RETURN-TO-WORK BEST PRACTICES 

ARAMARK Corporation: Focus on Empathy and Communication 

If a return-to-work program is to be successful, the driving forces must be empathy and communication with workers, according to Marshall Sherman, a risk manager with ARAMARK Corporation. Sherman stated that risk and human resources managers who can effectively communicate with employees will find that their return-to-work rates increase, their premiums go down, and their workplace becomes more productive. 

As director of risk management for ARAMARK, Marshall Sherman oversees a workforce of more than 90,000 domestic employees, most of whom are minimum wage earners. One of the country's largest privately held corporations, ARAMARK is involved in food and support services for school campuses across the country. The company generates over 6.5 billion in annual revenue, which is growing at a rate of 10 percent a year. 

With such a large workforce, Sherman is well aware of the potential for disaster with workers' compensation. Just a few years ago, his company was paying out huge sums in workers' compensation premiums. Today, largely due to the rollout of his workers' compensation program and managed care network, his company has seen cost reductions in the millions. 

Treat employees as friends, not adversaries. Summing up the philosophy behind his workers' compensation program, Sherman stated that the employer's attitude towards employees is all-important. If you think your employees are going to cheat you, then they will cheat you, Sherman stated matter-of-factly. On the other hand, treat your employee as a friend, not an adversary, and it will reduce your workers' comp costs, he asserted.

Among other things, the employer should explain the nuts and bolts of the workers' compensation program, Sherman advised. This means extensive education and training in all aspects of workers' comp, safety, and return-to-work. Employees should also be familiar with the workers' comp managed care network.

At ARAMARK, risk managers candidly explain to employees that if they're injured on the job, the company will pay their medical bills and may even replace their wages. Don't make it a mystery as to how the workers' comp program works, Sherman stated. If the employer doesn't tell them up front where their benefits are coming from, the employee will get the information from someone else--most likely an attorney.

Don't focus on bogus claims. Sherman debunked the myth that discussing the benefits of workers' compensation will only encourage employees to file bogus claims. He stated that employers focus too much on the bogus claims, noting that ninety-five percent of claims are legitimate. Don’t focus on the 5 percent that are bogus. That attitude is going to work against you, he advised.

At ARAMARK, Sherman also emphasizes quality medical care through the managed care network. This includes contact from the employer throughout the medical care. Accordingly, Sherman encourages his managers to stay in contact with the injured worker and show concern for them from the time of injury through the return-to-work. When an accident occurs, for example, someone immediately drives the worker to the doctor. If no one is available to drive the worker, he is taken to the doctor in a taxi. Sherman advised other employers never to assume that the worker could get to the doctor. They should consider it the company's job to assist the worker in obtaining medical attention, he stated.

Demonstrate concern. At ARAMARK, contact and concern do not stop at the doctor's office. After the initial doctor visit, a manager contacts the workers the same night to find out what happened. Among other things, the manager will ask the worker, “What did the doctor say?” Did you know we have a return-to-work program? All of this is designed to keep track of the worker’s claim and make sure that proper medical care is provided, as well as to demonstrate concern for the worker’s well-being. It’s amazing, when someone sprains their ankle on the weekend, everyone sends a card. But when a worker is injured on the job, no one seems to care, Sherman observed.

Case management. Sherman stated that a nurse case manager is assigned to every claim and maintains contact with the injured worker. The nurse explains to the worker what to expect from the system, and also explains to the doctor the company’s return-to-work program. “Don’t leave it up to employees to explain the return-to-work program to the doctors,” Sherman advised.

The ARAMARK program places special emphasis on making sure that the managed care network is accessible to employees. Other employers, Sherman advised, should make sure that the right doctor is nearby. A fifty mile drive to the doctor in Wyoming is no big deal; the same 50 mile drive in L.A. would be unreasonable, he commented. When medical care is not accessible or is inconvenient to employees, the employer loses.

Step into worker’s shoes. At ARAMARK, managers are encouraged to find out for themselves how workers are treated at the clinics. To foster this empathetic attitude, the company sends its managers and supervisors down to the clinics to check them out and ask whether they (the managers) would like to be treated there. Managers are encouraged to consider issues from the employee’s point of view. They should ask, “Is the doctor’s office too far away from work?” “Would I go there?” “How long did I have to wait?” “Was it clean?”

