Edition 2
April 2002

Texas Workers' Compensation Commission
Return to Work
Medical Review Division

Sample documents are intended as examples only. The information contained in this document is intended as a resource only. It is not meant to substitute for legal advice.

Employers may want to consult legal counsel, their workers' compensation insurance carrier, or other experts when establishing policies and procedures or when making decisions related to any individual situation. It is important to note that there may be other state and federal laws that also apply.

Inclusion of any sample in this document does not constitute recommendation by TWCC for use.

For additional information or questions, please contact Pat Crawford, Return to Work Education Coordinator, Texas Workers' Compensation Commission, at (512) 804-4804 or pat.crawford@twcc.state.tx.us or rtw@twcc.state.tx.us.

Early return to work following an injury helps control costs directly related to the injury and reduces the potential impact of the injury on the employer’s business as well as on the injured worker’s life.

Studies show that injured workers who are allowed to return to productive work as early as possible following an injury heal faster and better than those injured workers who remain off work. Injured workers who return to work during their healing period tend to require fewer medical treatments and incur less medical expense related to the injury. Work becomes part of treatment and rehabilitation and allows the injured worker to take an active role in his or her recovery.

Having an established and proactive return to work program provides employers with effective tools for managing workers’ compensation costs and the business costs related to lost time. Developing and integrating an early return to work program into routine business operations prepares everyone ahead of time in the event of an injury. Early return to work becomes an expectation for both employers and employees.

Texas employers are required, on written request of the injured worker, a doctor, the insurance carrier or the Commission, to notify the employee, the employee’s treating doctor, if known to the employer, and the insurance carrier of the existence or absence of opportunities for modified duty or a modified duty return to work program available through the employer. If those opportunities or that program exists, the employer shall identify the employer’s contact person and provide other information to assist the doctor, the employee and the insurance carrier to assess modified duty or return to work options.

The Texas Workers’ Compensation Commission (TWCC) is providing this information as a resource for employers who wish to develop a return to work program suitable for their own company or business. Along with general information about early return to work programs, this document includes a basic program outline and sample documents that can be adapted to meet the specific needs of any workplace regardless of the number of employees.

Samples included in this publication are intended for use as reference documents. Inclusion does not constitute any specific recommendation by the Texas Workers’ Compensation Commission.

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Having an established consistently applied early return to work program provides employers with the opportunity to significantly reduce workers' compensation costs. Lost time injuries are the most expensive injuries, with costs increasing every day that an injured worker is not able to work. An early return to work program can significantly reduce costs and improve productivity, safety, and employee morale.

Employers in Texas pay the highest medical costs associated with workers' compensation in the country. In addition to these costs, it is estimated that lost time due to on-the-job injuries costs employers 4% to 6% of total payroll. Successful return to work programs are reported to reduce workers' compensation costs by as much as 30% to 40%.

Studies show that injured workers who are out of work six months have only a 50% chance of returning to work at all. The longer injured workers are off work, the less likely it is that they will ever return to work. Workers' compensation costs grow as income replacement benefits continue to be paid during the injured worker's absence.

In addition to reducing the likelihood of malingering and of fraudulent claims, the benefits of an early return to work program are many for both employers and employees.

Benefits to the Employer Direct Savings

• Workers' compensation costs are reduced when Temporary Income Benefits (TIBs) cease or are adjusted when an injured worker returns to work;
• Medical and disability costs are reduced and recovery time shortened;
• Decreased loss ratios and experience modifiers help control premium costs;
• Productivity is maintained and human resources are used to the maximum extent; and
• Wage costs for substitute employees are saved.

• Company retains the production of skilled and experienced workers;
• Injured workers continue to contribute to the company;
• No expenses are incurred for recruiting, hiring, training, or salary of replacement workers;
• No overtime is required to make up for lost production;
• Work delays and business interruptions are eliminated when an experienced employee returns to work;
• Communications and relationships between employees and management are enhanced based on the commitment by all parties;
• Co-workers are not required to perform additional duties to compensate for an absent injured worker; and
• The company's interest and concern for employees are reinforced.

• Recovery time is shortened;
• Injured workers remain active and productive;
• Permanent disability associated with injury is reduced;
• Concerns about continued employment are resolved;
• Full or partial wages are earned bringing the injured worker's income closer to pre-injury wages;
• Stress, boredom, and depression from the injury or illness and from being unproductive are reduced or eliminated;
• Injured workers and their families experience less disruption to their lives;
• Loss of physical fitness and muscle tone due to inactivity is prevented;
• Injured workers maintain company benefits and seniority;
• Injured workers maintain contact with and support from co-workers and friends;
• Injured worker maintains job skills;
• Feelings of dependency and lack of control are alleviated;
• Pain and suffering are minimized and overall wellness is promoted;
• Family and social lifestyles are maintained; and
• Reduced accident and injury related costs may help preserve benefits and jobs as well as contribute to an improved work environment.

