in conjunction with Worker's Compensation Laws & Regulations.

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Accident Reporting

1. First, determine basically if the injury is work-related. Inadvertently filing claims for non-work-related injuries can be costly to the County. The claims adjuster determines any possible disputes if the employee claims the injury is work-related, so file the claim along with any information or concerns about the claim.
2. Non-work-related injuries should be filed with the health insurance provider.
3. If the employee's injury is as a result of a third party the County should contact your adjuster immediately and inform them of the situation. If the third party is found responsible for the accident this party will be responsible for covering all expenses attributed to the claim.
4. Once the injury is determine to be work-related, you must determine if, 1) The employee lost more than one day of work as a result of the injury, and 2) If there were any medical expenses as a result of the injury
5. If the answer to any of the above questions is yes, proceed down the flow chart. If the answer is no, complete TWCC-1 and file with your adjuster as Incident Only.
6. If the employee loses more than one day away from work, the injury incurred medical expenses or the loss of time was a result of occupational diseases. Complete both report the TWCC-1 & TWCC-3 form and send them to your adjuster.

Employee Notification and the Communication Process

7. Once both reports TWCC-1 &TWCC-3 have been sent to your adjuster, you should open a claim file for your own records. The initial letter should be sent to the employee in conjunction with the employee's rights, and a copy of the TWCC-1. The initial letter will help open a communication channel between employee and employer during the development of the claim. The accident log will facilitate tracking of the claim during the development.
8. The next step is to determine if the employee was able to return back to work. If the employee's back to work, send them a welcome letter.
9. If the employee is not back to work, find out through your adjuster or the treating physician if the employee is able to return-to-work with medical restrictions.
10. If the employee is unable to return-to-work with restrictions, monitor the claim on a regular basis for medical improvement until you can try to return the employee to work on full duty or temporary light duty if the physician allows it. Note: Always follows up on claims and work with your adjuster while the employee reaches maximum medical improvement (MMI).
11. In the event that the employee is authorized by the doctor to return to work with restrictions, ask the doctor for detailed instruction on the restrictions, and then get a time frame for the recommended restrictions. Work through your adjuster to get this important information from the medical provider.
12. Once the information is gathered from the provider, implement your return-to-work or light duty program.

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Internal Reporting Procedures
Initial notification procedures are developed to help facilitate communication with whoever handles the Workers' Comp Claim for the County. These procedures should also outline the ongoing communication process with supervisors, the employee filing the claim and others involved in the process.

Notification
Good reporting procedures here help with accident investigation and identifying witnesses who may have useful information in the event of a claim. Many times, such information can be very helpful, such as when a third party or a product failure is involved in the claim. This may help with the cost of Workers' Compensation claims if liability for the costs can be directed to that third party when they are at fault or negligent.

Here is some sample language for a reporting and investigation policy. You should customize your policies to fit the operations and structure of your loss control program.

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ACCIDENT REPORTING AND INVESTIGATION - XYZ COUNTY

PURPOSE:
The purpose of this policy is to establish a method to report and investigate accidents which occur to County employees, County vehicles (including equipment), and/or damage to County property. This policy applies to all accidents or incidents occurring on County-owned property or involving County property. Our goal is to prevent accidents through the identification and correction of factors that contribute to the cause(s) of accidents. In order to carry out this goal, we must have methods in place for the appropriate investigation of these causal factors. By focusing on these factors and taking action to correct these problems, we have an effective tool for the prevention of future accidents.

SCOPE:
This policy and subsequent responsibilities or procedures apply to all elected or appointed officials and County employees. The investigation will normally be conducted by the appropriate manager, foreman, or supervisor with the assistance of the Incident Review committee or Loss Control Coordinator, if necessary.

RESPONSIBILITIES:
This section of the policy outlines basic responsibilities for carrying out the purpose outlined above.

NOTIFICATION
When an accident or incident occurs, the department manager, foreman, or supervisor will file a "Employee Occurrence Report" with the Personnel Director immediately, but no later than 3 days after knowledge of the accident or incident. Phone contact is encouraged if possible to facilitate a quick investigation before the surrounding conditions change. Telephone number to report incidents is 000-0000. This phone may be used day or night. Once notified, the Personnel Director will forward this information immediately to the Incident Review team member and the Claims Management Committee for assistance with the investigation. The Employee Occurrence Report and the phone contact inform the Personnel Director of the overview of the accident and may include witness statements. This report will prompt the Personnel Director to file any necessary insurance claims regarding the incident.

