Kristin Tugman, MS, CRC, LPC September 2012

1. IARP New England Fall Conference How to effectively implement a Transitional RTW program: From the corporate office to the front lines Kristin Tugman, MS, CRC, LPC September2012

2. Agenda • Health and Productivity Development • Transitional Return to Work Building the Business Case: • To the corporate office • Corporate concerns • To the locations • Top concerns typically voiced by the locations • Transitional RTW program implementation • Development • Manager training • Demonstrating Return on Investment – Case Studies • The impact of ADAAA

3. A Health and Productivity Vision Protect productivity Health Risk Appraisal/ Disease Management/EAP Return to full productivity Collaborative solutions for all lost time events Mitigate future health & productivity issues Aging work force /musculoskeletal disorders Ambiguous impairments (depression/fibromyalgia) Medicalization of common health problems Medical costs, job performance and lost time are connected Corporate culture impacts the H&P connections The Corporate H&P information base guides the application of corporate and partner resources to:

4. Health & Productivity Challenges In the Modern Workforce The Aging Population • From 2000 – 2020 the 55-64 year old age group will increase by 73% and the 65 and older group will increase by 54% • EEs over 40 are out of work on average 8-18 days longer than the younger worker • 133 Million Americans live with Chronic disease and large portion of productivity, medical costs and lost time are attributed to this growing population Attracting and Retaining Younger Employees • From 2000-2020 the 35-44 year old worker will decrease by 10% • Do you live to work or work to live? • The younger workforce demonstrates a higher utilization of intermittent FMLA Ambiguous Impairments • Depression claims have experienced double digit increases over the last 10 years • Younger, less tenured, women are the most likely group to file a behavioral health claim • The younger worker is 4xs more likely to RTW after a behavioral health claim • There has been rise in other subjective disability claims • Incidence related to the sandwich generation There are Health and productivity program and integration solutions available to help address all of these areas of concern

5. STEP 1. Building the business case

6. Company Research and Development - incidence and duration by division and diagnosis(2012 is through September 18) • Overall average duration has increased in 2012 • BCO has increased most significantly • Musculoskeletal and injury drive incidence and duration – those ICD-9s are primarily back, arthritis, sprains, fractures and dislocations • The other category is primarily ill-defined symptoms that turn into more serious conditions such as heart. In addition there are about 5% vertigo and 2% ill-defined fatigue and pain

7. Company Research and Development - bargaining and non-bargaining – age by top diagnosis Musculoskeletal non-bargaining • Musculoskeletal duration is driven by 40-49 age group with 50-59 age group being lower Maternity non-bargaining • Maternity duration hovers around 8 weeks driven by younger population longer claims Injury - bargaining • The union group duration by age is as expected – as age increases, duration increases

8. Current Cost and Potential Savings

9. Question 1. What are corporate’s biggest concerns?

10. Corporate’s biggest concerns/questions • How much time will this take? What are the commitments needed from my team and the locations? • Will it work… this is my reputation on the line! • What have you seen for ROI in the past? • What if we don’t do this? • How will we figure out payroll if employees are working part time?

11. Step 2. Making the case to the Locations

12. The Pitch… The Corporate Endorsement • Company ABC is experiencing over 131 full time equivalents out of work all year long as a result of short term disability • We spend over 9 million dollars a year from our bottom line in disability related costs • As result – we are piloting a Transitional RTW program and I have Consultant X on the line to walk through the specifics of that program and what it may mean to your organization

13. Transitional Work • Transitional Return to Work Is: • Based on the fact that employees do not regain 100% work capacity instantly. Recovery is incremental. • Time limited with a return to one’s own occupation • Successful through manager participation

14. What are Transitional RTW Pathways? • A method of reducing lost time • A process to define functional capacity • What the employee is capable of doing within his or her own job • A strategy to reduce inconsistent and narrowly defined work site accommodations • A collection of agreed upon RTW pathways & options • A planning tool • A communication guide between employer, case manager/RTW Planner and physician • A method of documenting time limited accommodations offered and accepted

15. How to Build Pathways

16. Transitional Work Example: Line Worker Full Work Transitions Step 3: Full time work capacity Seek out assistance as needed Step 2: Work 40 hours per week On the line in a new rotation Step 1: 20 hours/wk Cross training Line worker who underwent back surgery and was out 6 weeks. It is recommended that the individual return to work incrementally return and time limit is 2 weeks to build up work capacity.

17. Sample Transitional RTW Pathways

18. 1/1/2011 – 12/21/2011 Sample - RTW Statistics • 554 STD claims submitted and paid for 2011 • 182 claims went longer than 40 days in duration and for the review period (not including maternity) • 212 reviews for RTW readiness during review period • 48 RTW successes – RTW own occupation • 32 Musculoskeletal/Injury • 4 Nervous Sensory • 3 Cancer • 1 Other – (foot problem) • 4 Digestive • 1 Genitourinary • 1 Infectious Disease • 2 BH • 2 RTW same ER, new occ – musculoskeletal, nervous/sensory • 1 RTW plan not implemented, ER refused • 2 RTW – release obtained • At least approximately 950 saved lost work days

19. Dramatic Increase in Reviews & SLWDs quarter over quarter with increase in successes following… (Sample – Service Industry) Saved lost work days continue to rise – up to 185 for 4th quarter 1st qtr – 51, 2nd qtr – 70, 3rd qtr - 158

20. Step 3. Site Visit and Program Development

21. Sample Site Visit Schedule • 9:00 AM - 10:30 AM - Meet with HR Team to review critical issues and program guidelines • 10:30 AM – 11:00 AM - Meet with SR. Operations to review program and ensure comfort level • 11:00 AM - 12:00 PM -  Meet with employees who have used the benefit within the last year (individual meetings – 15 minutes each) • 12N – 12:30 PM – Lunch Break • 12:30 – 2:00 PM - Tour of the facility • 2:00 PM – 4:00 PM - Meet with representation of supervisors/managers in groups (1 hr sessions) 5-8 managers per hour is optimal. • 4:00 PM - 4:30 PM  - Question/Answer and review of visit. Discuss next steps with hosts