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Successful return to work is time sensitive. There is a point in time for most injured or ill workers when an appropriate temporary assignment will expedite recovery both physically and emotionally.

Managing employees with work related injuries or illnesses requires an understanding of the behavioral forces that motivate an employee to be a productive participant in the workforce. Normally, an employee who is satisfied with his or her job and employment situation, and who suffers an injury or illness that results in absence from work, is self-motivated to return as quickly as possible. However, even the most dedicated employee’s attitude and outlook may diminish if the person remains out of the workforce for an extended period of time. The longer an employee is unable to work, the more difficult it becomes to return to full duty employment. By providing appropriate productive return to work opportunities, employers can significantly reduce injury related lost time.

Non-medical factors often present barriers to return to work. Issues such as personal fears and anxieties, decline in self-esteem, depletion of personal financial resources, family problems, potential loss of position or status at work, and fear of re-injury can lengthen lost time.

Unfortunately, lost time has become routine and expected even for relatively minor injuries. Injured workers who return as soon as possible following an injury are less likely to become treatment dependent. Unless lost time is medically indicated, it is always better for the employer to make every reasonable effort to keep an injured worker on the job. Monitoring an injured worker’s progress following return to work to ensure appropriate work assignments and adherence to medical restrictions will help with a successful transition back to full employment.

The stage is often set for extended lost time long before any injury has occurred. Training supervisors and managers to communicate sensitively and appropriately can greatly reduce the possibility of adversarial relationships between supervisors and employees that tend to interfere with or delay return to work.

If communication between supervisors and employees indicates mistrust or resentment toward an employee who files a workers’ compensation claim, injured workers are less likely to want to return in a timely manner. For example, questions to an injured worker as to the cause of an injury should be asked without pressure or judgment. Employees pick up quickly on negativity, and that negativity will undermine the likelihood of a successful early return to work program.

Besides emotional responses to an injury, such things as negative relationships with co-workers, disciplinary or pay issues, workload concerns, or job dissatisfaction can delay or interfere with successful return to work. Training supervisors to address disciplinary issues and other difficult situations can significantly reduce the possibility of extended lost time. If an employee has a problem before an injury, the problem is likely to be greater and more costly to resolve after an injury.

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Incorporating these basic elements can maximize the opportunity for a successful early return to work program:

• Commitment to the program by all managers and supervisors;

• Consistent application of the program;

• Emphasis on safety and prevention;

• Immediate medical care following an injury;

• Continuous communication with injured worker while off work;

• Monitoring an injured worker's progress and work assignments following return to work throughout the transition back to regular work;

• Involvement of employees in the development and implementation of the program as well as in determining of their own return to work activities following an injury;

• Continuous education and dissemination of information about the return to work program beginning before injuries occur;

• Review of accident and injury history;

• Development of job descriptions for most jobs that clearly explain essential job functions and tasks required;

• Information to help doctors understand the employee’s regular job, the return to work program, and available alternative assignments;

• Designated person to coordinate the early return to work program, monitor assignments, be responsible for workers' compensation reporting and required record keeping, and communications with the treating doctor and injured worker;

• Compliance with ADA, FMLA, the Texas Workers' Compensation Act, and any other state or federal law that might apply; and Periodic evaluation of the program.

An early return to work program should be simple, realistic, and suitable to the employer’s business needs. Putting the policy and procedures in writing is the first important step.

A written policy statement reinforces the company’s commitment to the program and helps make the expectation of early return to work an integrated part of the company culture. It helps to show that the company values its employees. Written documents provide readily available information helpful in communicating with employees, health care providers and insurance carriers. Having the information in writing ensures that everyone has the same information and helps ensure consistent application of the program.

Write, adopt, and post a policy statement that is brief and broadly written so that it does not require frequent revision. Post the policy statement in an easily accessible place as a constant reminder and encouragement of early return to work following a work related illness or injury. Include statements that do the following:

• Confirm the company’s commitment to the early return to work program;
• Explain the company’s return to work philosophy; and
• Stress the importance of safe operations and prevention of injury.

Write procedures that explain step by step what will happen from the time of an injury until after the injured worker returns to work. Include clearly stated and detailed instructions that identify specific roles and responsibilities. Identify the primary contact person and provide contact information.

Roles, responsibilities, and procedures may vary depending on the program and on other company policies and specific expectations. Provide information such as:

• Who an injured worker should notify in the event of an injury;
• What are the procedures for the injured worker to follow;
• Who is responsible for completing the TWCC-1, Employers First Report;
• Who is responsible for maintaining contact with the injured worker;
• What an injured worker can expect from the insurance carrier, treating doctor, and others;
• How and who determines the availability of medically appropriate work assignments; and
• How the incident is investigated.

• Policy Statement
• Procedures
• Roles and Responsibilities

• Obtain immediate medical attention for the injured worker;
• Follow company requirement for reporting job related injuries and illnesses;
• Complete an incident investigation report.

