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Toolbox: Return-to-Work - SAIF Corporation

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RISK MANAGEMENT<br />

<strong>Return</strong> <strong>to</strong> <strong>Work</strong><br />

<strong>Return</strong>-<strong>to</strong>-<strong>Work</strong><br />

<strong>SAIF</strong> <strong>Corporation</strong> is committed <strong>to</strong> helping injured workers return<br />

<strong>to</strong> work as early as possible. If an injured worker cannot return<br />

immediately <strong>to</strong> regular work due <strong>to</strong> physical limitations or<br />

constraints, <strong>SAIF</strong> return-<strong>to</strong>-work consultants will work with the<br />

employer and the treating physician <strong>to</strong> return the injured worker<br />

<strong>to</strong> a transitional/temporary job. <strong>Return</strong>-<strong>to</strong>-work programs play a<br />

major role in controlling claim costs and save millions of dollars<br />

in reduced time-loss payments.<br />

A return-<strong>to</strong>-work program is an essential part of a company’s<br />

loss control efforts. It can reduce the <strong>to</strong>tal number of claims,<br />

contain workers’ compensation claim costs, and encourage<br />

workers <strong>to</strong> participate in the process, thus enhancing their<br />

awareness of safety and their responsibility in the recovery<br />

process. Proactive return-<strong>to</strong>-work efforts can be a pricing and<br />

selection advantage for those who perform post-loss cost<br />

containment activities. A sample written program is included in<br />

this section. As with any new written process, check with a legal<br />

professional before implementing, <strong>to</strong> ensure that it is consistent<br />

with your other written policies.<br />

A return-<strong>to</strong>-work program simply provides transitional/temporary<br />

jobs, approved by the injured worker’s physician, in order <strong>to</strong> bring<br />

the worker back <strong>to</strong> work at the earliest possible time rather than<br />

waiting for the worker <strong>to</strong> be released for normal work duties.<br />

Communication with all parties–the injured worker, the<br />

attending physician, company management, the immediate<br />

supervisor, and the insurance company–is crucial <strong>to</strong> the success<br />

of the program. There should also be a provision for moni<strong>to</strong>ring<br />

the transitional/temporary job, until the worker is released for<br />

normal work or the worker’s condition becomes medically<br />

stationary.<br />

© <strong>SAIF</strong> <strong>Corporation</strong> Page 1 of 25 S-825 January 2007


Risk Management <strong>Return</strong> <strong>to</strong> <strong>Work</strong><br />

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Program benefits<br />

• Injured workers off work longer than six months have only a 50<br />

percent chance of returning <strong>to</strong> their job. If time loss exceeds one<br />

year, there is a 90 percent chance they will never return <strong>to</strong> work.<br />

• <strong>Return</strong>-<strong>to</strong>-work programs reduce medical costs. The injured worker<br />

heals faster, shortening the time medical treatment is required.<br />

• <strong>Return</strong>-<strong>to</strong>-work programs reduce legal costs. <strong>Work</strong>ers are less likely <strong>to</strong><br />

feel their rights have been violated causing them <strong>to</strong> hire legal council.<br />

• Cost reductions resulting from return-<strong>to</strong>-work programs directly<br />

impact your organization’s workers’ compensation premium rate.<br />

Manage the process<br />

The immediate supervisor serves a key role in making the process<br />

successful. Consistent and on-going communication with the worker is<br />

vital. The process should be treated in a positive, proactive fashion. The<br />

worker in a transitional/temporary job should be made <strong>to</strong> feel that he or<br />

she is a productive part of the work force. Care and concern should be<br />

expressed by all involved, including the worker’s peers. You should inform<br />

your claims adjuster and/or return-<strong>to</strong>-work consultant regarding any<br />

changes in the worker’s transitional/temporary work status.<br />

How <strong>to</strong> get your injured workers back <strong>to</strong> work and control workers’<br />

compensation costs<br />

1. Find a transitional/temporary job that fits the injury.<br />

Use your Release <strong>to</strong> <strong>Return</strong>-<strong>to</strong>-<strong>Work</strong> form (a sample is included in<br />

this section) or physician’s release form <strong>to</strong> determine the physician’s<br />

work restrictions. Then, if possible, identify a suitable<br />

transitional/temporary job within those restrictions. Provide a copy of<br />

this form <strong>to</strong> your worker and instruct the worker <strong>to</strong> have their physician<br />

complete the form at each visit and return it <strong>to</strong> you so that you may<br />

stay updated with their most current work restrictions.<br />

2. Do not wait for the physician <strong>to</strong> contact you.<br />

Write a description of the transitional job (using the Job Description<br />

form included in this section), identifying the physical requirements of<br />

your transitional/temporary position. When applicable, use the information<br />

previously obtained from your Release <strong>to</strong> <strong>Return</strong>-<strong>to</strong>-<strong>Work</strong> Form or<br />

other physician’s release information.<br />

Send the job description <strong>to</strong> the treating physician, introducing the job and<br />

expressing your willingness <strong>to</strong> accommodate the physical restrictions the<br />

physician identified. Offer <strong>to</strong> pick up the response, or provide a fax or<br />

contact number <strong>to</strong> the doc<strong>to</strong>r and ask them <strong>to</strong> advise you when it is<br />

completed from the physician’s office <strong>to</strong> speed up the process. Maintain<br />

contact with the physician until you obtain approval.<br />

© <strong>SAIF</strong> <strong>Corporation</strong> Page 2 of 25 S-825 January 2007


