Tuesday, January 7, 2014

The Misguided Conversation

This post is going to draw me some fire, but that's what my job is as the Disinterested Observer. If you think you might find offense in what I'm about to say, then that's fine. Just don't overwhelm me with hate mail (or hate postings to this blog!) because you're not going to convince me to change my opinion.

Here's the bottom line - Return to Work has no place in workers' compensation.

Note: This system is called workers' COMPENSATION.

It is NOT called workers' Return to Work.

All of the conversation in work comp about RTW is Bovine Excrement.

There, I said it. And I'll repeat to make sure you understand: RTW is Bovine Excrement in the context of workers' compensation.

Sure, there is some merit in RTW programs - I'm not attacking that. The fact is that IF you can get the injured worker back to work faster then there are great benefits for both the worker and the employer.

But somewhere along the way in the world of risk management we got steered toward thinking that the end all, be all outcome for a workers' compensation case is RTW.

It isn't and neither you, nor I, nor anyone else can do anything about it.


Because RTW requires two elements that do not necessarily and in fact typically don't align: a worker who WANTS to and CAN go back to work AND an employer who WANTS that worker back.

Both elements are requisite and they must occur simultaneously - there can be no RTW UNLESS both elements are present at the same time.

What are the motivations? We can not control the feelings of either the employer or the employee. We can not control why an employee may not want to work for a certain supervisor or company. We can not control why an employer, a supervisor, or whomever makes the decision, does or does not want an employee any longer.

I am reminded of a case that I had written about before involving a United Airlines mechanic. Vern had all sorts of workers' compensation issues, but most of all his issue was psychological (or perhaps psychiatric). Regardless, he felt that the people at United Airlines were out to get him. And the management at United felt that Vern was dangerous and didn't want him around any longer lest he create an even greater risk.

Working at UAL

While an extreme example, it is obvious that any attempt at an RTW program would be completely wasted on Vern.

I'm not saying that RTW programs are useless or don't have a place in workers' compensation, but the conversations I've observed over the past decade or so focusing on the job of RTW are misplaced. RTW is NOT the job of workers' compensation.

Again, it is workers' COMPENSATION. I don't like the term "workers' compensation" because it directs attention to money, but regardless, it does describe what the system really is all about when you really get down to it - money to workers for either medical treatment or just to give out money in some sort of organized (not necessarily logical) manner.

In the workers' compensation industry we have a singular job: provide medical treatment and money.


Yep, RTW can reduce the money part of the equation, and maybe a part of the treatment equation. But RTW is a compensation reduction technique. It is not the end goal of the game. It is only one element in a complex equation that we use to determine what the allocation of resources will be.

In the end our job is all about COMPENSATION. It is wealth redistribution on a basic scale, if you will.

Flame me. I'm fine with that. Then ask yourself how many times dedicated RTW programs have actually resulted in someone returning to work and staying there.

There's a reason why California got rid of vocational rehabilitation, and then RTW bonuses/incentives and penalties tied to permanent disability indemnity - because they don't work.

Use your RTW program discriminatingly. Subjecting everyone to that process is a waste of time and resources.

Flog me now...


  1. RTW programs vary wildly from state to state and from company to company. Fact of the matter, both the company and the employee must have the want/need to RTW, your right. Many statutes have been written around the exception,...yawn. When you compare Sally the soccer mom and Carl the carpenter who have the same injury, resultant surgery, recovery etc., the goal is they both can return to pre-injury activities and life as they know it, yes? Yet, they both are treated differently within the same medical and social systems. Why is my question? We could drone on about 66% of pay vs. 100% at RTW rates, disability payments, no payments for Sally but I would rather discuss not WC as a stand alone program, rather, as a piece of our integrated healthcare system.

  2. You're right De Paolo, you're behind the times, the appropriate acronym and terminology nowadays is SAW "Stay At Work" not Return to Work. That implies of course that they missed work to begin with :)

    I tell my clients all the time, we can (for the most part) care less about whether an EE returns to work, since CA WC has no requirements that an EE be RTW. However be careful of that positions, alas your WC claim segues into Employment/Civil law...for failure to address accommodation. How much are EPL claims SIRs? $25k+ nowadays...You're right, SAW/RTW is purely a cost/risk technique, but one that can save more than just WC premium dollars!

  3. As a practitioner representing injured workers in New York I appreciate the clarity of your thoughts. RTW has a role to help people, but the system of workers compensation is about the great trade off -- quick (reliable :)) medical care and some type of lost wage for a period of time. I am all for trying to get my clients to return to some form of productive employment - however as you so sharply noted - Return to Work is NOT the function of any of the workers compensation systems. In fact, if you look at the 2007 reforms in New York to me the greatest waste of effort was the return to work committee created as part of the reform -- IT NEVER MET!!!! How can I assure my clients that they should try to get back to work when there are no guidelines and no guidance from 'the system' - anyway -- I think that as a tool RTW or as the other commentator said SAW is helpful, but it should not be part of the decision making process affecting benefits. I also believe that educational efforts (or risk management or whatever we call it) can help all parties involved. thanks for making the post

  4. I do feel that a lot of time and money are wasted on parties that aren't on the same page, but I also feel that part of my job as a work comp practitioner is educating both the employee and employer on the benefits of RTW as quickly as is safely possible. Too many employers assume that the injured worker is going to automatically want to be out as long as possible and is looking for an angle to work, and too many employees assume that the employer is going to try to give them the shaft. There are a lot of preconceived, jaded assumptions in the work comp industry, and I feel part of my job is to help get past those.