Sample Written Program

For

Return to Work Program

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 Return to Work Program
(COMPANY NAME)

Purpose
This program is designed to provide policies and procedures for managing the return to
work of injured company employees with minimum time lost

Policy
It is the policy of [COMPANY] to provide a place of employment that is free from
recognized hazards that cause or are likely to cause death or serious physical harm to
employees or the public. However when serious physical harm does occur to employees,
[COMPANY] is committed to providing quality medical care and managing those costs
associated with that medical care. [COMPANY] is also committed to the effective return
to work of injured employees while enhancing their recovery.

Background
Returning employees to work who have been injured in the performance of their jobs is
an important component of [COMPANY] ‘s loss control program. Benefits of a return to
work program include:

Faster, more effective healing

Safer work environment
Direct and indirect savings in lost wages, medical costs and productivity
Improved morale by providing support to employees with alternate assignments
during recuperation.

Statistic have shown that without a return to work program, employees have little
incentive to return to work and are less likely to return to work the longer they are out of
work. This safety policy and procedure includes provisions for supervisory training, a
discussion of the return to work process, presents details on [COMPANY]’s preferred
medical provider network and presents information on transitional work assignments,
permanent job modifications and new position assignment requirements.

Responsibilities

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Management

Provide resources and support to supervisors in the return to work program.

Assist in employee placement decisions.
Encourage proper and ethical practices.

Supervisors

Complete accident and other report forms in the event of an injury

Pre-determine alternate duty options for the positions under their control
Provide job descriptions and alternate duty options to the Workers’ Compensation
Administrator, and Human Resources Manager
Complete Return to Work forms upon the return to work of the injured employee

Employees

Employees are responsible for promptly reporting any injuries to their supervisor and
going to the preferred provider as directed by their supervisor. They must also cooperate
with the Workers’ Compensation Administrator’s, Safety and Human Resources
Departments.

Workers’ Compensation Administrator

Administer the [COMPANY] Return to Work Program

Coordinate with preferred providers, Human Resources Department, and
supervisors in the placement of employees into transitional work assignments,
permanently modified jobs or new positions
Coordinate program communication by ensuring that timely distribution of
program materials are performed
Coordinate vocational rehabilitation training for employees who have received a
permanent disability as a result of a job injury
Maintain a central list of all [COMPANY] preferred providers

Safety Manager

Provide prompt assistance to managers, supervisors, and others as necessary on

any matter concerning this safety policy and procedure.
Assist in and develop the Return to Work Program training
Annually compile trends and statistical reports for tracking results of
[COMPANY] return to work program.
Provide consultative and audit assistance to ensure effective implementation of
this safety policy and procedure
Assist supervisors in returning employees back to work
Meet with injured employees to explain alternate duty position(s)

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Human Resources Manager

Assist the Workers’ Compensation Administrator in placement decisions that

require new position assignments
Provide information regarding wage and salary grade equity issues
Approve temporary assignments greater than ninety days

Definitions

Alternate Duty - Duties assigned on either a short term or permanent basis, and
medically approved by the authorized treating healthcare provider, to an injured
employee.

Permanent Job Modification - Jobs that are permanently modified for employees that
have permanent restrictions upon return to work following an injury.

Preferred Provider - A healthcare provider that has entered into an agreement with the
company to provide prompt healthcare services to an employee injured during the
performance of their jobs.

Transitional Work Assignment - Work assignments (duties) that are short term and
those employees with temporary restrictions are given upon return to work following an
injury.

Workers’ Compensation Leave - Period of time that employees are recuperating from
job-related injuries and during which the employee receive 66.667 % of their regular pay.

General Information

Training
Supervisors must accurately understand their key role in this program. Therefore,
supervisors should receive training that includes specific details on the Return to Work
process and their responsibilities under this program. This training will be initially
conducted as a one-time training with re-training every two years.

Return to Work Process

When an employee, who has been injured on the job and placed on workers'
compensation leave, has been released to return to work by the treating physician, there
are three possible return to work options.

Option 1: An employee has reached maximum medical improvement and has

been released to return to work by the treating physician. The employee is then
returned to the original position he/she held prior to workers' compensation leave

Option 2: An employee has not reached maximum medical improvement and is

ready to return to a transitional work assignment (limited or modified work duty)

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 with approval of the treating physician, but retains some disability which prevents
successful performance in the original position. The company will provide work
reassignment suitable to the employee's capacity which is both meaningful,
productive and advantageous to the employee and the company.