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3. When you get a physician’s approval of the job description:<br />

Call the injured worker and have him/her come in <strong>to</strong> your office <strong>to</strong> go<br />

over the job description (job duties) and sign the Job Offer letter (A<br />

sample is included in this section.) Make sure the work restrictions are<br />

clear <strong>to</strong> the worker and <strong>to</strong> all the necessary levels of supervision.<br />

If the duration of the Job Offer is unknown, use “temporary, <strong>to</strong> be<br />

reviewed periodically”.<br />

If the worker has no phone, is not returning calls, or has moved out of<br />

the area:<br />

Send a written Job Offer letter via both certified (restricted delivery) and<br />

regular mail. This letter should inform the worker that the physician has<br />

released him/her. Use your Job Offer letter (sample included in this section)<br />

<strong>to</strong> satisfy your legal requirements. Be sure <strong>to</strong> include a copy of the Job<br />

Description form signed by the physician.<br />

4. Notify your <strong>SAIF</strong> claims adjuster or return-<strong>to</strong>-work consultant:<br />

When the worker returns <strong>to</strong> work.<br />

If the worker refuses the modified work or fails <strong>to</strong> report <strong>to</strong> work on the<br />

start date.<br />

If the work available for the worker is less than on the Job Offer letter.<br />

5. Send a copy of the physician's release, the approved Job<br />

Description, and your written Job Offer <strong>to</strong> the <strong>SAIF</strong> claims<br />

adjuster and/or return-<strong>to</strong>-work consultant, along with certified<br />

receipts.<br />

6. Key fac<strong>to</strong>rs <strong>to</strong> remember:<br />

In order <strong>to</strong> ensure compliance with <strong>Work</strong>ers’ Compensation Law, make<br />

sure that you notify your <strong>SAIF</strong> return-<strong>to</strong>-work consultant if you have any<br />

questions regarding this process. Remember that in certain situations an<br />

employee may refuse an offer of modified employment and continue <strong>to</strong><br />

receive temporary <strong>to</strong>tal disability benefits. Those situations are<br />

highlighted on next page.<br />

© <strong>SAIF</strong> <strong>Corporation</strong> Page 3 of 25 S-825 January 2007


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ORS 656.268 (4)<br />

(c) …However, an offer of modified employment may be refused by the worker<br />

without the termination of temporary <strong>to</strong>tal disability benefits if the offer:<br />

(A) Requires a commute that is beyond the physical capacity of the worker<br />

according <strong>to</strong> the worker’s attending physician;<br />

(B) Is at a work site more than 50 miles one way from where the worker was<br />

injured unless the site is less than 50 miles from the worker’s residence<br />

or the intent of the parties at the time of hire or as established by the<br />

pattern of employment prior <strong>to</strong> the injury was that the employer had<br />

multiple or mobile work sites and the worker could be assigned <strong>to</strong> any<br />

such site;<br />

(C) Is not with the employer at injury;<br />

(D) Is not at a work site of the employer at injury;<br />

(E) Is not consistent with the existing written shift change policy or is not<br />

consistent with common practice of the employer at injury or<br />

aggravation; or<br />

(F) Is not consistent with an existing shift change provision of an applicable<br />

collective bargaining agreement<br />

This statute is further explained in OAR 436-060-0030(5)<br />

© <strong>SAIF</strong> <strong>Corporation</strong> Page 4 of 25 S-825 January 2007


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This is a sample policy provided by <strong>SAIF</strong> as a service <strong>to</strong> its insureds. Not all provisions<br />

may be applicable <strong>to</strong> your business. Before adopting any of this return-<strong>to</strong>-work policy,<br />

you should obtain legal counsel and advice.<br />

<strong>Return</strong>-To-<strong>Work</strong>: Sample Policy<br />

(Company Name)<br />

Note: This document is not designed as a substitute for reasonable<br />

accommodation under any applicable federal or state laws, such as Americans<br />

with Disabilities Act, The Rehabilitation Act of 1973, or other applicable laws.<br />

To preserve the ability <strong>to</strong> meet company needs under changing conditions,<br />

this company reserves the right <strong>to</strong> revoke, change, or supplement guidelines<br />

at any time with written notice. The policies and procedures in this return-<strong>to</strong>work<br />

program are not intended <strong>to</strong> be contractual commitments and they shall<br />

not be construed as such by our employees. This policy is not intended as a<br />

guarantee of continuity of benefits or rights. No permanent employment for<br />

any term is intended or can be implied by this policy.<br />

Objectives:<br />

(Company Name) has developed a return <strong>to</strong> work policy. Its purpose is <strong>to</strong><br />

return workers <strong>to</strong> employment at the earliest date following any injury or<br />

illness. We desire <strong>to</strong> speed recovery from injury or illness and reduce<br />

insurance costs. This policy applies <strong>to</strong> all workers and will be followed<br />

whenever appropriate.<br />

(Company Name) defines “transitional” work as temporary modified work<br />

assignments within the worker’s physical abilities, knowledge, and skills.<br />

Where feasible, transitional positions will be made available <strong>to</strong> injured<br />

employees in order <strong>to</strong> minimize or eliminate time loss.<br />

For any business reason, at any time, we may elect <strong>to</strong> change the working shift<br />

of any employee based on the business needs of this company.<br />

This is optional language that may be included depending upon your business need.<br />

