Modified Duty Closing the Claim. Overview Elements of an effective Modified Duty Program How to...
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Transcript of Modified Duty Closing the Claim. Overview Elements of an effective Modified Duty Program How to...
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.