Returning to Work & Staying at Work

By Dr. Adam L. Seidner
Each year, millions of American workers develop health problems that have the potential to temporarily or permanently prevent them from working. In the large majority of cases, employees are either able to stay at work (SAW) in spite of the condition, or return to work (RTW) after a brief recovery period. For some, significant work absence and life disruption occurs, sometimes leading to prolonged or permanent withdrawal from work.
During the period when they aren’t working, these individuals are considered "disabled" and many of them become involved with one or more programs addressing disability benefits or lost time. These programs may include:
  • Sick leave
  • Workers' compensation
  • Short-term disability (STD)
  • Long-term disability (LTD)
  • Social Security Disability Income (SSDI)
  • Leaves under the Family Medical Leave Act (FMLA)
  • Other state-specific medical leave programs
Many individuals who end up receiving disability benefits have conditions that began as common everyday problems like sprains and strains, or have anxiety or depression.

What Keeps Employees From Recovering and Returning?

Ever wonder why an employee isn’t getting better, or why their recovery is delayed? Since there can be several variables impacting an injured employees’ health, it’s important that we understand the factors that may be preventing or postponing their return to work.

Blind Spot: A Faulty Diagnosis

One reason may be that the diagnosis is incorrect. Researchers have studied missed or delayed diagnoses and have identified potential reasons for why they occur.
In 2015, the National Academy of Sciences, Engineering and Medicine released a follow-up of their landmark report, To Err Is Human. The new report, Improving Diagnosis in Health Care, continues the focus on diagnosis, which they described as a blind spot in health care.
According to their research, clues to an incorrect or missed diagnosis include:
  • Recovery is taking longer than you would expect based on management guidelines.
  • The condition or symptoms are getting worse.
  • Additional diagnostic testing is being ordered (imaging, lab work, electrodiagnostic tests).
  • Treatment durations and types are growing
  • Medication doses are increasing or additional medications are being prescribed

A Quality Network Can Help Improve Diagnostic Accuracy

The Hartford has developed a number of programs to ensure employees are properly diagnosed and receive appropriate treatment. One of these programs involves use of The Hartford’s Medical Provider Networks to help care for injured or ill employees. Our past experience shows that medical and indemnity results are better with network care, since medical providers are reviewed and selected based on clinical outcomes.
Network doctors are experienced in treating workplace injuries and facilitating an injured employee’s return to work. In California, we’ve implemented The Hartford Select Network (HSN), which not only focuses on taking advantage of cost discounts, but is increasingly focused on the quality of the providers within the network. The Hartford Select NetworkSM is unique and highly customized, and we plan to expand HSN to other states.

When Biopsychosocial Conditions Impede Recovery, iRECOVER® Can Help

In some disability cases, the diagnosis is correct, but the employee may still be experiencing delayed recovery from an injury. Various biopsychosocial conditions, such as genetic, biochemical, behavioral, cultural, or familial factors, can impact an employee’s path to recovery.
To mitigate the potential impediment, one of our case management programs is iRECOVER. If an injured employee is identified with a biopsychosocial condition that may delay recovery, iRECOVER provides a health coach to engage and work with that employee. The health coach will share the tools needed to address the employee’s issues and encourage a timely return to work.
In the next article, we discuss iRECOVER in detail and examine concepts like functional ability, treatment complications, adverse reactions from medications, and adherence, and how they can impact an employee’s ability to stay at or return to work.

About the Author

Dr. Adam Seidner, MD, MPH, is the chief medical officer for The Hartford. He is responsible for The Hartford’s strategy and policy across all lines of business with a particular focus on workers’ compensation and disability management.