The physical requirements of transitional/temporary work will be provided <strong>to</strong><br />

the attending physician. Transitional/temporary positions are then developed<br />

with consideration of the worker’s physical abilities, the business needs of<br />

(Company Name), and the availability of transitional work.<br />

In case of an on-the-job accident<br />

If you have a work-related injury and are missing time from work, contact our<br />

human resources or personnel department or <strong>SAIF</strong> <strong>Corporation</strong> for details<br />

regarding time loss.<br />

Transitional temporary work assignment<br />

(Company Name) will determine appropriate work hours, shifts, duration and<br />

locations of all work assignments. (Company Name) reserves the right <strong>to</strong><br />

determine the availability, appropriateness, and continuation of all transitional<br />

assignments and job offers.<br />

Communication<br />

It is the responsibility of the worker and/or supervisor <strong>to</strong> immediately notify<br />

Personnel of any changes concerning a transitional/temporary work assignment.<br />

Personnel will then communicate with the insurance carrier and attending<br />

physician as applicable.<br />

© <strong>SAIF</strong> <strong>Corporation</strong> Page 5 of 25 S-825 January 2007


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This is a sample policy provided by <strong>SAIF</strong> as a service <strong>to</strong> its insureds. Not all provisions<br />

may be applicable <strong>to</strong> your business. Before adopting any of this return-<strong>to</strong>-work policy,<br />

you should obtain legal counsel and advice.<br />

Employee responsibilities<br />

1. Accident reporting:<br />

A. An accident is any unplanned event that disrupts normal work<br />

activities and may or may not result in injury or property damage. All<br />

work-related accidents, injuries, and near misses must be reported<br />

immediately <strong>to</strong> Personnel.<br />

B. If an accident occurs, but does not require professional medical<br />

treatment, the supervisor should immediately be informed, so that<br />

an accident analysis can be completed. If first-aid treatment is<br />

needed, it should be sought on-site.<br />

C. If an accident occurs which requires professional medical treatment,<br />

the worker should follow the emergency response plan. The worker must<br />

fill out a workers’ compensation 801 form as soon as possible.<br />

2. <strong>Work</strong>er’s physical condition:<br />

A. If professional medical treatment is sought, the worker should inform<br />

the attending physician (Company Name) has a return-<strong>to</strong>-work<br />

program with light duty/modified assignments available.<br />

B. The worker should obtain a Release <strong>to</strong> <strong>Return</strong>-<strong>to</strong>-<strong>Work</strong> form and<br />

completed Job Description form (if available) from Personnel. This<br />

should be provided <strong>to</strong> the treating physician and should be returned<br />

<strong>to</strong> Personnel following the initial medical treatment.<br />

3. <strong>Work</strong>er return <strong>to</strong> work:<br />

A. If the attending physician releases the worker <strong>to</strong> return <strong>to</strong> work, as<br />

evidenced by completion of a Release <strong>to</strong> <strong>Return</strong>-<strong>to</strong>-<strong>Work</strong> Form<br />

and Job Description Form, the form(s) must be returned <strong>to</strong><br />

Personnel, within 24 hours for assignment of light duty/modified<br />

work. The worker must report for work at the designated time. The<br />

worker cannot return <strong>to</strong> work without a release from the<br />

attending physician.<br />

B. If you return <strong>to</strong> a transitional/temporary job, you must make sure that<br />

you do not go beyond either the duties of the job or your physician’s<br />

restrictions. If your restrictions change at any time, you must notify<br />

your supervisor at once and give your supervisor a copy of the new<br />

medical release.<br />

4. <strong>Work</strong>er unable <strong>to</strong> return <strong>to</strong> work:<br />

A. If the worker is unable <strong>to</strong> report for any kind of work, the worker must<br />

call in at least weekly <strong>to</strong> report medical status.<br />

B. While off work, it is the responsibility of the worker <strong>to</strong> supply<br />

Personnel with a current telephone number (listed or unlisted) and an<br />

address where the worker can be reached.<br />

C. The worker will notify Personnel within 24 hours of all changes in medical<br />

condition.<br />

© <strong>SAIF</strong> <strong>Corporation</strong> Page 6 of 25 S-825 January 2007


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This is a sample policy provided by <strong>SAIF</strong> as a service <strong>to</strong> its insureds. Not all provisions<br />

may be applicable <strong>to</strong> your business. Before adopting any of this return-<strong>to</strong>-work policy,<br />

you should obtain legal counsel and advice.<br />

Employer responsibilities<br />

1. Accident reporting:<br />

A. The supervisor will conduct an accident analysis on all accidents,<br />

regardless of whether an injury occurs.<br />

B. When an accident occurs which results in injury requiring<br />

professional medical treatment, Personnel will forward a completed<br />

workers’ compensation 801 form <strong>to</strong> the insurance carrier within five<br />

(5) calendar days of knowledge of the injury or illness.<br />

C. Other information will be forwarded as soon as developed including:<br />

1. Name of worker’s attending physician.<br />

2. Completed Release <strong>to</strong> <strong>Return</strong>-<strong>to</strong>-<strong>Work</strong> Form from attending<br />

physician and medical documentation, if appropriate.<br />

3. Completed transitional/modified or regular Job Description.<br />

4. Job Offer letter and responses.<br />

D. The supervisor will notify the insurance carrier of any changes in the<br />

worker’s medical or work status as soon as possible.<br />

2. Medical treatment and temporary/transitional duty physical<br />

condition:<br />

A. A Release <strong>to</strong> <strong>Return</strong>-<strong>to</strong>-<strong>Work</strong> Form and a completed Job<br />

