Lesson 6

Question 1

1.1 List the milestones between the return to work coordinator’s (RTWC) first contact with the employee and closing the employee’s file (3 questions)

Answer 1

1) the RTWC determines if assistance/intervention is required
2) The RTWC determines if a formal RTW plan is required
3) The RTWC determines if the RTW plan is successful and sustainable

Question 2

1.1.b What happens if the RTWC determines that intervention/assistance is not required

Answer 2

The reasons are noted in the employee’s file

Question 3

1.1.c What happens if the RTWC determines that intervention/assistance is required

Answer 3

The employee is referred to the appropriate rehabilitation provider or the RTWC arranges for other assistance

Question 4

1.1.d What happens if the RTWC determines that a formal RTW plan is not required

Answer 4

The reasons are noted in the employee’s file

Question 5

1.1.e What happens if the RTWC determines that a formal RTW plan is required

Answer 5

The first question is to determine if an employee can return to their preinjury position.

If it is possible the RTWC and the employee provide physical demand analysis information to the doctor. The doctor completes the RTW form and suggests options for a safe and timely return to work.

The RTWC, employee and employee’s supervisor along with an employee representative and the benefit provider agree on a RTW plan and implement it.

The plan is monitored by the supervisor and the doctor.

Question 6

1.1.f What happens if the RTWC determines that an employee cannot return to their preinjury position.

Answer 6

If it is not possible the RTWC, RTW committee and employee do a transferable skills profile and identify job options

Question 7

11.1.g What happens if the RTWC determines that the

RTW plan isn’t successful and sustainable

Answer 7

goals or specific objectives are modified with appropriate individuals

Question 8

11.1.h What happens if the RTWC determines that the RTW plan is successful and sustainable

Answer 8

The employee’s RTW file is closed

Question 9

1.2 Explain the purpose of first contact in the RTW process (2+may include)

Answer 9

1) to open lines of communication
2) to let the employee know the a support program is available

May include a meeting with a RTWC and/or an HR representative helping the EE fill out forms

Question 10

1.3 Identify the general guidelines on the timing of first contact by a RTWC

Answer 10

In the case of an accident the RTWC should contact the EE within 24-48 hours

In the case of an illness the RTWC should contact the EE within 10-14 days.

This should be a guide adapted to the nature of the illness or injury

Question 11

1.4 Outline factors that influence the decision to begin a coordinated, planned approach to return to work

Answer 11

Specific requirements of the EE’s condition and the work environment influence the decision to begin a planned RTW

This decision is also dependent on medical reports. Functional job information may help doctors determine when it is safe to start a RTW

Question 12

1.5 Outline the stages of the RTW process (7)

Answer 12

1) Providing treatment, rehabilitation, as applicable
2) Completing a functional capacity evaluation and/or other assessments
3) Providing information on how to obtain compensation and benefits

4) Developing a
RTW plan

5) Implementing the RTW plan
6) Monitoring and adapting the RTW plan
7) Evaluating the RTW plan

Question 13

2.1 Explain the role of an employee’s medical treatment in the development of their RTW plan

Answer 13

When an EE has been away for a certain amount of time many ERs have policies that require a doctor to complete a functional abilities form.

This is also required by the WCB in some provinces.

Returning employees may still require time off for treatments such as physiotherapy or counselling.

Once the doctor completes the form the EE should inform the WCB.

The WCB and insurance carrier will receive copies of the report and may be involved in developing a RTW plan for the employee

Question 14

What information is on a functional abilities form

Answer 14

what the employee can undertake without aggravating an injury or illness.

The report indicates functional restrictions and the expected date of resumption of duties

Question 15

2.2.a list three kinds of assessments used in the development of an employee’s RTW plan

Answer 15

1) Functional capacity evaluations
2) Physical demand analysis (PDA)
3) Cognitive and psychological assessments (neuropsychological or psycho-vocational)

Question 16

2.2.b What is a functional capacity evaluation

Answer 16

Completed to determine whether an EE can return to work and under what conditions.

