Return to Work SP# A-5

1.0 Purpose
2.0 Scope and Applicability
3.0 References
4.0 Policy
5.0 General Responsibilities
6.0 Procedure
6.1 Definitions
6.2 General Provisions
6.2.1 Training
6.2.2 Return to Work Process
6.2.3 Return to Work Rules
6.2.4 Preferred Provider Network
6.2.5 Transitional Work Assignments
6.2.6 Permanent Job Modifications and New Position Assignments
6.2.7 Post Return to Work Notification
6.2.8 Program Communication
6.2.9 Tracking Results of the Return to Work Program
6.3 Specific Responsibilities
6.3.1 Managers
6.3.2 Supervisors
6.3.3 Employees
6.3.4 Human Resource Manager and Workers' Compensation Coordinator
6.3.5 Division Safety Officer/Consultant
6.3.6 Safety Risk Management
6.3.7 Workers' Compensation Administrator
6.3.8 Human Resource Division
APPENDIX A: Guidelines in Matching Employees to Alternate Duty
APPENDIX B: Common Restrictions Based on Body Part
APPENDIX C: Form to Match Modified Duty to Injury

The purpose of this safety policy is to establish guidelines and procedures, consistent with NCGS 97-32.1, and the Office of State Personnel policies and procedures for returning injured North Carolina Department of Environment and Natural Resources (NCDENR) employees back to work with minimal lost time and as part of their recovery process.

Returning employees to work who have been injured in the performance of their job is an important component of NCDENR's loss control strategies. 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 in order to help them maintain a desirable productivity level
• Enhanced cross-training within NCDENR

Without a return to work program, the healing process may be prolonged, 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 includes provisions for supervisor training, a discussion of the return to work process, details on NCDENR's preferred provider network and information on transitional work assignments, permanent job modifications and new position assignment requirements. This document also outlines priorities for post-injury placement of employees, notes post return to work notification, how the program should be communicated and highlights how results of the program are tracked.

This policy denotes the areas of responsibility for managers, supervisors, employees, the Workers' Compensation Administrator, the Division Safety Officer, Safety Consultants and Safety Risk Management and Division/Office/Program Human Resource Managers and Workers' Compensation Coordinators and the DENR Human Resources Division.

This safety policy is established in accordance with the North Carolina General Statute Chapter 97 (Workers' Compensation Act, 1994), the North Carolina Industrial Commission Rules and Regulations (1995), North Carolina Office of State Personnel, Workers' Compensation Employee Handbook (1999), North Carolina Office of State Personnel's, Workplace Requirements for Safety, and the Americans with Disabilities Act (ADA).
In the event of a conflict between the provisions of this safety policy and applicable state or federal laws, the latter shall control.

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

It is the responsibility of each manager, supervisor, and employee to ensure implementation of NCDENR's safety policy regarding Return to Work. Specific responsibilities are found in Section 6.3

This section provides applicable definitions, establishes general provisions, and identifies specific responsibilities required by NCDENR's safety policy on Return to Work. 

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

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

Preferred Provider- A health care provider that has entered into an agreement with NCDENR, or its Third Party (TPA) Workers' Compensation program administrator, or the State of NC's WC Third Party Administrator to provide prompt health care services to an NCDENR employee injured during the performance of their job.

Transitional Work Assignment- Work assignments (duties) that are short term and that employees with temporary medical restrictions are assigned upon return to work following an injury. Also referred to as modified duties.

Workers' Compensation Leave- Period of time that employees are recuperating from job-related injuries and during which the employee receives 66.667 % of their average weeky wages.

This section details the provisions of this safety policy and procedure with each provision discussed in a separate subsection. The provisions adopted by NCDENR are:

• Training
• Return to Work Process
• Return to Work Rules
• Preferred Provider Network
• Transitional Work Assignments
• Permanent Job Modifications and New Position Assignments
• Program Communication
• Post Return to Work Notification
• Tracking Results of the Return to Work Program

The critical link in NCDENR'S Return to Work Program is supervisors accurately understanding and applying their role in this process. 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 conducted as a one-time training with re-training every three years, or as determined through safety audits or as case by case Return to Work issues require.