Description form (if available) will be provided <strong>to</strong> the worker <strong>to</strong> take<br />

<strong>to</strong> the attending physician for completion and/or approval.<br />

B. At the time of first medical treatment the Release <strong>to</strong> <strong>Return</strong>-<strong>to</strong>-<br />

<strong>Work</strong> Form must be completed and returned <strong>to</strong> Personnel. If one is<br />

not, Personnel will request one from the attending physician.<br />

C. The completed Release <strong>to</strong> <strong>Return</strong>-<strong>to</strong>-<strong>Work</strong> Form will be reviewed<br />

by Personnel. A temporary/transitional Job Description form will be<br />

prepared from information obtained from the attending physician for<br />

review and approval.<br />

© <strong>SAIF</strong> <strong>Corporation</strong> Page 7 of 25 S-825 January 2007


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This is a sample policy provided by <strong>SAIF</strong> as a service <strong>to</strong> its insureds. Not all provisions<br />

may be applicable <strong>to</strong> your business. Before adopting any of this return-<strong>to</strong>-work policy,<br />

you should obtain legal counsel and advice.<br />

3. Job Offer Letter:<br />

A. Upon receipt of a signed temporary/transitional Job Description<br />

form from the attending physician, a written Job Offer Letter will<br />

be prepared by the employer. It will be mailed by both regular<br />

and certified mail <strong>to</strong> the worker’s last known address or presented<br />

<strong>to</strong> the worker.<br />

B. The letter will note the doc<strong>to</strong>r’s approval and will explain the job<br />

duties, report date, wage, hours, report time duration of<br />

transitional work assignment, phone number, and location of the<br />

transitional assignment.<br />

C. The worker will be asked <strong>to</strong> sign the bot<strong>to</strong>m of the Job Offer<br />

Letter indicating acceptance or refusal of the offered work<br />

assignment.<br />

D. Copies of the Job Description, <strong>Work</strong> Releases, and Job offer<br />

Letters will be forwarded <strong>to</strong> the insurance carrier.<br />

4. Supervisor:<br />

A. The supervisor will moni<strong>to</strong>r the worker’s performance <strong>to</strong> ensure the<br />

worker does not exceed the worker’s physician release.<br />

B. The supervisor will moni<strong>to</strong>r the worker’s recovery progress through<br />

regular contact <strong>to</strong> assess when and how often duties may be changed.<br />

The supervisor will assess the company’s ability <strong>to</strong> adjust work<br />

assignments upon receipt of changes in physical capacities.<br />

<strong>Work</strong>er acknowledgment:<br />

• The return-<strong>to</strong>-work policy and procedures have been explained <strong>to</strong> me.<br />

• I have read and fully understand all procedures and responsibilities.<br />

• I agree <strong>to</strong> observe and follow these procedures.<br />

• I have received a copy of this policy and procedure.<br />

• I understand failure <strong>to</strong> follow these procedures may affect my<br />

re-employment, reinstatement, and vocational assistance rights.<br />

_____________________________________________________________________<br />

<strong>Work</strong>er Signature<br />

Date<br />

© <strong>SAIF</strong> <strong>Corporation</strong> Page 8 of 25 S-825 January 2007


<strong>Return</strong> form <strong>to</strong>:<br />

Name of worker<br />

RELEASE TO RETURN TO WORK<br />

Claim number<br />

Please fill out this form and return it <strong>to</strong> us at the address indicated above.<br />

1. Is the worker medically stationary Yes No If yes, date:<br />

(Provide closing information and complete Form<br />

827.)<br />

If no, estimated medically stationary date: Are there permanent restrictions Yes No Unknown<br />

Next scheduled appointment date:<br />

2. <strong>Work</strong>er is released <strong>to</strong>:<br />

full duty without limitations Date: (Do not complete lines 3 through 11. Sign below.)<br />

modified duty from (date): through (date): (specify limitations below)<br />

modified hours specify hours: from (date): through (date):<br />

not released <strong>to</strong> work Est. RTW date:<br />

If modified release, provide date of anticipated regular release:<br />

Hours: No limitations 1 2 3 4 5 6 7 8 Other (specify)<br />

3. In a/an 8 10 12 other -hour workday,<br />

worker can stand/walk a <strong>to</strong>tal of<br />

4. At one time, worker can stand/walk<br />

5. In a/an 8 10 12 other -hour workday,<br />

worker can sit a <strong>to</strong>tal of<br />

6. At one time, worker can sit<br />

7. The worker is released <strong>to</strong> return <strong>to</strong> work in the following range for lifting, carrying, pushing/pulling:<br />

Pounds 100<br />

Occasionally<br />

Frequently<br />

8. <strong>Work</strong>er can use hands for repetitive: Right Left<br />

a. Fine manipulation Yes No Yes No Dominant hand<br />

b. Pushing and pulling Yes No Yes No Right Left<br />

c. Simple grasping Yes No Yes No<br />

d. Keyboarding Yes No Yes No<br />

9. <strong>Work</strong>er can use feet for repetitive raising and pushing (as in operating foot controls): Yes No<br />

