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Being Proactive on Workers' Compensation Claims

Washington state’s Department of Transportation’s Return to Work Unit focuses on completing claims and getting the employee healed and back to work.

On-the-job injuries are detrimental to the employee and the employer, resulting in lost time, financial hardships, unfilled positions and the stress of filing and managing compensation claims. Workers' compensation programs help ensure that injured employees receive the proper medical care and compensation, but such programs do have flaws.

For one, workers' compensation is expensive for both parties -- some employees pay a premium on their paychecks for the insurance benefit, and the employer picks up the rest. According to a study by the National Association of Social Insurance, workers' compensation medical care and cash benefits paid out in both the public and private sector totaled $57.6 billion in 2008, the most recent year for which data is available.

Delays are another common problem. Claim processing, whether it is handled by the state labor department, a department's internal human resources agency or workers' compensation bureau, can be delayed because of incomplete or incorrect injury reports, workers may not seek immediate treatment or providers may be slow to send medical reports to the employer. These delays contribute to unanswered questions for managers as to when an employee will return or receive modified work duty.

Department of transportation employees are in a unique situation. The field personnel are confronted with dangerous situations each day, be it working on the side of the highway, using heavy machinery, and, in the case of Washington State's Department of Transportation (WSDOT), working on the ferry system. WSDOT's workers' comp premiums amounted to more than $7.6 million in 2010. More than $6 million of this total is covered by WSDOT while the remaining $1.6 million is paid for by employees.

Plagued by the department's rising health-care premiums for industrial insurance claims, WSDOT decided it needed a better way to manage workers' compensation claims. Enter the Return to Work Unit, which is dedicated to handling claims from start to finish. The unit does this by taking a proactive approach to claim management, working with health-care providers, vocational counselors, managers and the injured employee to maximize his or her options and benefits, ensuring a successful recovery and return. Return to Work Unit employees coordinate with the state's Department of Labor and Industries, which processes workers' compensation claims and offers problem-solving help to unit employees, including access to occupational nurse consultants when necessary.

Since its implementation, the program has reduced the number of workers' compensation claims and the amount of time lost due to injury. In its first year, the program saved $1.5 million in claim reserves savings, time loss reduction and medical cost reduction. According to WSDOT, the Return to Work Unit brought work-days lost due to injury to a five-year low in 2010. From 2009 to 2010, the number of working days lost fell 30 percent.

I spoke with Secretary of Transportation Paula Hammond to find out more about how the Return to Work Unit impacts employees and the work the department does across the state. An edited transcript of our conversation follows.

How was the need for a dedicated unit recognized?

As an agency, we have over 7,000 employees and were bothered by the lingering number of claims we had for injured employees. It felt like we were spending a lot of money on employees' injuries, and it didn't feel like it was being managed well. All of the costs really added up for state government and we thought we could manage better.



What were the first steps in establishing the unit?

Previously, a lot of the work had been done in our regions, but it wasn't a collective management system. So we started looking at the top 10 list of employees who had been out the longest, those we had vague injury information on, and what work injured workers could perform.

The unit partnered with [the Department of] Labor and Industries and the managers of those injured, and became advocates for the employees to ensure their claim files were being taken care of, and challenging those who didn't pass muster.

Now, managers have a go-to person in the department [of transportation] who can offer suggestions on a return-to-work plan, [like] if there are other duties they can perform while healing.

What modified duties could injured employees complete?

If it's a highway maintenance worker, they can do inventory, office support or training that fits within their arena or job description. There's always work to do in an agency like ours ... if you have someone who can do it while they're out, then it's a great opportunity to get your necessary work done.

Is this work now completely centralized within the Department of Transportation?

Yes, it is now completely centralized. We work with the divisions and regions on the details, and work with the manager of the person's unit ... to foster a dialogue and partnership. We take the lead, but it's a partnership with Labor and Industries and the injured worker.

Why is the centralized unit so vital?

That's really what's needed. You need to have people who know that their job is to make sure these injury claims get resolved and employees get back to work. Out in the field, managers have two or three hats. With the unit, we have employees who are really focused on the relationship. That's what's made it a success.

What feedback have you received from employees who work with the unit after a workers' compensation claim?

I have heard that employees are very grateful that someone is dialoguing and checking in [with them] while they are injured. It is human nature that employees are grateful when they know someone cares. Injured employees are really willing and happy to find accommodations that work.

How have managers reacted to the unit?

Managers are, of course, most concerned about their employees. If you've had someone injured on the job, you have the personal concern and you have the concern for your work unit's production and productivity. They're hoping and wishing that the employee is well and that the work gets done. With the more constant contact, it really helps the managers plan ahead for what they might expect on the return of their employee. I think they're very satisfied.

We've hit on a process that really improves how government can be efficient and yet take care of our employees, who are our most important asset. They're [the ones] who get the work done for us on a ferry, or in our main arena or in our construction project offices. We need those people. We need them healthy. We want them to come back and contribute to our mission.

Do you think the program has helped improve the sometimes negative connotation surrounding workers' compensation?

I think so. If there ever was a negative connotation, it was that folks felt like a claim would never get resolved. With this system we have now, there is such active engagement with all parties who have been affected. The employee themselves appreciate the fact that someone cares and is finding solutions to get them back to work.

Tina Trenkner is the Deputy Editor for GOVERNING.com. She edits the Technology and Health newsletters.
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