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SANTA MONICA, Calif.-Adding more structure to a return-to-work program can enhance its success, especially among lower-skilled workers.

That is the advice of panelists who discussed the issue during the Fifth Annual Workers Compensation conference sponsored last week by Business Insurance.

"Companies are moving toward creating more structure in return-to-work," said Daniel L. King, president and chief executive officer of The Risk Control Group Inc. in San Clemente, Calif.

The risk management consulting organization specializes in outsourcing risk management and safety-related services to the food service, health care and hospitality industries.

He recommends following, in order, this hierarchy for vocational case management:

Return to work in the same job with the same employer.

Return to work in the same job, modified, with the same employer.

Return to work in a new job with the same employer.

Return to work to a new employer with a direct job placement.

Retraining for new job skills.

"This hierarchy supports the injured employee's strengths and capabilities and is the most cost-effective case management model," according to Mr. King.

In addition, he urged employers to find meaningful work-related experiences for recuperating employees, rather than making them perform demeaning tasks such as counting straws, as one hotel chain did.

He praised a program used by Specialized Distribution Management Inc., the largest distributor for Safeway Stores in California. The distributor created an innovative light duty and return-to-work program that uses a special "safety room" in a grocery warehouse to help train recuperating employees in safety and keep them in a work-type environment instead of at home watching television.

The room is equipped with chairs and tables and decorated with safety posters. Medically able employees are assigned there while recovering, to receive training on safety and health issues, and are held accountable for their attendance when not receiving medical care.

Mr. King also recommended performing a cost/benefit analysis to determine the savings most return-to-work programs can provide companies.

A return-to-work program at the self-insured University of Pennsylvania Health System has saved nearly half of a $6 million expense over the past five years, said Rosemary Osman-Koss.

She is the workers compensation manager for a rapidly growing Philadelphia-based health care system of six institutions.

The organization employs about 14,000 workers and has about 200 lost-time claims annually, including 20 to 25 from low-skilled workers who cannot return to their labor-intensive jobs, Ms. Osman-Koss said.

The heart of the health care system's effort is a four-part program used for workers at all skill levels:

Medical case management.

The employer coordinates contacts with medical providers, obtains current physical capacity evaluations and obtains medical approval of proposed return-to-work activities and jobs.

Return-to-work activities.

The employer surveys departments to determine possible sedentary or light-duty job tasks, maintains close contact with supervisors and workers and monitors the job's physical demands and job performance.

Internal job development.

The employer arranges regular meetings with human resources personnel, encourages return-to-work supervisors to hire their program's employees and advocates cost-effectiveness of returning injured workers to work.

Retraining employees.

Because higher-skilled workers usually can find jobs, the employer considers retraining all unskilled or lower-skilled workers.

That includes assessing a worker's work-related aptitudes and educational skills, providing training for upcoming jobs and providing outplacement services as needed.

The last component was added three years ago and is "very important," she said.

Thus far, the program has provided retraining services to 42 unskilled and lower-skilled workers. Of those, 39 graduated, and 26 have returned to work in new, budgeted jobs. "To me, this is a fantastic result," she said.

The retraining component has saved about $400,000 in annual wage loss benefits and $15 million in potential long-term wage loss benefits at the self-insured institution, she said.

However, it is important to remember the human element when retraining low-skilled workers, said Larry Kurtz, president of The Achievement Institute in Bryn Mawr, Pa. The organization provides employer-based assessment and retraining services for permanently injured hospital employees.

"They often fear that other employees will learn of their limited language and math skills," he said.

Common characteristics that may limit an employee's ability to return to work include language and math skills at less than a sixth-grade level, poor school records, fear of traditional group-oriented classroom learning programs because of past problems, and self-doubt.

"That has to be kept in mind," he said.

A good retraining program will include all of these steps: vocational assessment, planning, remediation, skills training-often on a one-to-one basis-interview skills preparation and outplacement activities.

It is important that the training room "doesn't look like a school," so it is best to use an office-like setup rather than a room with a blackboard, he said.

"If you skip a step, you set things up for failure," he said.

Individual success stories, such as a hospital cleaner with an injured back who becomes an office worker, are not only inspiring but good for the company and the worker.

Rebecca Shafer Bruce, president and CEO of Aon Management Institute in Glastonbury, Conn., moderated the panel.