INVESTIGATION TIMELINE
A determination will be made if it is necessary the manager/foreman to begin gathering evidence, e.g. photos, statements, etc. Recognizing the importance of accident cause recognition, it may be necessary to investigate and report accidents or incidents where no injuries or other losses occurred. The investigation will be conducted immediately, but no later than 3 working days after knowledge of the incident. Depending on the severity of the problem, the manager and Accident Investigation Team member will set a time for the investigation to begin. The investigation will be recorded on the Loss Control Coordinator's Accident Investigation Report by the department manager/foreman. Immediately upon completion (no later than 5 days after knowledge of the incident), the report will be sent to the Loss Control Committee Chair.

DEPARTMENT RESPONSIBILITY
The department manager/foreman will review the determined causes of the accident and immediately evaluate his/her work area for similar problems. The manager/foreman will take immediate action to either eliminate or control the identified problems. Notification of corrections as well as problems that cannot be corrected immediately will be sent to the Loss Control Committee Chair.

REVIEW OF FINDINGS AND RECOMMENDATION
The Loss Control Committee will review all findings of uncontrolled workplace or operational hazards to develop a proposed plan for correction and to communicate appropriate corrective action already taken. This information will be sent to Commissioner's Court for appropriate action.

ACTION BY COMMISSIONERS' COURT
The Commissioner's Court will establish funding as needed to correct these hazards in an appropriate manner. The Commissioners' Court, with the assistance of the Loss Control Committee, will develop a timeline for hazard correction by the department manager/foreman. The manager/foreman must post notice of the hazard or problem take appropriate interim measures to prevent accidents from recurring.

ACCIDENTS INVOLVING THIRD PARTIES
It is the responsibility of any County employee to assist any visitor reporting an injury suffered in or on County property. If the employee witnesses an accident, the employee should:

• render assistance.
• call Personnel Manager or supervisor.

If the injured party states that there was no harm, the employee must still report the injury to their supervisor. Supervisors must report incident immediately.

Employees will be asked to complete a special report called " Visitor Occurrence Report" to document third party accidents. If possible, get a written statement from the injured party and send all information to the Personnel Manager's office. Copies of this report are available in all offices.

INCIDENT REVIEW TRAINING
Accident investigations will be conducted as instructed in training sessions given to County managers, foremen, and Accident Investigation Team members. Initial training of these individuals will be conducted and subsequent training scheduled as needed to maintain the quality and effectiveness of the accident investigation program.

Verification of Information
It is important to verify information on a Workers' Compensation Claim through a few basic questions asked of the claimant, any witnesses, the supervisor or others directly involved in the accident or claim. This will help you to identify anything out of the ordinary that needs to be relayed to the adjuster for his/her consideration.

Here is a sample witness statement you may want to consider. These have proven effective in the past at helping to eliminate fraudulent claims, although this is not a legal basis for the County denying the claim. A licensed adjuster performs that job, if it is necessary.

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SAMPLE WITNESS STATEMENT

WITNESS STATEMENT

Name of Injured Employee _________________________
Date of Injury: _____________________

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Communication with the Injured Employee
It is highly recommended that a standard procedure be used to notify injured Workers' on their rights under Workers' Comp laws, in addition to providing them information on your County policy regarding return-to-work, communication processes with the employee, how it affects their sick leave, etc. It is also an important legal tool which notifies the employee about issues such as FMLA leave occurring (if that is your policy), salary continuation issues and the like. Here's a sample letter of notification to an injured employee. (NOTE - make sure your letter outlines what is consistent with your County policy). Sample Letter to the Employee

Date

Dear _______________

In regard to your reported job related injury or illness on [DATE], we have attached a copy of the Texas Workers' Compensation Commission Employee Rights and Responsibilities form and your copy of the TWCC-1, which is the report on which your Workers' Compensation Claim was filed. Please direct all medical questions, reports and requests for treatment authorization to this office.

