Who's Really in Charge of Return to Work? 

In workers’ compensation, there seem to be differing opinions around who’s really in charge of return to work.  The answer becomes clearer when you consider who ultimately must make the decision to return to work.  Sure, an employer has to offer return to work, and the medical provider needs to assess if the return-to-work offering is safe, but the worker is ultimately the one who makes a personal decision to return to work.  It seems, based on their publications, the American College of Occupational and Environmental Medicine is aligned with me on this point.  

Call me crazy, but how well do you accept decisions that were made for you by other people?  How well do you react to being pushed toward something you haven’t considered or bought into?   It all starts with the worker – doing so is the easiest, fastest, least expensive and most effective way for a worker to return to work or stay at work.  While the claims advocacy approach can be a foundational starting point, it is insufficient to solve the more complex work disability issues that are ruining lives and plaguing our industry. 

This is precisely why a worker-centric approach is a necessary cornerstone for any work disability prevention and mitigation program.  Back in October 2021, Vickie Kennedy wrote an Expert’s View article entitled “Introduction to a Worker Centric Model.”  In her editorial, she talked about how this approach uses evidence-based strategies to shift human behavior – specifically, the worker’s behavior toward choosing to return to work.  This doesn’t mean the employer and medical provider don’t play important roles in return to work - they do.   

Causing a worker to be sidelined, confused, unsure of their role or the role of others, having no voice, not being included, having things happen to them, and feeling like they are just a number is a recipe for disaster.  Let’s talk about the ingredients of that recipe for a moment.  Let me see…a splash of perceived injustice, a dollop of catastrophic thinking, a dash of fear/avoidance, and a heaping spoonful of uncertainty make it easy for a worker to choose not to return to work.  Put yourself in their shoes.  Do you like feeling this way? Are you able to use good judgement when you are in a crisis, in pain, and uncertain of the future?  When you feel this way, are you naturally pulled toward being compliant?  My guess is probably not.   

And don’t get me wrong, using a worker-centric approach doesn’t mean we give the worker everything they want or ask for.  That would be grossly negligent.  It means we take the time to discover the worker’s expectations, fears, concerns, goals and next steps.  Then, we collaboratively develop a plan with the worker and dynamically coach them to achieve their goals - within the boundaries of our jurisdictions and policies.  The worker-centric approach requires dynamic engagement and activation to combat system-driven inertia.   

I see a lot of evidence suggesting our industry would benefit from breathing life into the concepts found in the literature to better serve workers and employers – you know, the people who are the basis for the existence of our collective professions.  In practice, synthesizing these concepts into action isn’t rocket science but it does require courage, a cultural shift, leadership, investment and tenacity in order to see how it can be done. Oh, and by the way, it’s the right thing to do and can significantly reduce claim costs for employers and insurers. 

Ryan Guppy is the Director of Work Disability Prevention for Linea Solutions, Inc. and has almost 20 years of experience in work disability prevention, interdisciplinary chronic pain management, and vocational rehabilitation.  He previously led Return to Work Partnerships, within Washington's Insurance Services Division. As Chief of that program, Ryan ensured the Washington State Fund designed, managed, and effectively used innovative work disability prevention programs that provided workers with state-of-the-art services customized for their unique return-to-work and vocational needs.  Ryan is a certified vocational provider and trained in the Progressive Goal Attainment Program. He is currently a member of the Work Disability Prevention and Return-to-Work Committee of the International Association of Industrial Accident Boards and Commissions and Past President of the International Association of Rehabilitation Professionals – Washington Chapter.  In 2017 he received the Governor’s Leadership in Management Award.