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Disability and Disability Insurance

Return-to-Work Best Practices

Marcia Carruthers | August 1, 2014

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Injured workers

When employees experience illness or injury, it often impacts their ability to perform their jobs. In cases where an employee is losing time from work, it is in everyone's best interest to return the employee to work in some capacity as soon as possible. This philosophy ensures that all workers receive early interventions that are focused on returning them to the workplace in a timely manner, including making accommodations, if necessary. In the past, strategies and programs have been used to reduce workers compensation costs; however, they can also improve productivity and save time, money, and loss of talent by focusing on both occupational and nonoccupational cases. That's why return-to-work (RTW) is also one of the cornerstones to any integrated disability and absence management program.

This is the first of two articles on the topic. This month's article concentrates on defining the concept of RTW, explaining why it's important and how to initiate a formal program, establish goals, and explore key program elements. In Part 2, we will cover roles and responsibilities, interventions/triggers, outcome and success measures, and consideration for accommodations.


At any point in time, an estimated 4 to 10 percent of an employer's workforce is not at work. That is a significant number. Time away may be due to any reason including, but not limited to, personal days, vacations, sabbaticals, jury duty, bereavement leave, and injury or illness (both occupational and nonoccupational). Although some absences are necessary and allow time for recuperation and rejuvenation, employers must work to manage absences whenever possible given their impact on productivity, profit, and employee morale.

One way to manage time away from work is to promote—through plans, processes, training, and communication—RTW initiatives. Establishing an RTW program, including stay-at-work (SAW) elements, demonstrates an organizational commitment to employees, while also prioritizing corporate goals and objectives.

The roots of RTW, for most firms, are linked to safety programs and accident prevention tied to workers compensation. The goal has consistently been to develop programs that enable employees to return to a safer environment, as well as limit accidents and recurring exposures to foster a SAW mentality. Over time, the core concepts of RTW have and continue to be leveraged for not only workers compensation but also nonoccupational disability. Although RTW is still primarily focused on accidents, illnesses, and injuries, employees out for any reason (e.g., family medical leave, personal leave) benefit from a smooth transition back to their role.

Defining RTW

In its basic form, RTW is getting employees back to their jobs, taking into account individual circumstances, but establishing streamlined processes to treat employees in a similar manner. When examined in more detail, RTW is less about the short-term gain of returning an employee to his or her specific job and more about a sustainable culture that fosters employees' needs and considers not what keeps them from doing their jobs but what jobs they can accomplish and how they can be more productive in the short and long term. Given this, programs promoting return to employment vary based on the employer and its culture.

Typically, an RTW program can be defined as either a formal or an informal program. A formal RTW program is one based on specific written and disseminated organizational policies and practices that instruct and direct supervisors and employees in the RTW process following a leave of absence due to an injury, illness, or chronic disease. A formal RTW program's intent is to expedite the individual's recovery and return to productivity through referral, counseling, coordination of medical care, or modifying the work space or work duties. Formal RTW programs may include vocational rehabilitation services coupled with transitional work to reintegrate the individual back to full productivity. A formal RTW program may or may not be integrated with other benefits or absence or leave management services, although these are highly recommended. Reasons to have a formal RTW program include reduction of lost time, it being the "right" thing to do, statutory requirements, and protection of the investment in the workforce.

An informal RTW program is one where there are few or no written policies or practices to guide the management team or the employees who are absent due to injury, illness, or chronic disease. Any employer response is based primarily on a case-by-case basis guided by the personal relationships, communication, and/or local practices at the department or work unit level. Companies often begin with an informal process and move to a formal program to increase their success. Reasons to have an informal RTW program include reduction of lost time, implementation of the simplest strategy, and greater flexibility.

RTW can be considered both a plan feature and a process. As a plan feature, RTW coordinates with absence plan design. Within occupational and nonoccupational disability, participation in specific vocational rehabilitation programs that promote RTW may be required to validate the absence by an employer or have the absence qualified for compensability. When considering plan design, the most important factors are program goals, roles and responsibilities, and intervention or trigger points.