10. <strong>Work</strong>er is able <strong>to</strong>: Continuous<br />

67-100% of the day<br />

Frequently<br />

34-66% of the day<br />

Occasionally<br />

6-33% of the day<br />

Intermittently<br />

1-5% of the day<br />

a. S<strong>to</strong>op/bend ------------------ ------------------------ -------------------------- ----------------------- ---------------------<br />

b. Crouch ----------------------- ------------------------- -------------------------- ----------------------- ---------------------<br />

c. Crawl ------------------------- ------------------------- -------------------------- ----------------------- ---------------------<br />

d. Kneel ------------------------- ------------------------- -------------------------- ----------------------- ---------------------<br />

e. Twist ------------------------- ------------------------- -------------------------- ----------------------- ---------------------<br />

f. Climb------------------------- ------------------------- -------------------------- ----------------------- ---------------------<br />

g. Balance----------------------- ------------------------- -------------------------- ----------------------- ---------------------<br />

h. Reach------------------------- ------------------------- -------------------------- ----------------------- ---------------------<br />

i. Push/pull--------------------- ------------------------- -------------------------- ----------------------- ---------------------<br />

11. Other functional limitations or modifications necessary in worker’s employment:<br />

Not at all<br />

Additional comments may be written on back of form.<br />

Signature of medical service provider ∗ Printed name Date<br />

440-3245 (10/05/DCBS/WCD/WEB)<br />

∗ See OAR 436-010-0210 regarding who may provide medical services and authorize time loss.<br />

© <strong>SAIF</strong> <strong>Corporation</strong> Page 9 of 25 S-825 January 2007


Blank<br />

Back of Form page<br />

© <strong>SAIF</strong> <strong>Corporation</strong> Page 10 of 25 S-825 January 2007


EMPLOYER:<br />

ADDRESS:<br />

PHONE/FAX NUMBER(S):<br />

CONTACT PERSON:<br />

JOB TITLE OF WORKER:<br />

LOCATION OF JOB:<br />

JOB DUTIES:<br />

MODIFIED JOB DESCRIPTION<br />

WORKER:<br />

ADDRESS:<br />

PHONE NUMBER:<br />

CLAIM NUMBER:<br />

HOURS PER<br />

DAY/WEEK:<br />

ENDURANCE<br />

Never Intermittent


Blank<br />

Back of Form page<br />

© <strong>SAIF</strong> <strong>Corporation</strong> Page 12 of 25 S-825 January 2007


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Regular work job descriptions<br />

Definition of regular work for the purpose of this section means: an accurate<br />

description of the duties and physical requirements of the position the worker<br />

was performing prior <strong>to</strong> injury.<br />

There are many reasons your return-<strong>to</strong> work consultant may request a regular<br />

job description.<br />

• Your consultant may ask you for regular job descriptions in claims<br />

where Permanent Partial Disability (PPD) is anticipated.<br />

• Your consultant will encourage you <strong>to</strong> complete the job<br />

description with input from your employee whenever possible.<br />

• Your return-<strong>to</strong>-work consultant or adjuster may recommend in<br />

certain circumstances <strong>to</strong> have a vocational consultant obtain a<br />

more detailed description of your employee’s regular job.<br />

• A regular job description may be requested in order for the<br />

doc<strong>to</strong>r <strong>to</strong> clarify the work status.<br />

• Regular job descriptions are sometimes requested as a <strong>to</strong>ol<br />

for the overall management of a claim.<br />

(A sample job description form is included in this section, please contact<br />

your return-<strong>to</strong>-work consultant for assistance in completing this form)<br />

© <strong>SAIF</strong> <strong>Corporation</strong> Page 13 of 25 S-825 January 2007


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© <strong>SAIF</strong> <strong>Corporation</strong> Page 14 of 25 S-825 January 2007


EMPLOYER:<br />

ADDRESS:<br />

REGULAR JOB DESCRIPTION<br />

WORKER:<br />

ADDRESS:<br />

PHONE/FAX NUMBER(S):<br />

PHONE NUMBER:<br />

CONTACT PERSON:<br />

CLAIM NUMBER:<br />

JOB TITLE OF WORKER:<br />

HOURS PER<br />

DAY/WEEK:<br />

JOB DUTIES (attach narrative description if available, complete physical requirements below):<br />

ENDURANCE<br />

Never Intermittent


Blank<br />

Back of Form page<br />

© <strong>SAIF</strong> <strong>Corporation</strong> Page 16 of 25 S-825 January 2007


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Job Offer Letter<br />

Date _____________________________________<br />

Name of Employee ____________________________________________________________<br />

Address _____________________________________________________________________<br />

City, State, Zip _______________________________________________________________<br />

<strong>SAIF</strong> Claim ___________________________________________________________________<br />

Date of Injury ________________________________________________________________<br />

Dear: ___________________________________________ :<br />

Your attending physician, Dr. _________________________ , has released you for modified<br />

work. We have developed a temporary light duty job within the physical restrictions outlined by<br />

your doc<strong>to</strong>r. Your doc<strong>to</strong>r has reviewed and approved a description of the light duty job (see<br />

enclosed job description). The duration of this light duty position will be periodically re-evaluated.<br />

Job title:<br />

Wage: $ per (hour/week/month)<br />

Start time:<br />

Hours per day:<br />

Location:<br />

Start date:<br />

Hours per week:<br />

Duration, if known:<br />

Upon receipt of this job offer immediately contact: ___________________________________<br />