• Provide a safe work environment;
• Develop written return to work policies and procedures;
• Educate all employees about the program;
• Train employees on proper reporting of incidents and incident investigation;
• Promptly report job related injuries to the insurance carrier;
• Provide information to employees about the workers' compensation system and benefits;
• Regularly communicate with the injured worker during the time away from work and monitor progress upon the injured worker's return;
• Make every effort to develop and provide meaningful return to work opportunities;
• Communicate with the treating doctor and insurance carrier to encourage recovery and return to work;
• Develop functional job descriptions and identify physical requirements that clearly identify physical activities required to do the work.

• Know and follow safety policies and procedures;
• Report any injury immediately;
• If medical attention is necessary, inform your doctor that return to work opportunities are available to accommodate your physical abilities;
• Provide your doctor with a Return to Work Information Packet as provided by your supervisor;
• Notify your supervisor immediately if your work status changes;
• When your doctor releases you to return to work, report on the next regular shift; and
• Follow your doctor’s orders and restrictions at home and at work.

• Ensure proper administration of the all workers’ compensation claims;
• Maintain communication with the injured employee, health care providers, and the employer;
• Encourage and actively assist injured workers in the successful return to work.

• Provide appropriate, effective medical treatment that facilitates recovery and expedites return to productive work;
• Complete and file the TWCC-73, Work Status Report, as required, clearly indicating the employee’s work status and physical abilities; and
• Comply with all applicable TWCC rules and regulations.

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Prior to the initiation of an early return to work program, provide information to all employees, including supervisors and managers, about the human and financial costs of workplace injuries, the benefits of an early return to work program, and their roles and responsibilities.

All employees, including supervisors and managers, must agree that every effort will be made to return any injured worker to work as soon as possible following an on the job injury and understand why that is important. Everyone needs to understand that the return of an injured worker might require what is perceived as "special treatment". Understanding the program will provide reassurance that everyone will receive similar consideration and treatment if they are ever injured. Supervisors and managers should be held accountable for supporting the program and for assisting to provide return to work opportunities as often as possible.

Having an early return to work program does not obligate employers to create unnecessary work or to return an injured worker if there is no appropriate productive work available. Having a program does obligate the employer to try to provide meaningful productive work that accommodates the injured workers’ medical abilities as often as possible. Initiating a program may require new thinking and developing different perceptions of work assignments, such as dividing certain tasks between jobs to free up an uninjured employee to do other work, or temporary transfers to other departments. It is more economical to have a trained and experienced employee working at a reduced pace or schedule than not working at all.

Some employers present the early return to work program as part of their benefit packages. Including information about the program on a routine basis during safety meetings and new hire orientations, periodically reminding employees about the program in newsletters, and putting up posters or using payroll stuffers will help integrate the expectation of early return to work into the basic culture of the organization. Continuous reminders about the program reinforce the company’s commitment to employees and to successful return to work.

Providing information about the workers’ compensation system prior to an injury can be helpful in alleviating some of the concerns and misconceptions of employees. Reassure employees that, if they are injured on the job, returning to work does not impact their eligibility for benefits. Employees should know beforehand that Temporary Income Benefits may be reduced or suspended depending on the amount of earnings they receive for working. Temporary Income Benefits may be reinstated, depending on continued eligibility, if they are unable to continue working or if suitable work is no longer available through the early return to work program. Returning to work does not impact eligibility for medical benefits related to a compensable injury. The Texas Workers’ Compensation Commission has information available on the TWCC website at www.twcc.state.tx.us that will help educate employees about the workers’ compensation system and in communicating accurate information to employees.

Involving employees in the development and implementation of the early return to work program encourages a feeling of ownership of the program and maximizes the opportunities for success. Keeping the focus on safety and the emphasis on early return to work is a joint effort. The program will benefit from having the input of experienced and knowledgeable workers. The result should also be an improved safety record for the company or business.

Employees who are involved are more likely to encourage and accept return to work efforts on their own behalf and on behalf of their co-workers. Employees, supervisors, and managers who help with training and education efforts, reviewing accident history, developing job descriptions, recommending modifications to jobs, and identifying meaningful alternate assignments develop a sense of ownership and responsibility for the success of the program.

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Poor communication or lack of communication is the primary barrier to a successful return to work program. Maintaining
regular communication with the injured worker and with the treating doctor is vital to the return to work process.

Maintaining the Employer-Employee Connection

It is easy for an injured worker who cannot immediately return to work to become "disemployed" or disconnected from his or her employer. The longer an injured worker remains off work, the more probable it is that this detrimental separation will occur. Maintaining the employer-employee relationship with regular communication will help reduce the probability of lengthy lost time.

Coordinate between supervisors and/or the employer's designated contact person to facilitate routine communication during lost time. Expressions of sincere regard for the injured worker's quick recovery help the injured worker feel valued and missed.

Regular communication can include notices about company events such as picnics, awards, and birthdays, and mailing company newsletters and get well cards. Call the injured worker to determine if there are any questions or if assistance is needed.  Telephone calls provide an opportunity to show concern for an injured worker, to encourage the injured worker to follow the doctor's instructions while at home, provide information and encourage return to work.

