March 21, 2018

Sarah Tayts: RTW: If at First You Don’t Succeed, Try, Try and Try Again

BY Sarah Tayts, AIC, ARM, Return to Wellness Specialist for Eastern Alliance Insurance Group

Sarah TaytsIf I were to graphically represent “what RTW looks like,” for most claims, it would probably look as if it was charted by a toddler wielding a crayon. This is not due to my lack of artistic ability, but due to the fact that, like most things in life, a return to work trajectory is not linear in fashion.

In many cases, an injured worker receives work restrictions, their employer identifies work to accommodate those restrictions, and an eventual full duty return to work occurs. We hope for this ideal outcome every time, but studies suggest roughly one-third of injured workers who experience a sustained initial return to work will likely experience a recurrence of work absence within six months from the date of injury1.

What does this mean for employers and workers’ compensation carriers?
Clear recovery expectations are imperative for proper return to work planning. I’m fairly confident that not many claim representatives, case managers or doctors communicate the likelihood of recurred work absences to the employer or injured worker as they deliver a RTW note. How can we plan for return to work when we don’t know what to expect? That would be like packing for a vacation without checking the weather forecast.

I agree, maybe my faith in meteorologists is flawed. Luckily, there is research to support my point. In a 2002 study of 1566 injured workers who were receiving temporary total disability benefits, researchers found that workers’ expectations about their recovery had a statistically significant impact on the duration of their disability. Painting a realistic recovery map, including potential setbacks, will help employers and injured workers deal with recurrent absences and plan for a better outcome. No one wants to be blindsided, particularly when your business or finances are at stake.

Making RTW work
Undeniably, a failed return to work attempt can be discouraging. Sometimes it’s difficult enough to convince an employer to offer modified duty to an injured worker, let alone when the first attempt is viewed as a failure. Throw in a re-injury or aggravation while the injured worker is on modified duty and you’ll really be fighting an uphill battle.

I recall the level of anxiety I had as a claim representative when I was about to have a persuasive return to work conversation with a reluctant employer. You know the kind, in your initial conversation they emphatically informed you that “this is construction, there’s no light duty in construction.” I felt as if I had one shot to get it right, to sell my point, and convince the employer to offer a job. Just like asking someone to a high school dance– the stakes are high and all you want to do is get it right because if you say it correctly, there’s no way they could possibly say no, right? While hopefully the risk of public humiliation is irrelevant, the true consequences of failing to secure a job offer are ongoing TTD, vocational rehabilitation, reserve increases due to delayed recovery, etc.

Seldom do we consider the consequences of a failed return to work attempt for an injured worker. Some of us may believe we would have the wherewithal to pick ourselves up and dust ourselves off in the face of a work injury. In fact, I believe most people who haven’t experienced a work injury feel this way. An injured worker returning to modified duty will likely still have some level of residual pain, making them fearful of doing too much or moving the wrong way. Layer in a poor working relationship or an employer who accuses the injured worker of “faking” an injury and it’s no wonder there’s some apprehensive.

In 2005, researchers interviewed six injured workers about their experiences with the workers’ compensation system after sustaining a lost time claim. They found four recurring themes:

  • possessing little knowledge or understanding of their recovery process
  • lacking supported during the claims process
  • unsatisfying return to work opportunities that result in a negative experience
  • experiencing poor treatment from co-workers and supervisory staff

RTW Impression Management
What can we do to manage the RTW process, even when it doesn’t go as planned? It is important to understand why the return to work, well…didn’t work. Did the modified duty not fit the restrictions? Were the restrictions too liberal? Was the injured worker asked to do work outside of his or her restrictions? There are solutions to each of these challenges. Reduced hours, job rotation, or assistive devices are just a few examples, but any challenge can usually be met with open communication.

There are many delicate points in the RTW process. Setting reasonable expectations about how the process will likely go and how it can go wrong are part of an honest conversation that needs to transpire. Doctors and nurse case managers should be communicating realistic recovery expectations based on the injured workers’ unique situation. The details are what will help prevent recurrences of disability. Claim representatives should prepare employers and injured workers for potential setbacks. One of the biggest fears that injured workers have is that the insurance carrier, or their employer, is going to force them back to work before they are ready. Employers are reluctant to bring injured workers back because they think a re-injury is inevitable.

Returning an injured worker to modified duty isn’t always going to happen in a straight line. Just like a drawing done by a two year old, it’s not always going to be pretty, but we should take the time to appreciate the effort and respect the process. Sure, it might not look like a the ceiling of the Sistine Chapel, and a job offer letter may never be referred to as art, but anyone who has managed a return to work challenge will likely tell you it is an art that requires skill, practice and persistence. If at first you don’t succeed, try, try, and try again…

About Sarah Tayts
Sarah Tayts is the Return to Wellness Specialist for Eastern Alliance Insurance Group (EAIG) and oversees the company’s ecovery® program. As a RTW Specialist, Sarah works directly with EAIG clients, team members and agency partners to find effective and productive modified duty solutions. She also maintains the ecovery® blog, conducts webinars and uses other social media outlets to educate stakeholders on RTW best practices and benefits of RTW programs.

She graduated from Millersville University in Millersville, Pennsylvania with a Bachelor of Arts degree in Psychology and from the Chicago School of Professional Psychology with a Master of Arts degree in Industrial/Organizational Psychology with a concentration in Organizational Effectiveness. She has also earned the Associate in Claims and the Associate in Risk Management designations.

About Eastern Alliance Insurance Group
Founded in 1997, Eastern Alliance Insurance Group (EAIG) is a specialty underwriter of workers’ compensation products and services for businesses and organizations in the Mid-Atlantic, Southeast, Midwest and Gulf South regions of the United States. EAIG’s ecovery® is an exclusive program that helps return injured workers to wellness and productivity by using work as a therapeutic tool. EAIG has offices in Lancaster and Wexford, Pennsylvania; Charlotte, North Carolina; Carmel, Indiana; Franklin, Tennessee; Richmond, Virginia; and, Madison, Mississippi. EAIG’s Web address is

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