If you receive this letter after the start date of this job, the job will begin 24 hours after your<br />

receipt of this offer. Your workers’ compensation benefits may be adversely affected if you choose<br />

not <strong>to</strong> accept this job. Under Oregon law, you have the right <strong>to</strong> refuse an offer of employment<br />

without termination of temporary <strong>to</strong>tal disability if any of the following conditions apply:<br />

• The offer is at a site more than 50 mile from where the worker was injured, unless the work<br />

site is less than 50 miles from the worker’s residence, or the intent of the employer and<br />

worker at the time of hire or as established by the employment pattern prior <strong>to</strong> the injury was<br />

that the job involved multiple or mobile work sites and the worker could be assigned <strong>to</strong> any<br />

such site. Examples of such sites include, but are not limited <strong>to</strong> logging, trucking, construction<br />

workers, and temporary employees;<br />

• The offer is not with the employer at injury;<br />

• The offer is not at a work site of the employer at injury;<br />

• The offer is not consistent with existing written shift change policy or common practice of<br />

the employer at injury or aggravation; or<br />

• The offer is not consistent with an existing shift change provision of an applicable union contract.<br />

If you refuse this offer of work for any of the reasons listed in this notice, you should write<br />

<strong>to</strong> the insurer or employer and tell them your reason(s) for refusing the job. If the insurer<br />

reduces or s<strong>to</strong>ps your temporary <strong>to</strong>tal disability and you disagree with that action, you<br />

have the right <strong>to</strong> request a hearing. To request a hearing you must send a letter objecting<br />

<strong>to</strong> the insurer’s action(s) <strong>to</strong> the <strong>Work</strong>er’s Compensation Board, 2601 25th Street SE, Suite<br />

150, Salem, Oregon 97302-1282.<br />

Sincerely,<br />

Name, Title<br />

Department<br />

Telephone<br />

I have read and understand this job offer. I accept this job as offered. Yes ____ No ____<br />

_______________________________________ ___________________<br />

Employee Signature<br />

Date<br />

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Risk Management <strong>Return</strong> <strong>to</strong> <strong>Work</strong><br />

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Fast Facts about the Employer-at-<br />

Injury Program (EAIP)<br />

Effective 07-01-2005 per OAR 436-105<br />

What is it<br />

The Employer-at-Injury Program was created <strong>to</strong> encourage employers <strong>to</strong> help<br />

their injured workers return <strong>to</strong> work before their claims are closed. The<br />

program offers financial incentives <strong>to</strong> employers with the opportunity <strong>to</strong><br />

modify and create productive work for injured workers while the claim is<br />

open. The program is funded by the <strong>Work</strong>ers’ Benefit Fund assessment and is<br />

part of the <strong>Work</strong>ers’ Benefit Fund. Using the program does not affect<br />

premium or claim costs. It is voluntarily activated by the employer. The<br />

insurer responsible for the claim administers the program, reimburses the<br />

employer, and then requests reimbursement for program costs from the<br />

Department of Consumer and Business Services (DCBS).<br />

Types of assistance<br />

Wage Subsidy— Employers may be reimbursed 50 percent of a worker’s<br />

gross wages while on transitional duty for a maximum reimbursement of 66<br />

work days within a 24-consecutive- month period. Reimbursement is based on<br />

the wages paid <strong>to</strong> the worker. The request must be at least $200 in gross<br />

wages <strong>to</strong> be eligible for reimbursement, and only one wage subsidy is allowed<br />

per claim opening. All requests must be completed on <strong>SAIF</strong>’s wage subsidy<br />

request form (F3312), which can be found at www.saif.com forms library or<br />

by calling 800.285.8525 ext. 3652.<br />

The following types of wages are normally reimbursable:<br />

• Regular • Sick leave<br />

• Overtime • Commissions<br />

• Holiday • Piecework<br />

• Vacation<br />

(not cash-outs)<br />

• Tips as part of taxed<br />

earnings<br />

• Bonuses (only as part of a<br />

written contract)<br />

The following types of wages are not normally reimbursable:<br />

• Discretionary bonuses • Paid leave cash-outs<br />

• Tips (untaxed) • Wages/pay not clearly<br />

explained<br />

• Untaxed expense<br />

reimbursement (i.e.:<br />

Meals, lodging or per<br />

diem)<br />

• The first or last day of the<br />

wage subsidy if it is paid leave<br />

or an appointment time not<br />

provided.<br />

• Benefit<br />

programs/packages<br />

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Wage subsidy requests must be submitted with the following<br />

documentation:<br />

Payroll Records:<br />

• Proof of the <strong>to</strong>tal gross wages paid (i.e.: copy of pay stub or<br />

pay register)<br />

• Proof of daily hours worked (i.e.: time cards * or calendar records)<br />

• Identify rate of pay for all wages paid (i.e.: overtime, paid leave,<br />

shift change, etc).<br />

* Time cards must be provided if worker has an hour restriction. If time<br />

cards are not provided for periods without an hour restriction, the gross<br />

wages will be divided by the number of days in the payroll period and an<br />

average calculation will be done. Note: This could decrease the amount<br />

reimbursed.<br />

Medical Releases:<br />

• Any work releases that were provided <strong>to</strong> you regarding the accepted<br />

condition.<br />

<strong>Work</strong>-Site Modification – $2,500 maximum<br />

A work-site modification alters a work site by renting, purchasing,<br />

modifying or supplementing equipment, or changing the work process, so a<br />

worker can return <strong>to</strong> work within the specific written restrictions given by the<br />

medical provider. The form of modification will be determined based on the<br />

worker’s inability <strong>to</strong> perform the job due <strong>to</strong> the restrictions.<br />