Helping the injured worker to remain connected to fellow employees and to the workplace can encourage an employee to return faster, overcome obstacles to return to work, and maintain a positive frame of mind regarding returning to the work environment.

Communicating with the Treating Doctor

Usually, doctors only know what they are told about the employee's worksite and job requirements. Without a detailed job description of the injured worker's regular job, the treating doctor must base return to work decisions only on the subjective assessment of the job, usually provided by the injured worker.

It is not the job of the treating doctor to make employment decisions. The doctor is responsible for providing informatio regarding the abilities of the injured worker so that his or her employer can make informed return to work determinations.

After the initial examination, the treating doctor is required to send the employer and the insurance carrier a completed TWCC-73, "Work Status Report," stating the injured worker's physical capabilities as they relate to the injury and to the injured worker's ability to carry out job tasks. Changes in the condition of the injured worker are also reported on the "Work Status Report" periodically until the injured worker is fully released to return to work.

After reviewing the completed "Work Status Report," the employer can determine if there is suitable work available that accommodates the employee's restrictions. After this determination is made, an employer may make a bona fide job offer in accordance with TWCC Rule 129.5. If the injured worker does not believe that the available work is within restrictions, the injured worker can ask the treating doctor for clarification.

Information Packet

Having an information packet to provide to an injured worker and the treating doctor at the time of the initial visit can make the difference between a medical only claim and a lost time claim. Providing the information as soon as possible helps ensure that correct information is communicated in a timely manner.

Although it is not required, some employers find it helpful to obtain a medical release at the time of a work related injury pertinent only to the injury. With a signed release, the doctor may be more inclined to discuss medical information with the employer.

The prepared packet could include information such as the following:

• Letter to the treating doctor explaining the return to work program, providing carrier information and identifying an employer contact;
• Description of the injured worker's regular job, including task analysis and information about alternate assignments;
• Signed release of medical information;
• Form TWCC-73, "Work Status Report" with Part I: General Information portion completed;
• Information about the workers' compensation system and benefits, such as a copy of the TWCC publication Information for Injured Workers.

Coordinating Communication Efforts

The insurance carrier should be made fully aware of the return to work program and of the employer's desire to provide appropriate work for injured workers. The carrier can play an important part in bringing the employee back to work; therefore, it is important to clarify the employer's expectations of the carrier in this regard.

Coordinating communications and the exchange of information among the treating doctor, the employer, and carrier can prevent duplication of efforts, eliminate unnecessary calls, and prevent confusion.

Working with the carrier to prepare a bona fide job offer letter can help ensure compliance with the specific requirements of TWCC Rule 129.6, "Bona Fide Offers of Employment". The carrier can then follow up with any future actions that may be appropriate regarding benefit payments.

• Letter to treating doctor
• Release of medical information
• Form TWCC-73,Work Status Report
• Rule 129.6, "Bona Fide Offers of Employment"
• Letter making bona fide offer of employment

(Company Letterhead)

(Date of letter)

(Doctor's name and address)

Subject: (Employee's name and date of injury)

Dear Dr._____________:

Our Company has implemented a return to work program designed to return any injured employee to medically appropriate work as soon as possible.

Enclosed is a detailed job description for the regular job of the employee named above, which may be modified, if possible, to meet medical restrictions that may be assigned. If our employee is unable to return to his or her regular job, we will attempt to find an appropriate alternate work assignment. We will ensure that any assignment meets all medical requirements as they appear on form TWCC-73, Work Status Report. We will consider re-arranging work schedules around medical appointments if necessary.

If you need additional information about a possible work assignment or about our return to work program, please call (company contact name and number). Our insurance carrier is (name and address of insurance carrier).

Thank you for your participation in our efforts to return our employees to a safe and productive workplace.

Sincerely,



(Signature of company representative or owner)
(Title), (Name of Company)



Encls. Signed authorization
          TWCC-73, Work Status Report
          Job descriptions and task analysis

(Employee Name)
(Employee Address)
(Date of Birth)



I authorize (name of treating doctor) to release medical information to my employer, (name and address of employer), regarding my on the job injury that occurred on (Date of injury).

This information may facilitate my return to medically appropriate productive work.

__________________________________________
(Print employee name)



__________________________________________ Date: __________________
(Employee Signature)

TEXAS WORKERS’ COMPENSATION WORK STATUS REPORT

FORM TWCC-73

WORK STATUS REPORT INSTRUCTIONS

PART I: GENERAL INFORMATION - Contains space to record general information about the employee and the doctor/clinic. This section includes space to record a high-level generic description of the injury or condition (e.g. broken right arm, strained left knee, etc) and how it occurred. Also contains space to record the name and facsimile number or email address of the insurance carrier (carrier) and the employer, as well as the date of transmission. This space is intended to eliminate the need for a separate facsimile cover page. Because this information is intended primarily for transmission purposes, the report may be provided to the injured employee (employee) at the time of the examination, even if the information required in this section is not yet available.