Noting that the ultimate goal of workers comp is return to productive work, Sherman stated that as soon as a doctor lifts restrictions, the employee is returned to light duty. If the department cannot support the employee in a light duty position because of a financial burden, the manager is encouraged to take advantage of Sherman’s Marshall Plan.

According to The Marshall Plan, department heads are informed that the expense of carrying the employee on light duty will be picked up at the corporate level, if the manager demonstrates a financial need. That not only provides for consistent application of the return-to-work program, but also demonstrates a strong commitment on the part of upper management.

Sherman added that the company does not place a time limitation on return-to-work. But, he stated that it is important to get the right doctor, one who progressively brings the worker back to work at a higher capacity. Managers should also review the employee’s condition at least every two weeks. If doctors are not cooperating with you, if they Don’t want to give you the information you re looking for, pull the plug, he advised. Find a doctor who will work with you.

As proof of the success of his program, Sherman noted that a few years ago, his company had 75 medical only claims for every 25 lost time claims. Today, the medical only claims stand at 82 percent and the lost time clams are down to 18 percent. That is a remarkable trend, considering the growth of his company.

To keep the program fresh, Sherman rolls it out every so often. And each time, he reminds his managers of the underlying philosophy of the program: Look at workers comp as an employee benefit and treat it that way. If everyone does his job properly, there’s no need for an attorney. Above all, he says, “Don’t let the employee get lost in the system, and always communicate. If you have the trust of your employees, you can do wonders. But you must earn that trust.”

Tricon Global Restaurants: The Hot Buttons of Success

The importance of communicating about workers’ compensation--whether it’s with managers, supervisors, or employees--cannot be overestimated. Chris Mandel, a risk manager with Tricon Global Restaurants, believes that an effective workers comp program requires good communication, as well as an understanding of who the employees are and what they expect from their day-to-day work. In his experience with Tricon, Mandel has identified certain hot buttons of success that should aid other workers’ compensation managers in their ongoing efforts to effectively communicate.

Tricon is a purveyor of fast-food. Kentucky Fried Chicken, Taco Bell, and Pizza Hut are all part of its empire. A recent spin-off from Pepsi-Co, the company has 500,000 employees in more than 80 countries and 45 states. The company has 30,000 stores located around the globe, approximately 40 percent of which are company owned; the rest being franchises. It generates $11 billion in annual revenues.

According to Mandel, communicating important issues regarding safety and workers comp presents a unique challenge to store managers. For one thing, the workforce is made up of mostly hourly workers, many of whom are part-time. And turnover each year is 100 to 200 percent of those hourly workers. The significant turnover rate makes communicating important policies and information a particular challenge.

Workers comp is a strong focus. With 20,000 claims per year, much of Mandel’s communication and other efforts are focused on workers’ compensation, including an aggressive return-to-work program in each brand. His communication efforts are paying off, too. A few years ago, workers comp was 70 percent of the company’s total risk. Today, it’s more like 50 percent. In addition, the company had $100 million in annual losses from workers’ compensation claims; today, that figure has been reduced to $46 million. The success of the workers’ compensation program is borne out by the fact that less that 20 percent of the cases are lost time cases (30 percent is typical for most firms).

According to Mandel, the hot buttons to a successful workers’ compensation program are as follows:

1. Senior management buy-in. Senior management must be on board if a program is going to be successful. This is critical to the success of all risk management communications. People must realize that the top cares about them. Must be a part of the culture, if not the strategic plan.

As any workers comp executive knows, obtaining senior management buy-in is not always easy. The program must be based on information that is both relevant and quantifiable. In other words, before senior management will sign off on a program, they want to know what the bottom line is, what the financial impact of the program will be.

That last point underscores the importance of a good data system. According to Mandel, You need a system that is capable of taking your data and providing you with meaningful numbers and charts so people can see what the impact of claims are, or what the savings with a return-to-work program are. But even without data, you have to convince senior management of the need to set new priorities for safety and workers comp.