Example: The worker must help lift patients; the restriction is no lifting<br />

over 20 lbs. The employer can overcome this obstacle by purchasing a<br />

patient lift.<br />

<strong>Return</strong>-To-<strong>Work</strong> Purchases<br />

The purchases shall be the minimum purchases required for the worker <strong>to</strong><br />

return <strong>to</strong> the transitional work. Purchases can be for the creation of a<br />

worksite and/or position that is within the employer’s course and scope of<br />

trade or profession, or for skills building requirements.<br />

Tools and equipment — $1,000 maximum<br />

These are reimbursable when the item is manda<strong>to</strong>ry for the<br />

worker <strong>to</strong> do the job, and it does not have <strong>to</strong> be specific <strong>to</strong> the<br />

worker’s restrictions. However, the worker must be able <strong>to</strong> use<br />

the item and stay within the restrictions.<br />

Example: The employer created transitional work in the office<br />

entering data. The employer does not have a computer available.<br />

Purchasing a computer is needed for the worker <strong>to</strong> do the job.<br />

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Tuition, books and fees, and materials — $1,000 maximum<br />

These are reimbursable when a class or course of instruction is<br />

needed <strong>to</strong> enhance an existing skill or develop a new skill<br />

when skills building is used as transitional work or when<br />

required <strong>to</strong> meet the requirements of the job. Instruction must<br />

be provided by an entity accredited or licensed by an<br />

appropriate body, or be an accredited online or accredited selfstudy<br />

course. When skills building is the transitional work, the<br />

worker must agree in writing <strong>to</strong> take the class or course of<br />

instruction.<br />

Example: The worker that needed the computer also needed<br />

training on the computer. The employer wants <strong>to</strong> send the<br />

worker <strong>to</strong> a two-day class for training on the program.<br />

Clothing — $400 maximum<br />

Clothing is reimbursable when it is required for the job.<br />

Clothing the employer normally provides and/or the worker<br />

already possesses is not reimbursable.<br />

Example: The worker normally works in construction and the<br />

transitional work is in the office and requires business clothing.<br />

The worker doesn’t own business clothes.<br />

Other Things You Should Know:<br />

• Modifications must be provided for and used by the worker during the<br />

Employer-at-Injury Program.<br />

• <strong>Work</strong>er’s restrictions must be known on or prior <strong>to</strong> the date the worksite<br />

modifications are initiated.<br />

• Purchases do not include items the worker possesses or duplicate<br />

work-site modification items.<br />

• All return-<strong>to</strong>-work purchases and work-site modification items become<br />

the employer’s property upon the end of the Employer-at-Injury<br />

Program, except for modification items unique <strong>to</strong> the worker, such as<br />

clothing or a cus<strong>to</strong>m-designed <strong>to</strong>ol <strong>to</strong> adapt the worker’s prosthesis <strong>to</strong><br />

a job-related task. Such items become the worker’s property.<br />

• The division has the discretion <strong>to</strong> deny any reimbursement of the<br />

Employer-at-Injury Program assistance it determines is not<br />

reasonable, practical, or feasible, or considers an abuse of the<br />

program.<br />

• <strong>SAIF</strong> <strong>Corporation</strong> will reimburse employers for eligible requests prior <strong>to</strong><br />

<strong>SAIF</strong> receiving reimbursement from DCBS and/or <strong>SAIF</strong> <strong>Corporation</strong> can<br />

accept billing from the vendor <strong>to</strong> pay them directly.<br />

Contact your <strong>SAIF</strong> <strong>Return</strong>-<strong>to</strong>-<strong>Work</strong> Consultant prior <strong>to</strong> making a work-site<br />

modification or return-<strong>to</strong>-work purchase <strong>to</strong> ensure correct processing and <strong>to</strong><br />

facilitate necessary documentation.<br />

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Eligibility Requirements<br />

The employer:<br />

• Has and maintains Oregon workers’ compensation insurance coverage<br />

during and through the Employer-at-Injury Program.<br />

• Is the employer-at-injury as defined in OAR 436-105-0005<br />

(Employer-at-Injury means the organization in whose employ the<br />

worker sustained the injury or occupational disease, or made the<br />

claim for aggravation).<br />

• Is re-employing an eligible worker while the worker’s claim is still open.<br />

The worker:<br />

• Has an accepted Oregon compensable injury or occupational disease.<br />

EAIP Begins<br />

EAIP begins when specific work restrictions are known, and all of the above<br />

eligibility requirements have been met.<br />

There are two types of medical releases that qualify under these rules:<br />

A. A medical release that states the worker’s specific restrictions; or<br />

B. A statement by the medical service provider that indicates the worker<br />

is not released <strong>to</strong> regular employment accompanied by an approval of<br />

a job description, which includes the job duties and physical demands<br />

required for the transitional work. Note: For this type of work release<br />

<strong>to</strong> start the program the doc<strong>to</strong>r would have <strong>to</strong> have signed the job<br />

description on or after June 8, 2003.<br />

• Medical releases for “light work,” “light duty,” or “modified work”<br />

without other specific restrictions, are not considered acceptable<br />

cited restrictions <strong>to</strong> start the EAIP. An employer or insurer may get<br />

clarification about a medical release from the medical service<br />

provider who issued the release anytime prior <strong>to</strong> submitting the<br />

reimbursement request.<br />

• “Transitional work must be within the employers course and scope<br />

of trade and profession,” unless the work is skills building. For<br />

questions regarding this requirement please contact your <strong>SAIF</strong><br />