PART II: WORK STATUS INFORMATION - The doctor is required to indicate the employee’s current work status. There are three choices: able to work without restrictions; able to work with restrictions; and prevented from returning to work.

If the doctor believes that the employee can only work with restrictions or is prevented from returning to work, the doctor is required to provide an estimated date of expiration for the restrictions. These estimates are required to enhance claims management and to provide the employer with information that can be used to plan work coverage and plan for the employee’s return to work (whether with or without restrictions). An estimated expiration is speculative in nature. The further the date is projected, the less accurate it may be. Estimations are not binding and may be changed as needed based upon the condition and progress of the employee by filing a subsequent Work Status Report. Doctors need to provide reasonable estimates based upon the nature of the employee’s injury.

In addition, a doctor who believes that an employee is prevented from returning to work is required to provide a specific explanation of how the condition prevents the employee from returning to work. One of the goals of the Texas Workers’ Compensation Act is to ensure a speedy return to employment which is safe, meaningful, and commensurate with the abilities of the employee. It is the responsibility of the doctor treating or examining an injured employee to identify what the employee may be able to safely perform. It is not the doctor’s responsibility to ensure that the employer has a modified duty position that meets those restrictions - that is the employer’s responsibility if the employer chooses to try to accommodate the restrictions.

PART III: ACTIVITY RESTRICTIONS - If the doctor indicates that the employee is able to work with restrictions, the doctor is to indicate those restrictions in this section. The doctor is only supposed to indicate what restrictions are in place because of the workers’ compensation injury. Any restrictions that may have existed due to other conditions are assumed to remain and should not be duplicated here. The doctor should go over the restrictions with the employee at the time the report is provided.

The section was designed to include check boxes for common restrictions that may apply to the employee. If a box is not checked, it is assumed that there is no restriction on that activity. Also, if no specific body part is indicated in box #15, then it should be understood that the restrictions are whole body restrictions.

PART IV: DIAGNOSIS/FOLLOW-UP INFORMATION - Provides general diagnosis information and provides upcoming appointment information (if known at time of filing report) so that the carrier can better manage the claim and the employer can be aware of time where the employee might not be available for work. In addition, providing this information may reduce calls from carriers and employers seeking the information. However, doctors need ensure that the diagnosis information provided to the employer is at a general level and does not violate any confidentiality laws relating to the employee’s privacy rights.

The Work Status Report is primarily designed to be filed by the treating or referral doctor. However, other doctors can and will occasionally need to file this report. The following describes the various roles that doctors can play within the system:

Basic Instructions - Provide to injured employee at time of examination and fax or electronically transmit to: the insurance carrier and employer by the end of the second working day following the date of the examination. Report must be filed after initial visit, when there is a change in work status or a substantial change in activity restrictions, and on the schedule requested by or through the carrier (not to exceed one report every two weeks). Also file within 7 days of receiving functional job descriptions from the employer or a Work Status Report from a Required Medical Examination doctor that indicates that the employee is able to return to work with or without restrictions.

Rules 126.6, 129.5, and 130.110 lay out the complete requirements for filing this report (in addition, Rule 129.6 provides information on how the report might be used). The complete text to these rules is available on the Commission’s web site at .

Rule 129.6. Bona Fide Offers of Employment

(a) An employer or insurance carrier (carrier) may request the treating doctor provide a Work Status Report by providing the treating doctor a set of functional job descriptions which list modified duty positions which the employer has available for the injured employee (employee) to work. The functional job descriptions must include descriptions of the physical and time requirements of the positions.

(b) An employer may offer an employee a modified duty position which has restricted duties which are within the employee's work abilities as determined by the employee's treating doctor. In the absence of a Work Status Report by the treating doctor an offer of employment may be made based on another doctor's assessment of the employee's work status provided that the doctor made the assessment based on an actual physical examination of the employee performed by that doctor and provided that the treating doctor has not indicated disagreement with the restrictions identified by the other doctor.

(c) An employer's offer of modified duty shall be made to the employee in writing and in the form and manner prescribed by the Commission. A copy of the Work Status Report on which the offer is being based shall be included with the offer as well as the following information:

(1) the location at which the employee will be working;
(2) the schedule the employee will be working;
(3) the wages that the employee will be paid;
(4) a description of the physical and time requirements that the position will entail; and
(5) a statement that the employer will only assign tasks consistent with the employee's physical abilities, knowledge, and skills and will provide training if necessary.

(d) A carrier may deem an offer of modified duty to be a bona fide offer of employment if:

(1) it has written copies of the Work Status Report and the offer; and
(2) the offer:

(A) is for a job at a location which is geographically accessible as provided in subsection (e) of this section;
(B) is consistent with the doctor's certification of the employee's work abilities, as provided in subsection (f) of this section; and
(C) was communicated to the employee in writing, in the form and manner prescribed by the Commission and included all the information required by subsection (c) of this section.