If you are now unable to work because of this injury or illness, it is important that I be notified when you return-to-work. If you are now working but as a result of this injury or illness you have to miss work, it is also important that I be notified immediately.

In order to avoid any confusion regarding your County-provided benefits, I would like to bring the following to your attention:

1. __________ County will continue to pay the medical and life insurance premiums for your own personal coverage.
2. If you are classified as a peace officer you will receive salary continuation benefits in accordance with Article III - Section 52(e), of the Texas Constitution. ( See Attorney General Opinion Letter 93-62 for definition of qualifying officers.)
3. Except as otherwise provided in item 2 above, the insurance carrier will initiate

Compensation no later than the seventh calendar day of lost time unless you have requested in writing to my office to use accrued benefit time in lieu of compensation, vacation, or other accrued time. If you do not have any accrued time available you will have to take time off without pay. You may have elected optional benefits for yourself and/or dependents, the premiums for which are normally deducted from your paycheck. If you do not receive a County pay check from which to deduct these premiums, it will be necessary for you to forward your check or money order, payable to __________ County, by the following dates for the following amounts, or loss of coverage may result:

Due by the 5th of each month: TOTAL: $________________
Dental__________Vision__________Dependent Life_______Flex Fees________

Due by the 20th of each month: TOTAL: $_______________

Supplemental Life________Disability_________Dependent Health___________

Your leave is being designated as leave to which you are entitled under the Family and Medical Leave Act of 1993. This means that your job will be held open for your return for a period of at least 12 weeks as required by law, as long as your physician certifies that you are unable to perform the essential functions of your job and you follow your doctor's recommendations. Retention of your job after that period of time will depend on the specific needs of your department and your expected period of recovery, in accordance with County policy.

Our goal is to get you back to work as soon as your physician has released you, to either full or modified duty, and we are here to assist you in any way we can as we move towards that goal. Please feel free to call me at (___) ___-____ (or extension ____) if you have any questions or if your status changes.

Sincerely,

_________________________

cc: Elected Official/Department Head
Employee W/C file

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Communication with Adjuster
Other than routine communication on normal Workers' Compensation claims, prompt communication with your adjuster is necessary for the following reasons:

For Denial of Claim
Not everything is covered automatically under Workers' Compensation, and many times these determinations are not black and white in nature, but are considered on a case-by-case basis. Commonly, such issues as heart attacks on the job, issues about the employee being within the course and scope of their duties as an employee, and other issues such as drug or alcohol use leading to the accident may affect the compensability of the claim.

The early stages of the claim are crucial to successfully denying Workers' Compensation benefits, so if the County knows of any information of this nature, they should report it to the adjuster immediately. Certain information may not be used to deny a claim if it arrives too late in the process.

Fraud Issues
A very high percentage of Workers' Compensation claims are legitimate, and although there are very few times when employees are actually committing fraud, these seem to attract the most attention.

Committing Workers' Compensation fraud is difficult to deal with and few cases have been proven to be fraudulent in a criminal case. However, it does occur.

For fraud to occur, it must be proven that the claimant lied about something significant involved in the process. By adding more formal, signed statements when handling claims, fraudulent claims are frequently headed off.

Questions to ask regarding you adjuster and/or the status of the claimant

1. Is the claims adjuster in regular communication with the injured worker?
2. What is the current activity of the injured worker? Example: Is he/she going to the doctor regularly? Does it appear that the worker is progressing with the treatment?
3. What is the current medical status? The diagnosis? The prognosis? What is the expected return-to-work date or release from treatment date? If a "Return-to-work" program is available or a bona fide job offer is made, this information should be exchanged with the adjuster.
4. What is the current benefit status? Example; If TIBS are being paid, when may we expect MMI? If IIBS are being paid, when will weekly benefits be paid out? What was the impairment rate?
5. If the injured employee is not communicating with either the adjuster or the claims coordinator, discuss available options with the adjuster.

Dispute Resolution
Should there be a dispute over the status of a claim between the employee and employer, the following process is followed. This is prescribed by Texas law.

Return-to-work
A key cost containment measure in the Workers' Compensation system, RTW requires a significant level of communication to be properly administered. The following process outlines the basics for RTW.