Why Is RTW Important to Companies?

The reasons for implementing either a formal or an informal program can be as varied as the organization. As defined above, both formal and informal programs have advantages and disadvantages. However, research has shown that a number of compelling factors play into the decision.

Economic Factors

Medical costs, claim incidents, and duration are all corporate challenges. One study found that 66 percent of companies found these to be chronic, serious, or consistent problems.


Saving lost workdays and protecting your human capital are two of the most influential factors driving the decision to implement a formal RTW program.

Governmental Regulations

Federal, state, and local regulations and subsequent compliance are a source of possible influence, especially if employers are required to have a program in place.


An aging workforce leads to more attention to strategies to keep workers at work and making sure that all lost time is connected.

Proactive Stance

Managing lost time benefits society through longer-term positive effects on labor force participation.

RTW Works

There is a substantial body of knowledge that illustrates the effectiveness of RTW "best practices" if applied in a timely and appropriate manner.

Developing a Formal RTW Program

Any concerned supervisor and motivated employee can engage in RTW; no formal process is required. These ad hoc initiatives are beneficial for all parties involved, but they can create some inconsistencies in processes, which may be frustrating to employees and perhaps result in noncompliant interactions with employees or even legal implications. Without support, managers and supervisors cannot be expected to be aware of all federal and state requirements, and, therefore, they may innocently ask questions that may be inappropriate or forget to track cases in line with regulatory standards (e.g., state disability, family medical leave, etc.).

By developing a more structured program with an RTW focus, an organization can better manage its features. Expectations will be communicated, and all core parties (employees, supervisors, physicians, etc.) will know what is expected of them. Also, a formal process usually includes a provision for supplying physicians with details surrounding job requirements. This may translate into a greater comfort level for returning an employee to work with modifications or in a limited capacity. Additional gains in process include:

  • Streamlined communications to all core stakeholders
  • Training for managers to equip them with the appropriate tools to remain compliant
  • Formal triggers for RTW
  • Established modifications for job categories
  • Creative options for both internal and external jobs (e.g., job banks)
  • Ability to track against established processes and monitor outcomes
  • Financial and cost savings
  • A competitive advantage

Implementing an RTW program from scratch may be challenging because many organizations have not rigorously analyzed their causes and costs related to absence. Absent an established baseline, predicting or demonstrating savings can be difficult. Employers should study the experiences of industry peers or competitors to appreciate that their companies can replicate successes by other organizations if they install appropriate plans and processes. It is imperative that when considering implementing an RTW program, tracking is part of the overall solution. It is only through tracking the plans, processes, and outcomes (qualitative and quantitative) that results can be monitored and changes can be made to improve on the program over time.

Program Goals

Employers engage in an RTW program for many different reasons, including better management of the costs of benefits offered by their organization, creating a more employee-centric process, and supporting managers toward optimal productivity. The core RTW goals should be clearly defined at the outset, reassessing them on a regular basis. In some cases, they may be attained, and, therefore, more aggressive standards should be set. In other circumstances, goals may need to be modified if they no longer correspond to corporate need or if they have been set too high and require adjusting.

Although all program goals are important, the most common objective is reduced spending. Savings can be achieved through various mechanisms and incentives to establish and maintain an RTW program. At the outset, these may be difficult to quantify, but organizations achieve savings through:

  • Reduction in cost of absence (disability, workers compensation, etc.)
  • Decrease in replacement worker expenses (training, recruitment, team worker effect, etc.)
  • Decline in medical claim costs
  • Reduction in litigation costs
  • Earlier identification of fraudulent cases
  • Increased awareness of injury prevention and safety protocols
  • Improved employee morale, which may contribute to decreased turnover

If thoughtfully established, processes and plans represent a mutually beneficial solution for employees and employers. For employees, participating in an RTW program may assist in their recoveries. It typically allows them to begin working as they recover, which frequently translates into a feeling of physical and emotional growth. Absent employees, depending on their circumstances, may become disengaged from the workplace. At times, physical ailments may transition into emotional deterioration, resulting in longer recovery time.