(e) In evaluating whether a work location is geographically accessible the carrier shall at minimum consider:

(1) the affect that the employee's physical limitations have on the employee's ability to travel;
(2) the distance that the employee will have to travel;
(3) the availability of transportation; and
(4) whether the offered work schedule is similar to the employee's work schedule prior to the injury.

(f) The following is the order of preference that shall be used by carriers evaluating an offer of employment:

(1) the opinion of a doctor selected by the Commission to evaluate the employee's work status;
(2) the opinion of the treating doctor;
(3) opinion of a doctor who is providing regular treatment as a referral doctor based on the treating doctor's referral;
(4) opinion of a doctor who evaluated the employee as a consulting doctor based on the treating doctor's request; and
(5) the opinion of any other doctor based on an actual physical examination of the employee performed by that doctor.

(g) A carrier may deem the wages offered by an employer through a bona fide offer of employment to be Post-Injury Earnings (PIE), as outlined in §129.2 of this title (relating to Entitlement to Temporary Income Benefits), on the earlier of the date the employee rejects the offer or the seventh day after the employee receives the offer of modified duty unless the employee's treating doctor notifies the carrier that the offer made by the employer is not consistent with the employee's work restrictions. For the purposes of this section, if the offer of modified duty was made by mail, an employee is deemed to have received the offer from the employer five days after it was mailed. The wages the carrier may deem to be PIE are those that would have been paid on or after the date the carrier is permitted to deem the offered wages as PIE.

(h) Nothing in this section should be interpreted as limiting the right of an employee or a carrier to request a benefit review conference relating to an offer of employment. The Commission will find an offer to be bona fide if it is reasonable, geographically accessible, and meets the requirements of subsections (b) and (c) of this section.

Effective Date: December 26, 1999

SAMPLE: LETTER MAKING A BONA FIDE OFFER OF EMPLOYMENT

All letters making a bona fide job offer should be coordinated with the insurance carrier to ensure that all current requirements
are met prior to mailing.

(Company Letterhead)

(CERTIFIED MAIL-RETURN RECEIPT)

(Date)

(Employee name and mailing address)

Re: Bona Fide Offer of Employment

Dear (Employee name):

After reviewing information provided by your doctor, we are pleased to offer you the following temporary work assignment.

We believe this assignment is within your capabilities as described by your doctor on the attached TWCC-73, Work Status Report. You will only be assigned tasks consistent with your physical abilities, skills and knowledge. If any training is required to do this assignment, it will be provided.

This job offer will remain open for five (5) work days from your receipt of this letter. If we do not hear from you within five (5) work days, we will assume that you have refused this offer that may impact your Temporary Income Benefit payments.

We look forward to your return. If you have any questions, please do not hesitate to contact me.

Sincerely,




(Signature and title)

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The primary goal of early return to work is to return an injured worker to his or her original job as soon as possible. If an injured worker cannot return to regular work at full capacity, temporary modifications to his or her regular job such as schedule changes, reduced hours, reduced capacities, or sharing parts of the work with others are effective accommodations.

If an injured worker cannot perform regular duties, temporary alternate assignments can be the bridge back to regular employment. Injured workers who take an active role in the decision making process to determine their own return to work assignments are more likely to have a successful return to work.

Alternate assignments must be meaningful and productive. Demeaning or "make-work" assignments will defeat the purpose and could be seen as punishment. Assignments must be within the injured worker’s capabilities. When determining alternate assignments, consider jobs or tasks that need to be done but are rarely done due to lack of time. Consider the injured worker’s past work experience and skills. Alternate work assignments are generally short term in nature. Temporary transfer to another regular position that meets the injured worker’s medical restrictions is another choice.

Before actual assignments are needed, ask employees to identify everyday or new tasks that could be done by injured workers as temporary assignments. Develop and keep on hand a list of tasks that are not being performed now that would be helpful. Identify tasks that are only performed occasionally or that no one seems to have time to do. Tasks that could be performed by an injured worker that would help other employees to perform their jobs more efficiently are also a source of alternate assignments.

A job task analysis provides the basic framework on which appropriate assignments can be determined. Employees who perform the work are most familiar with how the work is done and are a valuable resource in completing the task analysis. By doing task analysis and job descriptions for their own jobs, employees can help identify possible modifications and changes leading to improved safety by identifying potential hazards and ways of eliminating them.

A job task analysis breaks down each job into separate physical tasks and describes details required to do the work, such as endurance required, postures, work environment, equipment used, and weights of objects to be moved. Having this information prepared prior to injury will expedite the determination of appropriate assignments and facilitate return to work in a timely manner.

Review accident and injury history to identify the jobs that are most likely to have an injury and identify the typical types of injuries that have occurred related to those jobs. Write detailed functional job descriptions for these and most other jobs using information from the task analysis. Keep job descriptions up to date and accurate. If an employee is injured, the information is readily available saving time and providing vital information to the treating doctor so that timely and appropriate return to work determinations can be made.