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Return-to-work Programs
Below is a basic listing of a step by step process which may be helpful as a framework for returning an employee to work.

1. Determine if the employee is authorized by the doctor to return back to work without restrictions. If the doctor authorized the doctor to return-to-work without restriction, return employee back to work and send him a welcome letter. Always try to get all doctor recommendations, and releases in detail instructions.
2. If the doctor made medical recommendations as a condition for the employee to return back to work, continue with the following.
3. Ask the doctor for detail instruction on the set restrictions.
4. Try to get a time frame for the recommended restrictions.
5. Work through your Alexis adjuster to get this important information from he medical provider.
6. Once the information is obtained from the doctor, see if it is possible to return the employee back to his or her original job with the restrictions set by the doctor. If the restrictions and employee modifications are not possible to return employee to original job, work with other departments to see if it is possible to relocate the employee on a temporarily basis or until the employee completes the time limit of the Return-to-work Program or the employee is able to return to his or her original job without restrictions (which ever one comes first) but never to exceed the time of the RWP.
7. Once an area is found where the employee can be a productive resource to the County, develop a temporary job description using as a guide the recommendations set by the medical provider.
8. Once the temporary job description is complete, prepare and send a copy to the doctor for him to review and authorize. Then schedule a visit to present a bona fide job offer to the employee using as a guide the bona fide job offer requirements.
9. During your meeting, review the temporarily job description and make the job offer. If the employee accepts the job send him a welcome back letter.
10. If the employee refuses the bona fide job offer contact your adjuster as soon as possible (and preferably immediately after the meeting with the employee).

Commitment of management, supervisors and employees to pursue RTW
As with other safety programs and loss prevention, the integrity of your return-to-work effort involves commitment of management to be effective. Having a written policy shows that commitment and reinforces the program.

If all officials do not agree on a County wide program, individual officials can still use these concepts within their own department or office to effectively control Workers' Comp costs and take care of employee morale.

Attached is a sample policy on RTW outlining responsibilities, etc.

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_____________________County is committed to providing a safe and healthy workplace for employees. The prevention of injuries and illnesses is our primary objective.

In the event an employee is injured on the job,__________________County has implemented a Return-to-work Process. This process will provide the injured employee with immediate appropriate medical attention and will attempt to provide opportunities to return the employee to safe, productive work as soon as medically possible.

The ultimate goal is to return the employee to his or her original job. The Return-to-work Process will attempt to provide alternative productive work that meets the injured employee's capabilities.

The support and participation of management and all employees are essential for the success of the Return-to-work Process for ______________________ County.

____________________	____________________
County Judge	County Sheriff
____________________	____________________
Commissioner Precinct 1	Commissioner Precinct 2
____________________	____________________
Commissioner Precinct 3	Commissioner Precinct 4

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Policy: To provide prompt, appropriate medical attention for employees injured while on the job and return them to productive work as soon as medically possible.

Procedure:

1. All employees will immediately notify their supervisor or other appropriate personnel at the time of the injury and/or incident.
2. An incident record will be completed for every reported incident whether or not medical attention is needed.
3. If medical attention is required; the injured employee will be accompanied by his/her supervisor to receive medical services.
   1. The employee or supervisor will provide the treating physician with a copy of his/her job description, essential elements, and introductory letter explaining the Return-to-work Process.
   2. A TWCC-1 will be completed upon report of injury.
4. If an employee is restricted from work, his/her supervisor will maintain communication with the employee in the following manner:
   1. Communication on the day of the injury.
   2. Communication every week thereafter until the employee has returned to work.

   Communication with the treating physician will be completed by the identified personnel (normally the claims coordinator) on a weekly basis, by phone, in person, or in writing.

5. When an employee is released by the treating physician to alternative productive work (light duty), the supervisor is responsible for attempting to develop alternative duty that complies with the physician's restrictions.
6. A copy of the work release from the physician will be kept by the employee's supervisor and the claim coordinator.
7. The supervisor will follow-up with the employee on a regular basis after the employee's return-to-work.

Every Effort Should Be Made to Develop Alternative Duty

I. County Claims Coordinator

1. Acts as County's liaison between employee, treating physician, and insurance company;
2. Maintains contact with:
3. Health Care Provider (treating physician),
4. Insurance Company or Third Party Administrator (RSKCO), and
5. Employee and employee's supervisor.
6. Develops and maintains recordkeeping and reporting systems related to injuries.