The longer employees are absent, the less likely they are to return to their original jobs. In some ways, this is simply a function of more complex conditions that necessitate long-duration absences, but industry experts agree there is a culture of absence that can cause employees to remain out simply due to the fact that they are not engaged in the workforce. They may realize the benefits of not working, or they may simply become detached from their prior identities and, over time, lose the drive to become productive in the workforce. This is not necessarily fraudulent behavior, as many employees are not purposefully remaining out of work, but they lack the desire to return, which can exacerbate their circumstances and translate into emotional or physical ailments.

RTW is not always about returning an employee to his or her specific job, although that is the ideal state. RTW also encompasses engaging employees in alternative jobs as stepping-stones toward full time, full duty, or a way for an employee to remain engaged during his or her period of disability.

Program Elements

Successful RTW programs are reported to have the following essential program characteristics.

Commitment of an Internal Champion

A culture of RTW begins though an internal champion (or group of supporters) who values the employees and truly wants them to regain useful employment. The champion's intentions are not based solely on costs or productivity, although he or she knows both are affected by positive RTW. Instead, the champion's personal commitment to employees is demonstrated in his or her ability to work with them in a proactive manner to achieve positive outcomes for all parties.

Establishment of Credible Evidence

RTW programs (and "best practices" of effective programs) need to match the goals of the employer. This is done through the following.

  • Attention to the implementation process, which emphasizes:
    • Consistency with organizational values
    • Adequate human and financial resources
    • Development/motivation/empowerment of an internal program champion
    • Education and communication with all stakeholder groups (specifically supervisors and physicians)
    • Simplicity, accessibility, and flexibility in program design
    • Professionalism and accountability on the part of those assigned to manage the program
  • Accessibility to all individuals with all types of impairments
  • Monitoring by an evaluation system that uses multiple outcome measures, occurs periodically (quarterly), and demonstrates value to the employer; in addition, employers need information on how to design and implement concrete steps to gather and interpret appropriate RTW data.
  • Support by incentives from the disability insurer or third-party administrator to support implementation and maintenance of an RTW program
  • Integration and coordination with all stakeholders to avoid a silo mentality yet maintain an employee-centric focus. Many organizations silo their various benefits programs into various operational categories to include environmental health and safety, health promotion, employee assistance programs, disability, RTW, group health, workers compensation, and other programs. The advocated approach integrates RTW with worker health, safety, and productivity as an overall business strategy. When organizations operate their benefit programs semi-independently and piecemeal, dysfunction and inefficiency eventually ensues. An integrated approach to RTW is recommended as a best practice, and this coordination will foster an effective culture of RTW over time.
  • Endorsement by upper management is essential, as it is certain that RTW must command senior management support.


Not all employees will be able to return to work, and every situation is unique, but best-in-class programs have an underlying culture that fosters RTW. Establishing a culture of RTW may be challenging and take time for some organizations yet prove relatively easy for others. Establishing a formal RTW program ensures consistent application, lowers risk and legal exposure, documents cost savings, increases productivity and morale, and supports a cohesive and integrated disability and absence management approach.


Disability Management Employer Coalition (DMEC), Foundation for Optimal Productivity: The Complete Return to Work Program Manual (2012).

U.S. Department of Labor, Bureau of Labor Statistics, Current Population Survey: Circadian Information, Shiftwork Practices (Washington, DC: GPO, 2005).

Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Steps to a Healthier U.S. Workforce Symposium, "Examining the Value of Integrating Occupational Health, Safety and Productivity Management Programs in the Workplace" (2004).

Syracuse University, Burton Blatt Institute, "Final Report: Corporate RTW Policies & Practices: A National Study" (2012).

Marcia Carruthers, MBA, ARM, CPDM, is cofounder and chairman of the Disability Management Employer Coalition (DMEC), a San Diego-based nonprofit trade association providing educational resources to employers in the area of disability, absence, health, and productivity. For information, visit or email Ms. Carruthers at [email protected].

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