Alternate assignments are considered temporary. Some modifications to the injured worker’s current job may result in permanent changes; however, most accommodations are for the duration of the healing period until the treating doctor releases the injured worker to return to full duty.

When the doctor gives the injured worker full release to work, the employee can go back to his or her original job. If the doctor continues medical restrictions, employers may want to reevaluate continuing alternate work assignments.

When unsafe aspects of a task are identified, the task should be redesigned to prevent injury. Solutions are often simple and inexpensive. The following are examples of options for employers to explore in considering redesigning tasks.

• Use lift tables, work dispensers, or similar mechanical aids
• Raise work level to an appropriate height
• Lower the employee
• Provide all materials at work level
• Keep materials that must be lifted later at work level

• Place all materials and tools in front of the employee
• Use conveyors, chutes, slides, and turntables to change the direction of material flow
• Provide adjustable swivel chair for seated employee
• Provide sufficient workspace for the whole body to turn
• Improve the layout of the work area

• Provide tools and machine controls close to the employee to eliminate horizontal reaches over 16 inches
• Place materials, work pieces, and heavy objects as near to the employee as possible
• Reduce the size of cartons or pallets being loaded, or allow the employee to walk around them and rotate them
• Reduce the size of the object being handled
• Allow the object to be kept close to the body

• Use lift tables, lift trucks, cranes, hoists, balancers, drum and barrel dumpers, work dispensers, elevating conveyors, and similar mechanical aids
• Raise work level
• Lower work level
• Use gravity dumps and chute

• Reduce size of the object (specify size to suppliers)
• Reduce capacity of containers
• Reduce weight of the container
• Reduce the load in the container
• Reduce the number of objects to be lifted or lowered at one time

• Change shape of object
• Provide handles or grips
• Provide better access to object
• Improve layout of the work area

• Use powered conveyors
• Use powered trucks
• Use slides and chutes

• Reduce weight of load
• Use non-powered conveyors, air bearings, ball caster tables, monorails, and similar aids
• Use four wheel hand trucks and dollies with large diameter casters and good bearings
• Treat surfaces to reduce friction
• Provide good maintenance of hand trucks, floor surfaces, and other work surfaces
• Use air cylinder pushers and pullers

• Move workstations closer or further away, depending on the need

The objective of a task inventory is to list the tasks necessary to perform a job. Most jobs have multiple tasks. This inventory asks you to list each task separately and show the specific actions or steps required to complete the task.

Follow these steps for completing a task inventory.

1. Use these definitions to fill out top of form.

2. Next, observe the job and break it down into specific tasks. List each task separately; then write down the following information about the task.

Job Title:________________________________________________ Reason:_____________

Analyst:_________________________________________________ Date:_______________

JOB TASKS:

Many types of assessment and analysis tools are available. This assessment asks you to describe a task and show information about physical demands and environmental conditions.

Follow these steps for completing the assessment.

1. Use these definitions to complete the top of the form:

2. Fill in Sections 1 through 5 and make any additional comments.

Pushing	Moving an object away from you, including kicking, slapping, pressing, and striking an object. Example: Pushing a dolly.
Pulling	Moving an object toward you, including jerking or sliding an object. Example: Dragging a box across the floor toward you.
Climbing	Using your legs, arms, hands, or feet to move up or down a structure such as stairs, ladders, scaffolds, and ramps. Example: Climbing a telephone pole to repair wires.
Balancing	Moving in a manner that requires you to keep from falling because of unstable surfaces such as slippery, moving, or narrow spaces. Example: Replacing shingles on a steep roof.
Bending	Using your back and legs to bend forward and downward. Example: Leaning over a car engine to do repairs.
Twisting	Rotating your upper body in a different direction than your lower body. Example: Reaching behind you to pick up parts while you remain seated at a machine.
Squatting	Lowering your body by bending at the knees. Example: Checking the air pressure in a car’s tires.
Crawling	Moving forward while on your hands and knees. Example: Crawling through a crawl space to get to plumbing.
Kneeling	Lowering your body onto one knee or both knees. Example: Kneeling on one knee to remove a flat tire from a car.
Reaching	Moving your hands and arms toward an object at arm’s length in any direction from your body. Example: Reaching upward to change an overhead light bulb.
Handling	Using your hands to hold, grasp, grip, or turn an object. Example: Holding a drill while drilling holes.
Fingering	Using your fingers to pinch, pick, or manipulate objects, especially small ones. Example: Picking up nuts and placing them on bolts.
Feeling	Using your hands and fingers to perceive the shape, size, temperature, or other characteristic of an object. Example: Laying your hand on the hood of a car to check for heat.
Repetitive	Using your feet or hands continuously in the same motion or motions. Example: Typing at a computer or using a foot pedal on a sewing machine.

