Modified Duty Closing the Claim. Overview Elements of an effective Modified Duty Program How to implement a successful program. Branch level roles.

Modified Duty

Closing the Claim

Overview

Elements of an effective Modified Duty Program

How to implement a successful program.

Branch level roles and responsibilities in following through with a Modified Duty Program.

What is Modified Duty?

Modified duty assignments must be given to injured employees with any kind of job restriction if at all possible.

These modified jobs are assigned when injured employees are not able to perform their regular job duties, and when the treating physicians have provided job restrictions to the employer.

– The restrictions are designed to promote healing and prevent further injury.

Modified Duty Program Goals

Maintain the health and productivity of employees who have been injured.

Prevent abuse of workers compensation insurance.

Reduce the cost of temporary disability benefits, or indemnity payments (lost wages).

Implementation

A Modified Duty Program consists of three elements:

– Program guidelines

– Roles and responsibilities

– Enforcement of program

Program Guidelines

Modified duty offer protocols

Nature of assignment

Length or duration of the assignment

Procedures for monitoring assignments

Program Guidelines

Procedures for returning to full duty

Procedures for non-modified duty candidates

Procedures for refusal of assignment

Performance standards and expectations

Roles and Responsibilities

Employee– Should be given thorough review of policies and

procedures regarding the Modified Duty Program during the new hire orientation.

– Injured employees who are offered modified duty should be provided with instructions regarding the details of the modified duty assignment.

– Injured employees are expected to attend all medical appointments as outlined by physicians.

– Other expectations should be outlined at this time as well (contact staffing company when restrictions change by doctor, etc.).

Roles and Responsibilities

Staffing Company Risk Manager

– May have all of the responsibilities of overseeing a Modified Duty Program.

– Identifying and securing of modified duty assignments throughout the organization, as well as with customers and other entities.

Roles and Responsibilities

Staffing Company Branch Manager– Primary responsibility is to show concern

for the needs of injured employees.– Immediate response to accident scene.– Providing supervised transportation to the

treating facility.– Offer available modified duty.– Maintain high level of communication with

staffing company corporate office regarding the injured employee’s status.

Roles and Responsibilities

Claims Administrator/Carrier

– TPA/Carrier plays vital role in adjusting the dollars reserved/paid on all claims.

– It is very important that the TPA/carrier is provided with all relevant information regarding modified duty job offers or refusals.

Roles and Responsibilities

Medical Providers

– Must provide quality medical treatment for injured employees.

– Relationship must be formed with preferred medical provider.

– Preferred medical providers should also communicate effectively to the staffing company in providing a diagnosis, treatment plan, employee restrictions, and possible modified duty options.

Roles and Responsibilities

Customers

– Benefits of a Modified Duty Program should be discussed with customers.

– Do customers have any availability of modified duty assignments on location?

– Establish this before a claim, when possible.

Benefits of Modified Duty Programs

Lowers workers compensation premium

Back Injury $50,000

Medical Cost(70%) $35,000

Indemnity Cost(30%) $15,000

What is the difference between paying $15,000 out of pocket to your employee vs. letting the insurance carrier pay $15,000 to your employee?

Benefits of Modified Duty Programs

Maintains an experienced workforce

Increases employee morale

Maintains productivity

Decreases litigation costs

Benefits of Modified Duty Programs

Discourages predators by eliminating the “paid for staying home” scenario.

Provides continuous employment with little or no wage loss to exemplary employees.

– This reduces negative influences on the semi-conscious predator.

Things to know…

Certain state regulations apply

– Example - AZ has passed legislation that states modified duty assignments must be completed at the branch or client location. Alternatives like not-for-profit organizations are not allowed.

Certain states have verbiage that must be included in the modified duty offer to be considered bona fide

– Example - TX Department of Workers Compensation Rule 129.6

Use your resources

– Check with your adjuster, TPA and/or insurance carrier.

Summary

Modified Duty assignments are designed to maintain the health and morale of injured employees and to prevent workers compensation fraud.

Have policies, procedures, and guidelines in place and inform employees of these during orientation.

Individual roles are clearly defined and communicated to all involved in dealing with an on-the-job injury.