Insurers and Third-Party Administrators (TPAs) have a role in helping injured workers return to work. Not only is it beneficial to the injured worker, but it also helps the bottom line for employers.

Insurers and TPAs can:

• Create Return-to-Work resources for employers, and be sure to promote them
• Ensure proper and fair administration of all workers’ compensation claims
• Maintain communication with the injured worker, medical provider, employer, WCB, and the injured worker’s legal representative
• Encourage employers to bring workers back after injury or illness
• Actively assist the employer with a successful RTW program implementation
• Authorize all necessary medical treatment promptly
• Work with employers on safety and provide incentives for cooperation

Nurse Case Management Services

Most insurers and TPAs employ nurse case managers. Here are some ways they can help an injured worker return to work.

• Identify possible complications
• Arrange for therapies and treatments that will heal the worker, as well as remove barriers. Ensure that medical treatment complies with the NYS Medical Treatment Guidelines
• Ensure timely scheduling of necessary and appropriate diagnostic testing and other procedures

Nurse Case Managers should follow these best practices.

• If the injured worker is represented by an attorney or licensed representative, all communication must go through the representative.
• Regularly communicate with the employer to help the worker return. Nurse Case Managers can facilitate return to work for an injured worker by knowing what jobs are available for the injured worker within their medical restrictions.
• Only the injured worker’s medical providers know when an injured worker can return to work without limitations. Until then, the Nurse Case Manager must be familiar with the injured worker’s level of disability and work duty restrictions.
• Develop transitional or light duty job descriptions for every injured worker.

Claims Adjusters

Claims adjusters play a crucial role in helping injured workers return to work. Adjusters can ensure that injured workers are receiving proper medical care by promptly authorizing treatment and prescriptions that fall under the Medical Treatment Guidelines and Drug Formulary. Denying or delaying recommended treatment and medication will also delay an injured worker’s recovery and ability to return to work.

Claims adjusters must always check the Board file or medical portal to see if the injured worker has a legal representative. If so, the claims adjuster should only communicate with injured workers through their attorney or licensed representative.

• Claims adjusters should contact medical providers to obtain current and future treatment plans, potential job restrictions and return-to-work dates. Information should be shared with the employer to ensure an early return to work. They can also arrange for transportation as needed to medical care and exams for injured workers