2. Supervisor training and communications: The key here is continuous reinforcement. It's a timing issue--tell people what they need, when they need it, Mandel stated. We have an average of two claims per store, so the average manager doesn’t deal with workers comp that often. But we have to get them the info when they need it. That’s the critical part. For Mandel the objective is to communicate in a timely, simple, and clear way.

Mandel added that supervisors want to know what’s in it for me? The best way to convince them of the importance of the return-to-work program is to tie it in to the bottom line. You need to get their attention, and the best way to do that is to make a connection between comp claims and the store’s profit and losses.

3. Hourly employee training and communications: Mandel tries to make safety issues fun and interesting, using techniques such as safety incentive programs. He noted, however, that the fast food business has a very young workforce, which presents a challenge to anyone trying to communicate a message like the importance of job safety. I find that the employees we have out there have short-attention spans, he commented. Undaunted, Mandel tries to fit his message to the audience, establishing what he calls an MTV culture. Whatever approach is adopted, Mandel stated that the objective is to communicate a concern on the part of upper management for the safety and well-being of employees.

4. The issue of churn: At Tricon, turnover is an astounding 100 to 200 percent a year. Obviously, this calls for continuous re-communication and reinforcement of basic principles. Ultimately, the restaurant manager holds the key, he said. Get them effectively trained and it will take care of many problems down the road. They have the most stability. So despite turnover, the supervisor understands the importance and will communicate it to the new employees.

5. Accountability: Tricon encourages its restaurant managers to act like owners. To encourage that attitude, Mandel stated, Tricon gives each store manager a piece of the action, a certain amount of company stock. Another means of making managers accountable, he stated, is tying their performance to key long term strategies. At end of the day, it’s critical to tie performance to profit and loss, he said. Managers bonuses, therefore, hinge on the profit and loss of the store.

6. Measurement: Involve operators in measurement design. Mandel stated that employers should give managers timely and accurate data measures. Use ranking and comparisons. Store managers always want to know how they are doing vis-à-vis their peers, Mandel stated. They like to compete on all levels, including comp. Noting that terminology can often obstruct good communication in this area, he suggested that the financial and other performance measures be made user-friendly. Change the lingo from incurred losses, for example, to lingo that they can understand.

7. Coaching and supervising: People like advice and counsel, Mandel stated. What they Don’t like is someone telling them what to do or monitoring their performance. At Tricon, coaches are sincerely interested in both the work and the people who make it happen. They recognize successes and guide managers toward success and away from failure. But when failure occurs, they deal with it. He noted that the company relies on the sports analogy, considering members of the team to be coaches who are building and supporting teamwork and team results.

8. Keeping it fresh: Repetition helps reinforce messages, Mandel stated, but it can grow stale over time. He stated that effective communication requires creative design and execution. The manager should tailor the message to the person receiving it; strive to deliver the message in a way that is calculated to involve the receiver and the sender. He suggested that the managers team up with training, operations, and other messengers to keep the message aligned with the organization, its culture, and overall strategy. He cautioned, however, that not everyone is going to be as creative as you want them to be

Deloitte & Touche: The Reasons for Success and Failure 

Why do some return-to-work programs succeed and others fail? That question prompted many insights from Steve Beigbeder of Deloitte & Touche, LLP. In his career as a employer consultant, Beigbeder has distilled several important elements from both successful and unsuccessful return-to-work programs. 

Beigbeder stated that return-to-work is probably the most dreaded area that we face in workers comp. He noted, however, that it is critical to master the components that make up an effective return-to-work program--and to avoid the pitfalls that lead to an ineffective program. A strong return-to-work program can have a significant impact: successful programs have lowered costs and premiums for many employers and helped to create the soft insurance market. 

Even if return-to-work is not an issue for an employer now, it soon may become one. Statistics from the Social Security Administration estimate that disability costs will increase 37 percent over the next decade, largely as a result of the aging baby-boomer population. In addition, overall costs for disability have been steadily increasing at a rate of 8 percent a year since 1990. All told, the cost of occupational and non-occupational disability is estimated at well over $200 billion dollars a year. 

The Do’s 

According to Beigbeder, the essential ingredients to a successful return-to-work program are as follows.

 ____ 1. Ensure an immediate response. Ideally, when an injury or illness occurs, the injured worker’s direct supervisor should immediately contact the worker. The supervisor should show concern for the worker and explain what to expect from the workers comp system. Employees are used to responding to the supervisor, and they’ll appreciate getting some directive from them, Beigbeder explained. It’s also important for employees to know that their injury is important to the supervisor.

 ____ 2. Establish a strong relationship with the medical providers. Beigbeder advised that employers take advantage of whatever medical programs are available. At the very least, establish a face-to-face relationship with the medical providers. He added that managers should tour the medical facilities and have the doctors tour the employer’s facility. Know who will be working with the employees, he stated. And make sure the medical providers understand your goals and expectations.

____ 3. Always investigate the accident. Beigbeder emphasized the importance of investigating every accident. It can be demoralizing to employees to see how accidents go un-investigated. It’s hard to imagine a better way of demonstrating a lack of concern on the part of the employer than disregarding the cause of an employee accident.

____ 4. Make expectations known to everyone involved. Beigbeder stated that it is important for the employer to clearly communicate its expectations. He noted, for example, that the claims manager may be juggling 200 cases, which will obviously impact how much attention individual cases will receive. The employer should know what is going on with each of its cases. If employees are waiting too much time for medical care, for example, the employer should know about that and take remedial action. Otherwise, employees get the impression that the employer is simply unconcerned.

____ 5. Have your return-to-work system in place. Employers should have their systems worked out in detail: who makes decisions, what the expected time lines for return-to-work are, and who reports to whom. Also, make sure that light or modified duty jobs are available. Statistics show that many employers have return-to-work programs in place, but fail to have jobs available when the worker is released for light or modified duty.

____ 6. Take a cue from the ADA. Beigbeder stated that the ADA has helped employers understand the need to write good job descriptions. A good job description--one that includes the physical requirements of the job--makes the doctor’s job a lot easier, he explained, because it allows the doctor to concentrate on the medical issues. To say, must have computer skills, doesn’t help. You must have specific descriptions. Beigbeder noted that many companies are videotaping someone performing the job. This can be a great substitute. It’s a lot cheaper than having the doctor inspect the job.

____ 7. Draft a clear statement of policies and procedures. Make sure all constituents understand their responsibilities. If a union is involved, its responsibilities should be outlined in the program. The excuse of I Don’t know what to do, should not be an acceptable response.

The Don’ts

While the above points are the hallmarks of successful programs, Beigbeder also outlined a number of pitfalls that employers should avoid. 

____ 1. Don’t make the program punitive. A punitive program accomplishes nothing, Beigbeder asserted. He cited a company’s policy that required employees on light duty to paint a waist high line around the facility. When the task was finished, the worker had to do it again--until the worker was able to return to full duty. Such policies only end up hurting the employer, he said.

____ 2. Don’t apply the program inconsistently. Whether an employee is injured at work or at home, the return-to-work program should apply across-the-board, Beigbeder explained. Disparity in treatment helps fuel the suspicion between workers comp and disability, he said. Employees wonder why they get time off for a non-work injury, yet must report to work as soon as possible after a work-related injury.

____ 3. Don’t assign sedentary work. If the doctor doesn’t prescribe sedentary work, Don’t assign it, Beigbeder said. The employer should concentrate on assigning active work. Get employees back in their department doing their regular work, with their usual co-workers. Keep jobs as physically challenging as the doctor will allow, but Don’t go overboard, Beigbeder advised. Employers, he stated, should not exceed the doctor’s restrictions. As soon as you lose the doctor’s confidence, you better look for another doctor.

____ 4. Don’t fail to update the doctor’s restrictions. Don’t go more than two weeks without having the doctor see the employee again and update the restrictions. He suggested that the employer should ensure that the employee is making progress. As adjustments are made to the employee’s medical restrictions, the job should be tailored to the new restrictions. 

Continuing on this point, Beigbeder suggested that if the doctor provides unrealistic restrictions, the employer should get a second opinion from an independent medical examiner. But, be sure to let providers know what the job is, so they can establish adequate restrictions. Otherwise, the only information they are getting is from the worker. To illustrate this last point, he cited as an example an employee who told her doctor that her job was mixing cement. Considering her job, the doctor took her off work. The employer called the doctor and said, we re a jewelry manufacturer: she mixes cement in a Dixie cup. 

In addition to the above guidelines, Beigbeder stated that employers should develop an underlying philosophy to their program that focuses on people issues. Look at how workers are affected by the program. If employers can do that, they will find that a lot of borderline cases will not be filed as comp, he stated. Combined with the fundamentals above, such a philosophy should help employers achieve more successes and less failures in their efforts to return workers to productive work. 

Workers Transition Network: Counseling And Nonprofit Work 

According to Steven Smolinsky, a return-to-work specialist with the Workers Transition Network in Pennsylvania, most employees want to work, even those who have been on the disability rolls for years. They’ve just lost their drive because of the devastating effects of the work injury, not to mention the turbulent atmosphere surrounding the typical workers comp claim. At a workers comp conference in Chicago, Smolinsky discussed how the Workers Transition Network, an enterprise specializing in return-to-work, has achieved remarkable success in this area using non-profit work and intensive counseling of injured workers. 

Joined by Leah Brecher-Cohn, a counselor at the Workers Transition Network, and disability management consultant Richard Lewis, Smolinsky explained that to understand why these workers are not in a rush to get back to work, it is important to understand the downward spiral they travel when injured. These are the psychosocial factors affecting return-to-work which Smolinsky summarized as follows: 

• The pre-injury phase: Before the injury, employees typically have personal and professional relationships at work, which gives them a sense of value and self-worth. Equally important, they have control over their lives. 
• The injury: When a worker is injured, everything changes. They immediately develop a fear of being disabled. They also become disconnected, losing the relationships that have sustained them on a daily basis. They lose trust for and become angry with everyone whom they perceive as having contributed to their condition. 
• Post-treatment phase: The worker’s condition is often exacerbated during this phase. If they were a little depressed before, they become much more depressed. They often lose direction and have trouble moving on with their lives. 
• Re-employment phase: For the Workers Transition Network, the key focus is on the re-employment phase. By providing the worker with a positive work environment and intensive counseling, the program is designed to break through the negative factors outlined above. 

According to Brecher-Cohn, the key component is the interim employment with a non-profit organization. Overall, the goal is to get the employee working full-time--to stoke the worker self-esteem and re-establish their work ethic. 

The Network focuses on non-profits in the worker’s own community. In that way, the worker begins to feel valued by giving back to their community. Workers are placed with non-profit groups like Meals on Wheels, the Red Cross, the American Cancer Society, and the American Lung Association.

Although the non-profit placement is the Network’s primary innovation, their program has several other important elements: 

• The individual assessment: The program begins with an assessment of each injured worker by a personal counselor. The counselor looks into the worker’s case history and physical restrictions and then makes a vocational assessment. The emphasis is on what jobs the employee would like to do, given their medical restrictions. 
• Counselor involvement: The counselors assume that the employee wants to get back to work. To develop trust with the worker, the counselors listen to the worker’s story and become their advocate. Although the employer or insurer pays the Network, the counselors perceive themselves as working for the employees. 
• Career planning: The crux of the program is helping the worker develop realistic expectations, as well as a specific job search plan. The counselor discusses job prospects, considering all possible leads--from the employee’s church, their friends, their neighborhood, etc. The worker records everything in a personal booklet, a collection of notes on job prospects and contacts. 
• Permanent placement: While the non-profit job is a smooth transition, the ultimate focus is on permanent paid employment. To that end, the Network helps employees with the specific task of finding a paying job. Significantly, 70 percent of these cases result in full re-employment. 

The program works in unintended ways, too. Smolinsky recounted setting up the program at a manufacturing company that had 30 employees who had been on disability an average of two or more years. Before the program was even begun, they obtained seven settlements and four miraculous cures. Overall, the program was a huge success, cutting costs in half. 

A 20-year veteran of disability management, Lewis confessed that he was initially skeptical of the program, assuming it was just another workers comp rehab program. But he said the program s cachet is the intensity of the personal counseling and the use of the non-profit interim employment. The program works because it supports a work environment that is real, Lewis remarked. The results are so much different than I’ve seen in other programs, that I have to believe there is something remarkable about their program.