II. The Supervisor or Management Staff

1. Orients and trains employees on the County Return-to-work Process;
2. Accompanies employee to the physician after injury and informs physician of the County Return-to-work Process (letter to physician will suffice);
3. Maintains weekly contact with injured employee and ensures all necessary documentation and recordkeeping forms are completed appropriately;
4. Provides all necessary/relevant information to County Claims Coordinator;
5. Ensures injured employee is complying with physicians rehabilitation schedule and/or restrictions (light duty); and
6. Reviews employee's condition on a scheduled basis to ensure return to original duty.

III. The Employee

1. Understands internal procedures for reporting a work-related injury;
2. Must inform treating physician that modified duty or light duty is available;
3. Maintains contact with Supervisor on a weekly basis;
4. Complies with all physician's medical restrictions while on light duty; and
5. Returns to work the next scheduled shift after obtaining physician's release.

IV. The Health Care Provider

1. Provides immediate & appropriate medical care to injured employee;
2. Assesses the abilities of injured employee (what can employee do?);
3. Provides injured employee's physical restrictions in terms of job functions;
4. Provides information to County Claims Coordinator and TPA; and
5. Is requested to become familiar with the County's Return-to-work Process.

Bona Fide Offers of Employment
If an employee is released by a doctor to return-to-work in any capacity, you should provide the employee with a bona fide offer of employment that meets the requirements of TWCC Rule 129.5. In order to be valid, the offer must comply with the rule below
. Rule 129.5 Bona Fide Offers of Employment

1. In determining whether an offer of employment is bona fide, the commission shall consider the following:
   1. The expected duration of the offered position;
   2. The length of time the offer was kept open;
   3. The manner in which the offer was communicated to the employee;
   4. The physical requirements and accommodations of the position compared to the employee's physical capabilities; and
   5. The distance of the position from the employee's residence.
2. A written offer of employment which was delivered to the employee during the period for which benefits are payable shall be presumed to be a bona fide offer, if the offer clearly states the position offered, the duties of the position, that the employer is aware of and will abide by the physical limitations under which the employee or his treating physician have authorized the employee to return-to-work, the maximum physical requirements of the job, the wage, and the location of employment. If the offer of employment was not made in writing, the insurance carrier shall be required to provide clear and convincing evidence that a bona fide offer was made.
3. Employment is "geographically accessible" to the injured employee if it is within a reasonable distance from the employee's residence unless the employee establishes through medical evidence that the employee's physical condition precludes travel of that distance.

The written bona fide offer of employment should be sent to the employee by certified mail, return receipt requested. Please send a copy of the letter and receipt to the Third Party Administrator or the Texas Association of Counties (Claims Department).

For assistance in developing a bona fide offer of employment; please call the Texas Association of Counties' Claims Department at 1-800-456-5974.

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Sample Letter to Treating Physician
(Date of letter)

(Physician's name)
(Physician's address) Dear (Physician's name):
(Employee name) is employed by (County name) as a (occupation or job title). He/she was injured on (date of injury) and you treated him/her on (date of treatment).

(County name) has implemented a Return-to-work process. This process is designed to return an injured employee to the workplace as soon as medically possible. If (employee name) is unable to return to his/her original job, we will make every attempt to return this employee to modified duties or an alternative duty position. We will also ensure that this position meets with ALL Medical Restrictions that you prescribe. (Employee's name) is aware of our desire to return him/her to the workplace. If necessary, we are willing to rearrange work schedules around diagnostic or treatment appointments.

(County name) has identified job duties that may be suitable for a "return-to-work" situation. Enclosed is a job description with attached required physical demands that may be appropriate for (employee's name) based on our knowledge of his/her injury. Please assist us by reviewing the attached position and providing your recommendations. We would also like updated recommendations after each appointment.

Please call me at (County Claims Coordinator telephone number) if you have any questions about our Return-to-work process or on the proposed job position. Thank you in advance for your participation in our efforts to return (employee's name) to a safe and productive workplace.

Sincerely,

(County representative)
(Title)
(County name)

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