Option 3: An employee has reached maximum medical improvement and has

been released to return to work by the treating physician, but has received a
disability which prohibits employment in his/her previous position. The company
will attempt to place the employee in a permanently modified job or another
position suitable to the employee's capacity which is both meaningful, productive
and advantageous to the employee and the company. This work placement may be
a permanent assignment or either a part-time or temporary assignment until a
permanent assignment is found. If a position is not available for work placement,
Management will appoint the employee to the first suitable vacancy which occurs.
In some cases the extent of disability may be that vocational rehabilitations will
be necessary. If so, Management will make the necessary arrangements for such
training to assist the employee in obtaining suitable employment.

Return to Work Program Guide

Every employee should be entered into the Return to Work Program upon medical
certification that the employee may return to some type of work duty. Written return to
work authorization must be obtained from the preferred medical provider. Every attempt
should be made to modify the employee's current job to meet restrictions.

Injured employees should usually be under the direct supervision of the supervisor in the
area in which he/she is working. However, supervisors should understand their
responsibility and be willing to work with employees not normally under their control.

The Workers’ Compensation Administrator and the treating physician shall make the
final decision, with input from the injured employee’s supervisor and Human Resources
Manager, as to when an employee returns to work in either his/her original position, a
transitional work assignment, a permanently modified job or a re-assigned position.

Preferred Medical Provider

The preferred provider network is a list of physicians who have agreed to treat injured
company employees when such injuries arise out of the performance of their job duties.
This preferred provider list should include orthopedic, neuro-surgeon, neurologist, urgent
care or emergency room physicians. This list shall be maintained by the Safety Manager
with updated lists being made available to the Workers’ Compensation Administrator.
The preferred provider list is to be updated annually.

Transitional Work Assignments

Employees may be provided with transitional work assignments during their recuperation
in order to maintain desirable productivity levels. These assignments should be short term

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in nature (no greater than 90 days) until the employee is able to return to his/her original
job assignment.

Permanent Job Modifications / New Position Assignments

Permanent job modifications and new position assignments are used for employees who
receive a permanent disability as a result of an injury. Permanent job modifications may
be the same as transitional work assignments except the transitional work assignments are
temporary in nature. If an employee cannot be placed in a permanently modified job, then
that employee may be assigned to another position that meets the restrictions imposed
upon the employee by the treating physician.

Program Communication
The Return to Work Program must be effectively communicated to injured employees,
affected supervisors, and preferred providers. Program communication will be achieved
by the training of supervisors, safety orientation training for employees and the
distribution of program literature.

Injured employees and affected supervisors - The Workers’ Compensation Administrator

will provide an employee information package on Workers’ Compensation and Return to
Work information that provides specific details on injured employees and affected
supervisors responsibilities and required actions.

Preferred medical providers - Annually, each provider will receive a copy of the
Employee Handbook on Workers’ Compensation, a WC packet, a return to work
information sheet, and a copy of this safety policy and procedure from the Workers’
Compensation Administrator. Additionally, if needed, they will receive verbal
communication from the Workers’ Compensation Administrator and from Safety/HR
Managers.

Matching Employees to Alternate Duty

Step 1. The Workers’ Compensation Administrator will list all restrictions provided by
the physician.

Step 2. The Human Resource Manager will list all alternate duty jobs and their wages,
including regular jobs with modifications available.

Step 3. The doctor's restrictions are then being matched to the best possible alternate
duty. In the case where there may be a unique restriction from the physician, a check of
the alternate duty job chosen will be made to ensure it meets with the restrictions or can
be modified to meet the restriction.

Step 4. For all identified and available job description(s) that meets restrictions, examine
the wage section to ensure that none of the alternate duty jobs pays more than the original
job.

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Step 5. Forward the job description(s) to the physician's office and to the Safety and HR
Manager. The physician will sign off on all jobs that are appropriate and make comments,
as necessary, for each case. The physician then returns the information to the HR
Manager.

Step 6. If the physician has identified more than one job as appropriate, the best alternate
duty position should be chosen to best meet company needs.

Step 7. The HR Manager meets with the injured employee and physicians as needed to
explain the alternate duty position.

The information and suggestions contained in this material have been developed from
sources believed to be reliable. However, Frankenmuth accepts no legal responsibility
for the correctness or completeness of this material, or its application to specific factual
situations