Nonprofit jobs provide bridge back to work

Off-site transitional duty positions can help employers reduce workers compensation costs and have gained traction as employers strive to reduce opioid dependency among injured employees.

But the nature of the work that can be offered through off-site work options and whether an employee can be compelled to accept the positions varies by state, experts say.

Memphis, Tennessee-based Sedgwick Claims Management Services Inc. began offering off-site transitional duty work in 2018 as part of its managed care services due to growing interest in the placements by the third-party administrator’s clients, said Andrea Buhl, senior vice president of Sedgwick’s clinically integrated medical program.

“Employers are looking for creative ways to reduce their overall claims costs,” said Ms. Buhl.

The longer an employee is out of work, the more difficult it is for them to return and “the higher the costs to the employer,” said Debra Livingston, CEO of ReEmployAbility Inc., based in Tampa, Florida, which links employers seeking off-site transitional duty work for injured workers with nonprofits who need labor.

York Risk Services Group Inc. has offered off-site modified duty programs for nearly 20 years, and the number of employers using the return-to-work approach has been increasing each year, said Kimberly Wickert, director of work programs for the Jersey City, New Jersey-based TPA.

“What we’ve seen the last few years … we know that if we get people back to work, we’re going to see less dependence on opioids,” she said.

York clients in industries such as trucking, logistics and staffing also offer offsite modified duty employment as a way to decrease their overall workers comp costs and indemnity, she said.

When risk consultant Kathleen Peck accepted the role of risk manager for MVP Staffing in Deerfield, Illinois, she found the company’s workers compensation insurers and third-party administrators were frustrated. “Claims were spinning out of control” because the company, which operated in more than 40 states, didn’t have the ability to control a work environment or modify tasks and was struggling to get injured workers back into a job, she said.

Ms. Peck partnered with an off-site transitional duty company, and began attacking the legacy claims for temporary total disability, some of which had employees who had been out of work for two years.

After obtaining doctor’s notes indicating each workers’ level of functionality, the workers received offers of employment at a nonprofit — generally within 10 miles or less of an employee’s home — to work within their restrictions. To her surprise, the legacy claimants began to receive full-duty work releases.

“We had people accepting those jobs, then actually starting to show physical improvement by their next office visit,” she said. “People were shocked they got released back to full-duty work.” 

But states have varying restrictions regarding off-site transitional work. Pennsylvania and Colorado both have specific jurisdictional requirements regarding the offer of modified duty, and other states govern how the offer is made, which can include whether the modified job duty description must be approved by a physician, said Ms. Livingston.

In North Carolina, temporary light duty work must be approved by a physician in the manner that it is typically approved for permanent job offers, said Leigh Anne Foster, Franklin, Tennessee-based assistant vice president of case management services and return-to-work programs at Gallagher Bassett Services Inc.

Texas requires a bona fide offer of employment consistent with the treating physician’s certification of an employee’s work abilities, said Pat Crawford, return to work specialist for the Texas Department of Workers Compensation.

Whether benefits can be suspended for declining the offer of an off-site transitional job also varies by state. Total temporary disability payments cannot necessarily be discontinued when a worker is released by a treating provider to return to work in Massachusetts, New Hampshire, New Jersey, Pennsylvania and Rhode Island, according to a survey released in April by Cambridge, Massachusetts-based Workers Compensation Research Institute.

For Ms. Peck, after seeing such success with legacy claims, she expanded the off-site transitional work program to new claims, and Genex Services Inc. was brought on as a telephonic case manager.

Case managers informed the workers’ physicians that the off-site transitional duty job could be tailored to accommodate any activity of daily living, and physician notes were often obtained right after an injury — sometimes even before the claims adjuster had contacted the employee. The goal was to get workers into the off-site transitional duty position before any patterns of disability took hold or before the worker had time to retain counsel, Ms. Peck said.

According to Bobbie Doyle, Charleston, South Carolina-based director of telephonic case management at Genex, based on vendor averages, about $1.8 million in indemnity costs and $6.96 million in medical costs have been saved through the program for the staffing firm. About a quarter of all cases were referred into the off-site transitional duty program and nearly half of the employees in the program achieved full-duty work release in 44 days.

Ms. Peck said the program allowed her to get workers engaged in meaningful work before there was a chance a disability mentality could take hold.

“I still believe at the end of the day that people heal,” she said.