The following chart illustrates the major components of the 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 scenarios.

Scenario 1-An employee has reached maximum medical improvement (MMI) and has been released to return to work by the treating physician/ health care professional.

Scenario 2-An employee has not reached maximum medical improvement and is ready to return to a transitional work assignment (limited or modified work duty) with approval of the treating physician/ health care professional, but retains some disability which prevents successful performance in the original position.

Scenario 3-An employee has reached maximum medical improvement and has been released to return to work by the treating physician/ health care professional, but has received a disability which prohibits employment in his/her previous position.

For scenario 1, when an employee has reached maximum medical improvement and has been released to return to work by the treating physician/health care professional, NCDENR shall return the employee to the original position he/she held prior to workers' compensation leave.

For scenario 2, when an employee has not reached maximum medical improvement and is ready to return to a transitional work assignment, NCDENR shall (re)assign and provide work duty suitable to the employee's capacity which is both meaningful, productive and advantageous to the employee and NCDENR. This work reassignment shall be a temporary assignment and shall not exceed 90 days without approval from NCDENR Human Resources. When the employee reaches maximum medical improvement, NCDENR shall return the employee to the original position held prior to workers' compensation leave.

For scenario 3, when an employee has reached maximum medical improvement and has been released to return to work but has received a disability that prohibits employment in the previously held position, NCDENR shall 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 NCDENR. This work placement may be a permanent assignment or either a part-time or temporary assignment until a permanent assignment is found. For scenario 3, work placements shall abide by the following:

• If a position is not available for work placement, NCDENR shall appoint the employee to the first suitable vacancy that they qualify for, as it occurs. During the interim period in which a suitable vacancy is not available, the employee shall be referred to the Office of State Personnel for reemployment assistance and a possible return to work in another state agency.
• Work placement efforts shall continue for a period not to exceed nine (9) months, except with the approval of NCDENR Human Resources Division.
• In some cases the extent of disability may require vocational rehabilitation. If so, NCDENR shall make the necessary arrangements with the North Carolina Division of Vocational Rehabilitation, or other such health care provider, for evaluation and to provide the training necessary to assist the employee in obtaining suitable employment consistent with his/her performance capabilities.

The general rules of NCDENR's Return to Work Program include:

• Every employee will be entered into NCDENR's 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 from the preferred provider.
• Every attempt should be made to modify the employee's current job task to meet the restrictions. (See Appendix A for Guidelines in Matching Employees to Alternate Duty.)
• An injured worker should not be placed in a job that pays more than the regular job.
• An injured worker should not be placed in a job that has work conditions more advantageous than their regular job, except for short term modified duty assignments.
• Injured employees should be under the direct supervision of the supervisor within the work area where they are normally assigned. However, in rare cases a temporary assignment to another area during return to work may be necessary.  In that case, supervisors should understand their responsibility and be willing to effectively supervise those injured employees not normally under their control.
• The Workers' Compensation Administrator and the treating physician/health care professional shall make the final decision (with input from the injured employee's supervisor and Human Resource 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.

NCDENR's preferred provider network is a list of physicians and health care professionals that have agreed to treat injured NCDENR employees when such injuries arise within the scope, or performance of their job duties.

This preferred provider list (network) should include orthopedic, neurosurgeon, neurologist, urgent care and/or emergency room physicians. This list shall be maintained by the division/office/program Workers' compensation coordinator, safety officer, or Human Resource Manager. Upon receipt from the Third Party Administrator (TPA), the DENR  Workers' Compensation Administrator shall make the list available to the Division/Office/Program WC coordinator.  Each division/office/program shall share its list with their supervisors.  Supervisor's shall ensure that employees that report to them are aware of the preferred provider location for the employee's assigned duty station, including field activities.

At a minimum, the preferred provider list (network) shall be updated annually.
The network is typically compiled and provided by the State's Third Party Administrator (TPA), but it can be amended through input from the Division/Office/Program's to the Departments Workers' Compensation Administrator.

