MARINA DEL REY, Calif. -- Teamwork is the key to successful return-to-work programs.

That was the message sent loud and clear by speaker after speaker at a discussion of "keys to responsive return-to-work programs" at Business Insurance's Sixth Annual Workers Compensation Conference in Marina del Rey, Calif., late last month.

Keeping employees "in the loop" throughout the return-to-work process improves workplace morale and enhances a positive perception of the employer, said Jean M. Long, occupational health program manager-loss control at Fireman's Fund Insurance Co. in Novato, Calif.

Ms. Long pointed out that the direct medical and indemnity costs of workplace accidents are but the tip of the iceberg. Accidents generate indirect costs as well, such as time lost by supervisors and other employees at the accident site, damage to tools and equipment, the cost of hiring and training new employees and decreased employee morale and efficiency.

A survey of companies with successful return-to-work programs showed that the overwhelming majority, among other things, communicated regularly with employees, considered alternative placement of injured workers and had modified work schedules in place, said Ms. Long. But getting all of these factors in sync requires the time and effort of numerous people working as a team. There has to be a written return-to-work policy enjoying upper management commitment, said Ms. Long. And there has to be a constant effort at communication and education about the program, she said.

Addressing the issue of return to work requires teamwork among the employer, the medical provider, managed care vendors and others, she said. But the payoff comes in the form of reduced lost work time, lower claim costs, enhanced morale and greater profitability, she said.

The "biggest problem in return to work is money," said Marshall Sherman, director-risk management, school nutrition services at Philadelphia-based Aramark Corp. To encourage managers to bring people back to work, he established what he calls a "Marshall Plan," through which managers can negotiate extra funding to get extra temporary help and the like, he said. Through such innovation, he said, Aramark has had six consecutive years of reducing lost-time accidents, while growing at an annual rate of 10%.

"Creating a positive first impression through courtesy and rapport" is the cornerstone of successful return-to-work programs, said Clifton K. Matsuno, administrator-rehab services at San Francisco-based Sedona Therapies.

For example, at United Airlines' onsite physical therapy unit at San Francisco International Airport, where Mr. Matsuno works as a consultant, patients are greeted within three minutes of their arrival. The onsite facility generates a positive atmosphere, so much so that at least one patient wrote a poem of praise for the treatment available there, he said. Patients and therapists work closely together at the onsite unit, with the goals of shifting the patients' focus toward returning to work quickly and enjoying the treatment process, said Mr. Matsuno.

At Oakland, Calif.-based Clorox Co., worker safety has always been a priority, said Sorata M. Wright, corporate risk manager. But accidents do happen, and the company has a return-to-work program in place to deal with their aftermath.

One key component of Clorox's program is accommodation of work restrictions. Another is the requirement that physicians be familiar with the workplace environment; doctors are invited to take plant tours. The program also involves claims management, coordination with human resources and safety departments and the presence of onsite nurses for high-exposure facilities.

Yet another view of return to work came from Dr. John J. Larkin Jr., vp-clinical affairs for Integra Group of Mason, Ohio. He said that one of the biggest problems with managed care is that the software used by managed care providers is designed to provide claims management, not disease management. Because of his concern over deteriorating quality of medical service under managed care, Dr. Larkin developed a workers comp disease management software program.

Dr. Larkin pointed out that getting timely, accurate information about the nature of a workers comp injury is critical. He estimated that about 80% of injuries are initially misdiagnosed during the first six weeks of a workers comp claim.

Thorv Hessellund, director-vocational programs for Concord, Calif.-based Paradigm Health Corp., moderated the discussion.