Provide information about limitations and restrictions as well as current abilities.

These are the matched to the requirements of the EE’s job.

Question 17

2.2.c What is a Physical Demand Analysis (PDA)

Answer 17

detailed information about job demands

Assessments may be completed by the EE’s doctor. In situations where there may be concerns or uncertainty about what an EE can do a more complete assessment may be done by a specially trained assessor.

Most employers have a complete job analyses on all positions

Question 18

2.3 What factors are considered when a physician is making a fitness to work decision (7)

Answer 18

1) location of work (is it remote? isolated? near medical facilities?)
2) Description of the job
3) Hours of work
4) Job functions (lifting, standing etc)
5) Occupational health and safety hazards
6) Special job requirements
7) Psychological demands and stresses (interpersonal and social group dynamics, exposure to conflict)

Question 19

2.4 Explain the role of health status in planning for an employee’s return to work

Answer 19

The required health status is based in the employee’s working conditions.

The doctor evaluates the level of function of the relevant bodily systems and compares that level of function to the level required in the employees job

Question 20

2.5.b Describe the basis and implications of the NIDMAR’s fitness to work outcome being Fit

Answer 20

The employee may be considered not disabled, temporarily partially disabled or permanently partially disabled.

The employee will not be a hazard to self or others in the context of stated working conditions.

Patients aren’t necessarily fit for any job just this specific one

Question 21

2.5.a List the four possible outcomes of NIDMAR’s fitness to work evaluation

Answer 21

1) Fit
2) Fit - subject to work modification
3) unfit for a specific job
4) unfit for all jobs

Question 22

2.5.c Describe the basis and implications of the NIDMAR’s fitness to work outcome being “Fit - subject to work modification”

Answer 22

The employee may be considered not disabled, temporarily partially disabled or permanently partially disabled.

If certain alterations are made to working conditions the employee could be considered fit

Question 23

2.5b Describe the basis and implications of the NIDMAR’s fitness to work outcome being Unfit

Answer 23

The employee may be considered temporarily totally disabled for a specific job, permanently totally disabled for a specific job, temporarily totally disabled for all jobs or permanently totally disabled for all jobs.

The clinical impairment and working conditions are incompatible.

This assessment may be temporary if the employee has further healing to do. There are presently no work modifications that would permit fitness.

Question 24

2.6 Explain the role of independent medical examinations (IMEs) in developing a RTW plan

Answer 24

There will be cases in which the employer and employee will benefit from a third party IME to assess functional capacity.

This may occur when an RTWC, the employee, the employee’s supervisor, the employee’s representative and/or the benefit provider can’t reach agreement on an RTW plan.

The doctor should be informed of the nature of the dispute and given as much information about the functional demands of the job

Question 25

2.7 Explain the factors that impact decisions about benefits and support programs in the RTW process (7)

Answer 25

1) whether the injury/illness is work related
2) whether the injury/illness is the result of a motor vehicle accident
3) Whether the employer provides STD and/or LTD
4) whether the employee has private insurance
5) whether the employee is eligible for EI
6) Whether the employee is eligible for CPP/QPP
7) Whether the employee is permanently disabled and requires significant job modifications

Question 26

2.8 Provide examples of benefit period guarantees that can encourage employees to participate in a RTW program (3)

Answer 26

1) a LTD benefit payable for the duration of the program
2) If the program involves a change in job for the EE, LTD benefits payable for the duration of the rehabilitation program and, in any event, until the date the disability is due to change to include any occupation
3) If the disability reoccurs (within 6 months of return to full time work) continuation of LTD benefits for up to 24 months as long as the employee is in the 2 year own occupation period or participating in a RTW program

Question 27

2.9 Explain how any reduction in LTD benefits paid while an employee is being paid by a RTW program influences employee motivation to participate

Answer 27

If reduction is 100% there is no motivation to participate.