In order to assist in their recovery efforts, while maintaining a desirable productivity level, employees may be provided with transitional work assignments, or modified duties, during their recuperation, as applicable. These assignments (sometimes called limited or modified duty) should be short term in nature (no longer than 90 days) until the employee is able to return to his/her original job assignment. Ideally, these transitional work assignments should already be defined prior to an injury. Ideas for defining transitional work assignments include:

• Getting a list of jobs that may be performed on an annual, monthly, weekly or daily basis. Examples may include rainy day jobs, jobs that would require overtime or temporary help to complete or any job that employees may do on an occasional basis.
• Jobtasks that supervisors identify as outside those for any specific job title. These tasks could then be assigned as part of a transitional work position.
• Those jobs/tasks identified, discussed and documented during a safety meeting as suitable for transitional work assignments or modified jobs.

Permanent job modifications and new position assignments are used for employees who receive a permanent disability as a result of an injury, and who are medically documented as unable to perform the original job duties. In many instances, permanent job modifications may be the same as transitional work assignments, except 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. 

When an injured employee has missed work days due to the injury and returns to work, the supervisor shall contact the Division/Office/Program's Payroll Coordinator and WC coordinator to alert them of the employee's return.  The DENR Workers' Compensation Administrator shall be notified and the Third Party Administrator. This process minimizes the possibility of unauthorized payment and overpayment.

NCDENR's Return to Work Program must be effectively communicated to injured employees, affected supervisors, preferred providers and Third Party Administrator. Program communication for all DENR employees will be achieved by training supervisors, discussed at safety orientation training for employees and the distribution of available program literature.

Upon receipt of a Form 19 indicating lost time, the Workers' Compensation Coordinator will either provide a hard copy of, or direct the employee to the NC Employee Handbook on Workers' Compensation.  A DENR Return to Work brochure will be provided to the injured employee and their affected supervisor as budget and resources allow. These items provide information and specific details on the responsibilities and required actions for injured employees and affected supervisors. The injured employee shall also receive a Workers' Compensation (WC) packet from their supervisor. 

Preferred providers will receive information directly from the TPA or DENR WC Administrator. This information includes an annual mailing of the Employee Handbook on Workers' Compensation, a WC packet, a return to work brochure and a copy of this safety policy  from the Workers' Compensation Administrator's staff. Additionally, they will receive, as needed, verbal communication from the Workers' Compensation Administrator's personnel and from Safety Risk Management personnel. 

Results of NCDENR's return to work program shall be tracked by annually compiling trends and statistical reports from internal or TPA databases, as derived from reports submitted from the division/office/program,  OSH 300A summary, and/or information available from the TPA.

In February of each year, each division/office/program shall provide an annual report to the Workers' Compensation Administrator summarizing its involvement in the DENR Return to Work program.  This report shall include a comparison of lost work days for the previous and current calendar year, as well as efforts undertaken to identify and provide transitional duties and assignments for injured workers.

Managers will be responsible for:

• Providing resources and support to supervisors in the return to work process
• Assisting in the employee placement decisions, as applicable
• Encouraging proper and ethical practices in all phases of the return to work process

Supervisors will be responsible for :

• Giving WC packets to injured employees as soon as practical following the injury
• Completing the Form 19 upon the injury of an employee and ensuring its submittal to the Workers' Compensation Coordinator and Department WC Administrator within one day of their knowledge of injury.
• Pre-determining alternate duty options [ transitional work assignments (Limited or modified duty) and permanent job modifications] for the positions under their supervisory control
• Providing job descriptions and alternate duty options to the Workers' Compensation Administrator, Human Resource Managers,  Workers' Compensation Coordinator, DENR Safety personnel and preferred providers to secure employee placement following an injury.
• Ensuring that current information about the name and location of the DENR Preferred Provider is given to their direct reports
  
• Ensuring that injured employees are entered into the Return to Work program
  
• Proper notification of the return to work of the injured employee
• Following established departmental protocols for the Worker's Compensation process
  

Employees shall be responsible for promptly reporting any injuries to their immediate supervisor and going to the preferred provider as directed by their supervisor. They will also cooperate with the Workers' Compensation Administrator's staff, preferred providers, Workers' Compensation Coordinator, Human Resource Managers, and DENR Safety  personnel in the treatment, recovery and return to work phases of the process.  (To ensure prompt medical attention, life threatening and severe injuries requiring emergency treatment are to be done so at the emergency medical facility nearest to the injured employees location.) 

