Can you hear me now? Would you rather not?

Keep in contact, but vary approach by worker

An injured employee may feel completely ignored or conversely, given the impression that his or her every move is being monitored. Striking the right balance can result in a safe and quick return to work.

"There is no hard and fast rule, as each employee situation varies," says Hilary H. Mitchell, BSN, MS, MBA, director of employee health for the Total Rewards program at Pitney Bowes in Stamford, CT. "Some employees need more frequent contact, others less."

The company's disability department and workers compensation vendor contact an injured employee as soon as the report of the claim is received. Managers also reach out to check the worker's status. "For many employees, this is the first time they have ever entered the workers' compensation world," she explains. "They're concerned about pay, benefits, and their job."

Managers communicate the company's return to work policies, explain what modified duty means, and provide return to work planning from the very beginning of a claim.

"When employers fail to maintain communication, members can become lost in the system," says Kenneth A. Pravetz, health and safety officer at the Virginia Beach (VA) Fire Department. "The employee often gets frustrated by the change in status and lack of direction."

In poorly defined return to work programs, the point of contact for the injured employee is assumed to be someone else. The supervisor thinks occupational health or risk management is maintaining contact, and vice versa.

"In reality, no one is maintaining contact with the employee," he says. The opposite can also be true, though, with a worker feeling harassed because too many people from different departments are all asking the same questions.

"Often, people that the employee has no previous knowledge about enter the employee's life asking very personal questions," he says. "The employee can feel violated and untrusting."

This is especially likely if an accident is involved and there is a question of how or why the event occurred. To avoid problems, he says to use these practices:

• Clearly define the return to work process, and train employees in how it works.

• Have points of contact in each department who communicate with one another.

• Ensure that the member's department maintains communication with the employee. "This includes the immediate supervisor, who normally has the closest relationship with the injured worker," he says.

Overall, an injured worker's safe return to work is a balancing act between the need to get back to work quickly and the need for a full recovery.

"Invest in getting the best physical outcome for the employee," Pravetz advises. "If this means keeping the worker off longer for additional rehab, that should be the decision."

Get the employee back to the organization in a limited capacity as soon as possible, however. "Most often, rehab will go a lot faster if the employee is working compared to lying on the couch," he says. If your return to work program is part of a comprehensive wellness program, the organization should see fewer injuries and lower health costs.

The likely outcome is employees who feel valued, and reduced lost time. "Employees will have greater knowledge of the various functions within the company," he says. This is especially true if employees are given limited duty assignments in other divisions.

Don't miss red flags

To encourage early return to work after an injury, provide frequent follow-up visits and on-site physical therapy if appropriate.

"Generally after the initial visit, I have injured workers return for a follow-up visit in two days, especially if they are on modified duty or off work," says Jennifer Rooke, MD, MPH, FACOEM, FACPM, medical director of Atlanta Lifestyle Medicine.

The second visit gives a good idea of how medications are working and helps assess the patient's motivation to get better and return to regular work. This assessment is particularly important for patients who have non-traumatic musculoskeletal injuries such as low back pain.

"Whenever possible, I will upgrade the work status to regular work at this visit," she says. After the second visit, injured workers are typically seen on a weekly basis until recovery and discharge.

"Insurers and employers sometimes complain about on-site physical therapy," she says. "But it is also a great way for the doctor to keep track of the injured worker's progress."

Red-flags such as symptom magnification are identified before they lead to long-term disability. "Staying in touch by e-mail may be helpful in primary care," she says. "But in the workers' comp setting, I like to see the worker and examine any new complaints after an injury."


For more information about communication with injured workers, contact:

• Hilary H. Mitchell, BSN, MS, MBA, Director of Employee Health, Total Rewards program, Pitney Bowes, Stamford, CT. Phone: (203) 922-5996. E-mail:

• Kenneth A. Pravetz, Health and Safety Officer, Virginia Beach (VA) Fire Department. Phone: (757) 385-8713. E-mail:

• Jennifer Rooke, MD, MPH, FACOEM, FACPM, Medical Director, Atlanta (GA) Lifestyle Medicine. Phone: (404) 769-3928. E-mail: