By Dara Barney
For Peter Federko, CEO of Saskatchewan, Canada’s Workers’ Compensation Board, the concept of returning an employee back to work after an injury really does start with the injured worker, but doesn’t end there.
“How do we get the people who have already bought in to the idea of return to work, and how do we get the people who aren’t there yet to understand why this is good for not just the injured worker, but the employers, caregivers, insurance companies, regulators/legislators and attorneys too?” He asked in multiple International Association of Industrial Accidents Boards and Commissions (IAIABC) Disability Management and Return to Work Committee meetings involving people from all over the world, a committee of which he is chair.
The answer wasn’t simple. It involves a 127-page comprehensive paper published last spring intended to raise awareness and engage stakeholders in further dialogue around the importance of this issue and explain what's in it for them from different international perspectives involved in the project’s makeup. The title is officially “Return to Work: A Foundational Approach to Return to Function,” which includes appendices that provide samples of what is considered best practices from within the United States and beyond.
In an exclusive interview with WorkersCompensation.com, he answered the very first question: “What is up with the title?”
“So we (IAIABC Committee) decided to undertake the project of this paper to engage all players and actors in the workers’ comp world that should care about the injured worker. It isn’t only about returning to work. It is about returning to day-to-day functions, and not just in the workplace. The injury not only impedes workdays, but home activity as well,” he said. “I could have an impairment, but that doesn’t make me disabled. If we don’t take the steps necessary to return to a functional space, a minor impairment could turn into a permanent disability.”
Each party has a specific set of responsibilities, as described in the paper: “Full reintegration of the injured person is not possible without all the key stakeholders committing to the restoration of health and function of the injured person. This paper will explore some common misperceptions and realities that exist among these stakeholder groups when it comes to return to work efforts.”
The stakeholders include the injured worker, employer, caregivers, insurance company, regulators/legislators and attorneys. Federko described each role to WorkersCompensation.com:
Injured Worker: “Employees at the end of the day make the decision to go back to work or not. They need to be a full participant as the person pushing to have function restored to not just work, but be able to perform tasks at home and carry out activities they enjoy and improve their quality of life.”
Employer: “The employer is the one that has to be willing to accept that worker. We often hear from employers who say they don’t want the injured employee back until they are 100 percent. That is a huge loss, losing a trained individual, at a cost that far exceeds an insurance premium that has to be paid to restore and care for the worker. The employer should be ready and willing with modified duties to welcome the worker back to work. That not only helps the employer, but eases anxiety in the employee, which makes for a more productive and positive workplace environment.”
Caregiver: “The caregiver is the most influential of anyone within the workers’ comp community. They are the first person to see the injured worker, and they’ve taken an oath to advocate and not cause additional harm. The caregiver gets to set the tone with encouragement, and not just prescriptions and time off. If a doctor tells a patient ‘this is the worst I’ve seen,’ the patient will believe it and it will hinder their recovery in a physical and psychological way. If the caregiver’s predisposition is that of a positive one, with ideas on how the patient can improve and continue in day-to-day life, that injured worker has a strong foundation to rely on to move forward.”
BOB BREAK: “Bob Wilson (President and CEO of WorkersCompensation.com) tells a story about a surfer, Bethany Hamilton,” Federko said. She is the 27-year-old “Soul Surfer” who lost her arm at 13 in a shark attack. “The doctor not only gave her a list of things she couldn’t do, but a list of things, much longer than the first, of things she could do,” Federko said. To read Wilson’s 2013 blog post on Hamilton, click here.
Insurance Company: “It is a little different in Canada vs. the United States, but there are similar responsibilities and tasks. In Canada, all the players come to us (Saskatchewan Workers’ Compensation Board). We facilitate all the roles: Reporting, registering, premium assigning, etc. We have duties as the facilitator to not only make contact with the injured worker but be there to aide in early and safe return to work strategies.”
Regulators/Legislators: “The regulators/legislators set the tone. Without the workers’ comp system, people fall into a Social Security system paid by taxpayers, and then tax revenue is lost because people aren’t working anymore. Simply administering legislation reformed to reduce the cost of the system without regard to the actual purpose in assisting in getting the injured person back to work is not the role regulators should play. They need to charge the workers’ comp industry with that responsibility, similar to Montana Texas, Oregon and Washington where that support is incentivized. At a minimum legislation or regulation ought to make it clear that returning workers to work is a fundamental responsibility of the compensation system."
Attorneys: “Attorneys should become advocates and lobbyists for return to work. They should be less focused on monetary settlements and more focussed on getting the workers back to work thus helping from a legal perspective. Wilson has talked about this culture change by renaming workers’ comp to ‘workers’ recovery.’ We are all on the same page that a cultural change is necessary (attitudes and behaviors) with respect to return to work. Each player in the system has to do their part to bring about this cultural change and it will take more than simply changing the name of the system. Attorneys should be pressing for return to work and not just a settlement — there is more than money at stake here.”
As noted in the paper, “Workers are sometimes perceived as malingering, not interested in returning to work or function, or even seeking fraudulent opportunities. The reality is that workers often return to function, and work, before the insurance carrier is even aware of the injury. Workers, in most cases, receive reduced compensation from the compensation or social systems, compared to their pre-injury wages, and would like to get back to work at full pay. Workers also desire to be contributing members of society and their communities.”
With that, WorkersCompensation.com asked Federko about hindrances, and how it contributes to the return to work and return to function systems.
“Opioids, personal motivation, unnecessary delays, complex processes, fear of re-injury, employer’s perception of the malingering worker, psychological setbacks, communication issues, etc. are main hindrances that can create some real barriers. Each person, as mentioned in our workers’ comp roles, are important to this system,” he said. “Not any one by itself contributes to derailing this system, but a few of them tied together can create some real damage. If the healthcare provider is telling you ‘it is the worst they’ve ever seen,’ the employer thinks the employee is a dirty-rotten scoundrel feigning an injury for money and time off, and the lawyer is only focused on getting the most money possible, it won’t be good. But if the employer puts the worker at the center as the main focus, and the other roles contribute as they should, we can get more employees back to function, back to work.”
According to the paper, “Research shows that returning to work speeds up the injured worker’s healing process, and therefore it is in the best interest of injured workers to proactively pursue return to work and function (Waddell & Burton, 2006).”
In speeding up the healing process, and writing this paper on getting the workers’ comp industry back on track in returning to work and returning to function, WorkersCompensation.com came to the near-end of the interview with this question: “What are the main themes of the paper?”
“The first is that there is a lot of room for improvement with respect to the return to work process from an economic and human perspective. Everyone needs to want to be an active participant in this. We all need to understand our roles, and why we should care about this. It ultimately will save money, it will save families from grief, it will make the system better and society as a whole better. The possibility is out there: anyone can get hurt at work.”
When asked to convey the three most important messages of the paper, Federko answered: “Read and talk to people. Go to different conferences, like IAIABC and have conversations with everyone involved in the industry,” he said. “Engage with each other about the system, and how we can improve it to prevent unnecessary disabilities.”