The division/office/program Human Resource Manager and Workers' Compensation Coordinator will be responsible to:

• Provide consultative assistance to managers and supervisors in RTW strategies and solutions.
• Provide available brochures or booklets (or their on-line address) to supervisor's regarding the DENR Return to Work process
  
• Assist in the location of permanent Job Modifications and New Position Assignments
• Meet with supervisors and injured employees to explain alternate duty position(s)
• Monitor compliance by supervisors regarding RTW issues and reporting discrepancies to their Division/Office/Program Management
• Assist in the maintenance, updating, dissemination and retention of the Preferred Provider list on a periodic basis
• Notifying the Department's Workers' Compensation Administrator when an employee has been released to return to work, including the effective date. (This must be done to avoid overpayment of compensation.)
  

The division/office/program Safety Consultant/Officer will be responsible for:

• Providing consultative assistance to managers and supervisors in RTW strategies and solutions. 
• Provide RTW training to Supervisors on a periodic basis.
  
• Working with the division/office/program Incident Investigation Subcommittee and supervisor to ensure that proper corrective action has been implemented regarding the root cause of the original injury so that the risk of injury to another employee is reduced or eliminated.
  

As staffing allows, Safety Risk Management will provide prompt assistance to managers, supervisors, and others as necessary on any matter concerning this safety policy and its procedures. Safety Risk Management will develop and assist in the appropriate training associated with this document. Additionally, Safety Risk Management will:

• Provide consultative and audit assistance to ensure effective implementation of this safety policy and its procedures
• Provide supervisors with options for return to work methods
• Communicate with preferred providers as needed on specific and relevant aspects of NCDENR's Return to Work Program
• Coordinate placement decisions between the Workers' Compensation Administrator, the preferred providers, division/office/program/office staff and supervisors

The Workers' Compensation Administrator will be responsible for:

• Administration of NCDENR's Return to Work Program
• Coordinating the program communication aspects by ensuring that information and program materials noted in this safety policy are provided in a timely manner
• Coordinating vocational rehabilitation and training with the appropriate health care provider and/or TPA for employees who have received a permanent disability as a result of an on the job injury
• Maintaining a central list of all NCDENR preferred providers
• Dissemination of the NCDENR Preferred Provider list as provided by the Third Party Administrator to division/office/program human resource managers and worker compensation coordinators
  
• Communicating with  Workers' Compensation Coordinators, Human Resource Managers, NCDENR Human Resource Division, Third Party Administrator, preferred providers, and supervisors in the placement of employees into transitional work assignments, permanently modified jobs or new positions
• Annually compile trends and statistical reports, as provided pursuant to 6.2.9 above, for tracking results of NCDENR's return to work program

• Assisting the Workers' Compensation Administrator and the Human Resource Manager's in placement decisions that require new position assignments
• Providing consultative services in wage and salary grade equity issues
• Approving temporary assignments greater than ninety days

1. The supervisor should list all restrictions provided by the physician.
2. The supervisor then lists all alternate duty jobs and their wages, including regular jobs with modifications available.
3. The doctor's restrictions should then be matched to the best possible alternate duty. In the case where there may be a unique restriction from the physician, check the alternate duty job chosen to make sure it meets with the restrictions or can be modified to meet the restriction.
4. Take the 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.
5. Forward or take the job description(s) to the physician's office. The physician will sign off on all jobs that are appropriate and make comments as necessary for this particular case. The physician will forward them back to the supervisor and Human Resource Manager.
6. If the physician has identified more than one job as appropriate, the best alternate duty position should be chosen to best meet NCDENR needs.
7. The Supervisor and Human Resource Manager will meet with the injured employee and physicians as needed to explain the alternate duty position.

Effective: January 2005