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Complex return-to-work problems solved through integrated approach

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SAN FRANCISCO — Stay-at-work and return-to-work programs have historically been associated with workers compensation, but including employees with nonoccupational injuries can help companies better manage the costs of worker absence, experts say.

The return-to-work process should be the same for all workers, whether they have an occupational or nonoccupational injury, said Jason Parker, president and senior disability management consultant at CentriX Disability Management Services Inc. in Vancouver, British Columbia.

Prolonged work absences are typically “caused by nonclinical factors” such as personal decisions and levels of engagement, Mr. Parker said, adding that a person's recovery expectations are the strongest predictor of absence duration for most types of claims.

Since employees who have positive expectations return to work sooner, professionals shouldn't be asking, “Is this a work comp claim? Is this a (Family and Medical Leave Act) claim? Is this a non(occupational) claim?” Mr. Parker said. Rather, they should ask employees, “What do you think needs to happen for you to return to work successfully?” he added.

“Some of these distinctions that we make between work-related injuries or illnesses and personal injuries or illnesses are somewhat artificial,” said Dr. Robert K. McLellan, chief of occupational and environmental medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.

When workers comp was created more than 100 years ago, work injuries seemed more straightforward, Dr. McLellan said: “You dropped a brick on your toe, it broke your toe. It's pretty straightforward cause and effect.”

But increasingly — with the burden of chronic diseases as people are getting older and working and getting aches and pains — this distinction between what's work-related and what's life-related is getting blurrier,” he said.

Mr. Parker and Dr. McLellan are among the experts who say they're in favor of integrating stay-at-work and return-to-work initiatives. The importance of implementing such programs, which address workers that have both occupational and nonoccupational injuries, was a popular topic at the Disability Management Employer Coalition's 2015 conference in San Francisco earlier this month.

Sophisticated employers tend to have integrated return-to-work programs, but it's more common to see companies with “formalized return-to-work/stay-at-work programs for workers comp,” said Terri L. Rhodes, CEO of DMEC in San Francisco.

Concerned about overstepping privacy boundaries, some human resources professionals think they can't talk to an employee about nonoccupational disability, Ms. Rhodes said. “There's still this mindset” that workers “should be disabled for a certain period of time” before they return to work. “That doesn't happen in workers comp, where it's like, "Let's see what you can do.' “

While workers with occupational injuries are required to accept light-duty work, only a small number of employers hold workers with nonoccupational injuries to the same standard, said Denise Fleury, Orange, California-based senior vice president of disability and absence management for Sedgwick Claims Management Services Inc.

In addition, on the workers comp side, there's more pressure to get employees back to work as soon as possible to prevent a recordable injury, Ms. Fleury said.

What some employers don't realize is that “costs can mount pretty sizably” in the case of either an occupational or nonoccupational injury, said Boston-based Christopher Kroger, vice president of national accounts for Liberty Mutual Benefits, a unit of Liberty Mutual Insurance Co. that provides group disability, group life and absence management products and services.

“It's unfortunate that more employers don't apply the same resources” to returning employees with nonoccupational injuries to work, Mr. Kroger said. “We do have employers that use the same processes (on both sides), and they do see shorter durations” of absence and better outcomes.

“A broken leg is a broken leg,” Ms. Rhodes said, echoing a point Mr. Parker made during his keynote speech. “It shouldn't matter where the disability originates from or what bucket is going to be paying it. (Return-to-work) should be embedded in (a company's) culture.”