22. Question 2. What are the location’s biggest concerns?

23. The location’s top concerns • I don’t want to buy a workers’ compensation claim! Prove it! • We don’t have “light duty” • How will we adjust productivity measures to ensure managers don’t get penalized for having a “light duty” worker • What if an employee is on heavy medication? • Now every employee is going to want to be on light duty! • I can’t have someone in my shop at less than 100% - the work is too physical, it is too dangerous! • Why wouldn’t I just pay OT or a temporary worker and get 100% output so that I ensure I meet my productivity goals! • What if patient care is negatively impacted because a less than 100% nurse couldn’t effectively respond in an emergency?

24. Step 4/Question 3. Why? Manager Training

25. Question 3. Answer Without Managers there is no program!

26. Agenda Transitional Return To Work (TRTW) Philosophy Company’s TRTW Program Location Statistics What We Have Done so Far / Site Visits Responsibilities Process for the TRTW Program Transitional Return to Work Pathways / Modification Options Pay While on TRTW RTW Tracking Contacts / What’s Next Questions

27. Rationale for the Transitional Return to Work Program Productivity & Staffing Lost time disrupts operations and productivity leading to overtime or work not being completed. Leads to a drain on operations and overall EE well being. Operations already functions on a skeleton crew Organizational Consistency Ensure employees are offered the same opportunity for transitional return to work when appropriate

28. Transitional Work Employees do not regain 100% work capacity instantly. Recovery is incremental.

29. Site Visits – Location 1 and Location 2 Purpose • Met with managers and supervisors to introduce the TRTW program and gain insight into potential barriers or issues with the program • Toured facilities to fully understand job requirements Findings • Order builders and night shift workers have the most lost time issues • Two to four week transition plans are optimal • Part-time to full-time transitional work preferred • Job modifications possible to a degree – preferable that TRTW plans do not include “light duty” assignments typically given following occupational injuries • Some managers not aware that STD costs are currently paid for through payroll budgets • TRTW will increase employee productivity

30. Company RTW Coordinator Responsibilities Discuss the RTW plan with the Return to Work Liaison (Vocational Consultant) Discuss the RTW plan with the Employee’s Manager Follow up with the Unum RTW Liaison with regard to the feasibility of the plan Be available to discuss progress with the Employee’s manager Contact the RTW Liaison if questions with the plan arise

31. Company Manager/Supervisor Responsibilities Discuss the RTW plan with and give feedback to Company RTW Coordinator Verify the employee is scheduled to work the number of hours agreed upon in the TRTW plan Meet with the Employee to discuss the plan upon the first day of transitional work Meet with the Employee daily or weekly to discuss progress and ability to move on to the next step in the RTW plan Follow up with company RTW Coordinator for your location if progress is not moving as expected HR is only involved in the initial set up of the program or when escalated issues arise

32. Sample TRTW Plan

33. Step 5. Return on Investment Case studies

34. Hospital – Case Study The Challenge • 1200 life hospital group with high STD and LTD incidence and longer than expected STD durations Action steps • Performed Lost Analysis to determine areas of opportunity • Implemented structured TRTW program with TRTW pathways • Enhanced partnership through program solutions with claims teams Outcomes • 7 day reduction in STD durations 6 months over 6 months • 79% reduction in flow through rate year over year • 450 saved lost work days saved in less than one year

35. RTW Development – Hospital A Duration comparison Consistent improvement during review period Expected Duration = 55 Days * Pilot TRTW program began 2/1/2007 *All duration experience above includes the STD elimination period and expected is based on plan design, industry, and demographics

36. The Call Center Challenge • Call center environment with high incidence of Behavioral Health claims with higher than average durations • High level of frustration among management due to high incidental absence and the subjective nature of behavioral health claims • No structured return to work program • Increased employee anxiety around return to work

37. Transitional Return to Work ProgramImplemented May 2009 Length of Transition Plans are more than 2 weeks and up to 30 days • Reduce Work Hours • Shift change • Modify Work Schedule • Increase Breaks • Reduce Exposure to Targeted Stressors • Training • Project work • Coaching • Alternate sit/stand • sit and stand as is necessary at their desks • Training • Project work • Coaching • Reduce Keying • Training • Coaching

38. Sample Transitional RTW Plan – Major Depression

39. Transitional Return to Work (TRTW)and Behavioral Health (BH) Case Management

40. A New Reason for Employer’s to Consider Transitional RTW The Amendment to the ADA

41. Top 5 ADAAA Mistakes • Failure to identify essential functions • Failure to engage in the interactive process • Failure to accommodate • Adopting inflexible leave policies • Disregarding privacy rights

42. Recent ADA violations • Sears September 2009: EEOC reached a $6.2 million settlement with Sears, Roebuck & Co. based on an alleged policy of failing to accommodate employees after leave • Supervalu January 2011: EEOC reached $3.2M settlement with Supervalu Inc. based on alleged policy of terminating employees at the end of medical leaves of absence instead of bringing them back to work with reasonable accommodations and failure to allow employees to participate in light duty programs if they were not injured on the job. • JP Morgan November 2009: EEOC reached a $2.2M settlement with JPMorgan Chase to settle a class action suit alleging that employees were terminated after they exhausted six-month medical leaves without any analysis of whether it was possible to accommodate their limitations so that they could return to work.

43. Additional Questions??? Kristin Tugman Ktugman@Unum.com 207-575-2751