Some LTD plans have a max earnings level before LTD reduction. Some have a 50% of earnings reduction. Some have a limit of 100% of pre disability earnings. Or some combination thereof

Question 28

2.10 Compare accommodation and service coordination in a RTW plan

Answer 28

Accommodation involves steps take to adapt the work environment so that it fits the capabilities of the returning employee. It might include changing aspects of the job or adding specialized equipment.

Service coordination is a form of case management that involves identifying and making available services that will assist employees in returning to work. For example support groups, financial counseling services etc.

Question 29

3.1 Explain the role of the insurer in implementing a RTW plan

Answer 29

The RTWC consults extensively with the insurer to ensure that early return to work does not affect an employee’s benefits coverage.

By involving the insurer in developing a RTW plan a RTWC can ensure that, if the return is not fully successful, the employee’s coverage can be reinstated without penalties.

In addition insurers may cover the cost of some accommodations and training.

Question 30

3.2 List the hierarchy of return to work options from most to least preferable (4)

Answer 30

1) Return to work, same job, same employer.
2) Return to work, different job, same employer
3) Return to work, different employer
4) self employment

Question 31

3.3 Illustrate how job accommodation can be achieved using assistive devices or by modifying the work environment (5 - what can be included, examples or general ideas)

Answer 31

• can include any modification of job demands or hours
• physical or structural modifications
• installation of assistive devices (computer hardware/software, hearing aids, specialized keyboards, magnifying optical lenses)
• can be temporary or permanent
• modification to the environment can include physical changes to work area or equipment or the way parts of the job are done

Question 32

3.4 Explain how human rights laws and duty to accommodate legislative requirements impact the development of a RTW plan (2 points)

Answer 32

Employers may be required to show that job requirements presented as a reason to prevent an employee from performing a job are bona fide occupational requirements.

Employers also have a duty to accommodate and must show that they have made a reasonable attempt

Question 33

3.5 Describe the role of transitional work in a RTW plan

Answer 33

Transitional work includes any group of tasks or jobs not intended to be the end result of the RTW process.

May include modified work hours and duties. The employee is intended to eventually return to other original tasks

Question 34

3.6 Outline the risks associated with transitional work (3)

Answer 34

Clear guidelines are needed since

1) there may be a tendency to slowly add tasks that could impede a full return or that could create a new trauma or illness
2) There may be a tendency for the employee to overextend (overwork) in an effort to get back to work as soon as possible
3) An employee may become so attached to the transitional work that there is a reluctance to return to former duties

Question 35

3.7 Explain the role of work hardening in a RTW plan

Answer 35

Gradual physical conditioning designed to develop an employee’s strength and endurance.

In some cases it is accomplished through modified hours and gradually increasing the time spent on completing tasks. Can also include a work hardening program at a separate rehabilitation facility.

Question 36

4.1 Identify potential outcomes of the evaluation of a disability management program (9)

Answer 36

1) Evaluations measuring disability management program results
2) Identification of costs of disability management programs
3) Identification and implementation of realistic cost containment strategies
4) Qualitative and quantitative evaluations
5) Assessments of the effectiveness of health care providers and resources
6) Identification of key elements of an effective data management/program management system
7) Implementation of confidentiality safeguards for disability management data
8) Evaluations of employee/supervisor satisfaction with the program
9) Incorporation of accident and illness reporting systems

Question 37

4.2 Provide examples of key success indicators that a disability management program is achieving its program targets (7)

Answer 37

1) Number and severity of injuries
2) Average absenteeism per full time employee
3) Overtime and relied staffing
4) average time from an employee’s specific injury or illness to their return to work
5) Period of time employees continued to work for the employer following their involvement in an RTW program
6) Costs of insurance and insurance claims
7) Amount of income lost by employees who are off work

Question 38

4.3 Identify factors used in cost/benefit analysis to assess the effectiveness of a disability management program (5)

Answer 38

1) insurance costs
2) Decreases in average absences and associated costs following an injury or illness
3) Costs of staff turnover, including supervisor time, recruitment and training
4) Increases in productivity as a result of retaining skilled and healthy employees
5) assistive technology and modifications to work stations