<strong>Return</strong>-<strong>to</strong>-<strong>Work</strong> Consultant.<br />

EAIP Ends<br />

The insurer must end the program when the first of the following occurs:<br />

• The worker’s claim is closed.<br />

• The worker or employer no longer meets the eligibility requirements.<br />

• The Employer-at-Injury Program reimbursement is requested<br />

(submission of wage subsidy form).<br />

• Sanctions under OAR 436-105-0560 preclude eligibility.<br />

Note: The insurer may end the Program at any time while the worker’s claim<br />

is open.<br />

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Other Things You Should Know<br />

• A medical release must cover the period wages that are <strong>to</strong> be<br />

reimbursed.<br />

• If a medical provider gives restrictions for a specific period of time (or<br />

the worker misses a follow-up appointment), the worker must get a<br />

continued work release within 14 days from the date the restrictions<br />

end (or from the date of the missed appointment) or the work release<br />

expires.<br />

• A medical release with no specific end date or follow up appointment<br />

expires in 30 days. If the worker does not get a continued work<br />

release within the 30 days, the work release expires.<br />

• Doc<strong>to</strong>rs cannot backdate work releases <strong>to</strong> cover lapse in authorization<br />

of work releases.<br />

• All requests for reimbursement must be submitted <strong>to</strong> <strong>SAIF</strong><br />

<strong>Corporation</strong> within one year from the end date of the program. <strong>SAIF</strong><br />

<strong>Corporation</strong> encourages you <strong>to</strong> submit your request as soon as you<br />

can identify a program end date <strong>to</strong> assure timely submission.<br />

<strong>SAIF</strong> <strong>Corporation</strong> developed this information as a quick reference<br />

guide on how <strong>to</strong> access benefits from the Employer-at-Injury<br />

Program. For actual rule quotes, refer <strong>to</strong> OAR 436-105. Please<br />

contact your <strong>SAIF</strong> <strong>Return</strong>-<strong>to</strong>-<strong>Work</strong> Consultant with any questions at<br />

800.285.8525.<br />

How <strong>to</strong> apply:<br />

To access the EAIP program, contact your return-<strong>to</strong>-work consultant, as<br />

employers apply for assistance <strong>to</strong> these programs through <strong>SAIF</strong><br />

<strong>Corporation</strong>. Because of our strong belief in the return-<strong>to</strong>-work concept<br />

we would be happy <strong>to</strong> assist you in developing a tracking/submission<br />

plan. We will also help guide you through the eligibility requirements<br />

and accurately complete the necessary documents <strong>to</strong> qualify (Samples of<br />

the required forms for the Employer-At-Injury Program are included in<br />

this section or can be found at <strong>SAIF</strong>’s website www.saif.com, and<br />

clicking on Find a form.) Once a claim has been found eligible, <strong>SAIF</strong><br />

reimburses the employer for expenses incurred and the Department of<br />

Consumer and Business Services reimburses <strong>SAIF</strong>.<br />

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Preferred <strong>Work</strong>er Program<br />

This program was created <strong>to</strong> encourage the reemployment of qualified<br />

Oregon workers who have permanent disabilities from on-the-job injuries<br />

and who are not able <strong>to</strong> return <strong>to</strong> their regular work because of those<br />

injuries. It may be used both with the employer-at-injury or with a new<br />

employer. Program incentives <strong>to</strong> employers include:<br />

Premium Exemption<br />

Claim Cost<br />

Reimbursement<br />

Wage Subsidy<br />

Obtained<br />

Employment<br />

Purchases<br />

<strong>Work</strong>-Site<br />

Modification<br />

An employer does not pay workers’ compensation<br />

insurance premiums or premium assessments on<br />

a preferred worker for up <strong>to</strong> three years from the<br />

date the worker starts work. Request for<br />

premium exemption must be reviewed and<br />

approved by the Department of Consumer and<br />

Business Services (DCBS).<br />

If a preferred worker has a new injury during the<br />

premium exemption period, DCBS will reimburse<br />

claim costs <strong>to</strong> the insurer, and the claim will not<br />

increase the employer’s workers’ compensation<br />

rates.<br />

DCBS will reimburse an employer 50 percent of a<br />

Preferred <strong>Work</strong>er’s first six months’ wages.<br />

DCBS may reimburse the employer for the cost of<br />

items purchased <strong>to</strong> help the worker obtain a job or<br />

<strong>to</strong> continue employment. Examples of these<br />

expenses are: tuition and books, <strong>to</strong>ols and<br />

equipment, clothing required for the job, moving<br />

expenses, and rental allowance.<br />

DCBS may reimburse the employer for <strong>to</strong>ols,<br />

equipment, and work-site redesign needed <strong>to</strong> help the<br />

worker <strong>to</strong> overcome injury-caused limitations and do<br />

the job.<br />

Only WCD can determine eligibility for the Preferred <strong>Work</strong>er Program and its<br />

benefits. Call (<strong>to</strong>ll free in Oregon) 800.445.3948 between 8 a.m. and 5 p.m. <strong>to</strong><br />

have questions answered and learn more about the program benefits.<br />

© <strong>SAIF</strong> <strong>Corporation</strong> Page 25 of 25 S-825 January 2007

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