New Insights Into Modified Duty's Benefits

Do modified duties work to reduce workers’ compensation costs? Aside from anecdotal evidence, we haven’t had firm evidence. But a study reported late last year, based on in depth interviews with over 600 workers scattered throughout the workforce, says that employers with modified duty programs bring their workers back faster.

Moreover, worker health improves. An employer trying to manage work injuries without a very fast-acting return-to-work program will have sicker injured workers and higher costs

In a worksite without modified duty, the study (cited at the end) reported that about half of work injuries result in disability lasting at least eight days, roughly the threshold for a lost time compensable claim. In worksites with modified duty, only a quarter of injuries result in disability that long.

Using some rules of thumb about the costs of medical only and lost time claims, one can conjecture that modified duty, with respect to very prompt RTW, cuts workers’ comp costs in half.

But the researchers producing this study were looking for something else than costs. They were looking at whether early RTW helps or complicates the injured worker’s recovery. And they concluded that it does help.

The research team was primarily studying the impact, if any, of prompt RTW— within seven days post injury — on pain intensity and functional capacity, measured three months after injury.  This is a smart, and as best I know, the only instance of assessing fast-acting RTW on the health of the worker.

The study is timely in that the findings align with the “claims advocacy” approach to claims, which is to be more worker-centric. Providing modified duty helps the worker to recover her or his health.

Let’s go over the thought process of the researchers. They wanted to study the connection between modified duty programs, very prompt RTW (including staying at work) and the health of the worker, reported by the worker many weeks post injury. That timing would take into account the worker receiving medical care and for most cases resolving the claim.

The researchers did not search for any attributes of injury response other than modified duty, though it is highly likely that worksites with modified duty do other things to help workers recover, such as staying in close touch and managing medical care. This is a limitation I can live with. Another limitation is that the researchers looked only at low-back injuries.

To be sure, a prompt RTW program will not eliminate all pain and loss of function. The authors warn that what happens with medical treatment, comorbid health conditions, patient education and family support can overwhelm the impact of very early RTW. But a fast-acting RTW program is an initiative that the employer has great discretion in designing and implementing. 

The authors caution that employers need to be flexible in temporary job assignments. They need, for instance, to account for recovering workers who experience symptoms weeks or months after injury. 

How does fast RTW programs manage to improve worker health? It’s not really clear. One thing that can seriously complicate early RTW is fear of reinjury. The authors cite studies which show that this fear can be a path towards chronic pain. They say that efforts to restrict activity and avoid pain can lead to repeating a cycle of disengagement, deconditioning, recurring pain and despair. “Early RTW may help or break this cycle of automatic thoughts and activity restriction” and reduce pain experiences, they wrote. Thus, very early RTW is an effective element in treating injuries.

Here are some details within the findings. Keep in mind that the researchers interviewed the workers, not management. Among those workers who anticipated their employer ‘s support for job modification, 39% stayed on the job and only 23% had more than seven days off work. But among those with no expected modified duty, only 17% stayed on the job and nearly half (48%) were out for more than seven days.

Let’s do the math. Any injury with no lost time or less than eight lost days most likely is a medical only claim, in almost all states without any indemnity benefits. Let’s assume they cost on average $1,000. 

Injuries with durations of at least eight days will be lost time compensable claims, with medical and indemnity benefits. They average about $50,000 in costs.

An employer with a prompt RTW program can expect to have half the workers’ comp costs of one without such a program, at least for low-back injuries. 

The article, in the October, 2018 issue of the Journal of Occupational and Environmental Medicine, was authored by a team led by William Shaw. Its title is, “Early return to work has benefits for relief of back pain and functional recovery after controlling for multiple confounds.”

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