	Not present 0%	Occasionally 0-33%	Frequently 34-66%	Constantly 67-100%	Height of Lift	Distance of Carry
1-10 lbs
11-20 lbs
21-50 lbs
51-100 lbs
>100 lbs

	Not present 0%	Occasionally 0-33%	Frequently 34-66%	Constantly 67-100%	Description
Vibration
Noise
Extreme heat
Extreme cold
Wet / humid
Moving parts
Chemicals
Electricity
Radiation
Other

SECTION	GUIDELINES
Job Title	Provide the title and the location of the job, if appropriate.
Purpose of Job	Focus on outcomes of the job rather than process. List required expectations and special requirements. List shift or hours worked, full or part-time.
Education & Work Experience	Describe required or desired licenses, certifications, number of years’ experience, training, and other qualifications.
Skill Requirements	Relate all pertinent skill requirements to job functions when possible.
Job Functions	Answer these questions when describing essential and marginal job functions: Does the job exist to perform this function? Would removing this task fundamentally change the job?
Job Duties	Be as specific as possible. State how frequently a task is performed and what equipment, tools, and materials are used.
Physical Demands	Be very specific. Use measurements, frequency, and duration. Describe body position, required exertion, and parts of the body used. Give hours per day spent performing each function.
Environmental Conditions	Describe temperature, hazards, and other conditions.

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The Texas Workers' Compensation Act (TWCA) was enacted, in part, to provide the mechanism for an injured worker who sustains a compensable injury in the course and scope of employment to receive medical and income replacement benefits. The Americans with Disabilities Act (ADA) was enacted to protect people from discrimination on the basis of disability. The Family Medical Leave Act (FMLA) was enacted to provide job security to employees who have serious medical conditions or who must meet personal and family obligations to tend to vital needs at home.

These laws serve different purposes; however, they interrelate in a return to work context when an employee with a compensable injury also meets the criteria for protections under the ADA or the FMLA.

Employers should seek expert advice when making decisions related to any particular situation and obtain legal advice regarding the coordination of return to work programs, the ADA, and/or the FMLA. Consistent application of the return to work program can alleviate concerns of disparate or discriminatory treatment of employees.

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Some of the Return to Work information included in this resource document was gathered from or provided by the following sources:

Welch, Edward M.; Workers' Compensation Strategies for Lowering Costs and Reducing Workers' Suffering; Selected proceedings from conferences held in Lansing, Michigan on April 22, 1987 and May 12, 1988; LRP Publications, Fort Washington, Pa.

Pementel, Richard; The Return to Work Process: Case Management Approach. Milt Wright & Associates, Inc. Publications.

Barnes, Dennis E.; How to Manage Affirmative Return to Work Programs. Texas Back Institute, Council on Education in Management, 1994.

Dent, Gene L.; Return to Work By Design: Managing the Human and Financial Costs Disability; Martin-Dennison Press; Stockton, CA: 1990.

Evangelista-Uhl, G.A.; Transitional Duty. AAOHN Journal 47.

Griffith, Victoria; Both Sides Now.CFO, June 1997.

Crawford & Company Healthcare Management; "Structured Return to Work and the Americans with Disabilities Act"; Health Cost Monitor; Vol.2, No.3; 1993.

ITT Hartford, Loss Control: Return to Work Programs.

The Riskletter; North Carolina Study Shows Need for Return to Work Programs in Workers' Comp", Vol.2, No.2; 1993.

Derebery, v. Jane, M.D.; and William H. Tullis, M.D.; Delayed Recovery in the Patient with a Work Compensable Injury"; Journal of Occupational Medicine; Vol.25, No.11, November 1983.

Lipson, Fran: "How to Cut the Waste from Workers' Compensation"; HR Magazine; June 1993.

Hefre, Patricia F.; Evaluating the Practicality of Return to Work Programs: Increasing Costs and Legislation Changes Make Disability Related Problem too Costly to Ignore. Crawford & Company. 1993.

Physical Medicine and Rehabilitation: State of the Art Reviews-Vol.6, No.2, June 1992. Philadelphia. Hanley & Belfus, Inc.

Comprehensive Loss Management for USF&G: Development of a Return to Work Program.

King, Erin R.; Job Related Pain May Have Many Causes. CBS Health Watch. March 2001.

Bowling, Maddy; The Halo Effect: Measuring the Power of Intangibles Workers' Compensation. The Journal of Workers' Compensation. 1997.

Various research reports and information provided by or regarding return to work programs, statistics, new developments, and activities in other jurisdictions.

Texas Workers' Compensation Insurance Fund (TWCIF) Return to Work Kit, February 1998.

The Workers' Health and Safety Division of the Texas Workers' Compensation Commission.

29 Code of Federal Regulations, Part 1630, Americans with Disabilities Act.

Title 29, Part 8225, Code of Federal Regulations, "Family and Medical Leave Act of 1993" WH Publication 1419; U.S. Department of Labor, Employment Standards Division, Wage and Hour Division, April 1995.

Texas Workers' Compensation Act and Rules, Texas Labor Code Annotated, Title 5, Subtitle A, Sec. 451.001.

Research and Oversight Council on Workers' Compensation, HB 3697 (76^th Legislature, 1966), study findings on medical cost and quality of care, workplace safety, and return to work programs.

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