BEST PRACTICES IN FEDERAL WORKERS’ COMPENSATION: SUPERVISORY COURSE

1. BEST PRACTICES IN FEDERAL WORKERS’ COMPENSATION: SUPERVISORY COURSE SUPERVISOR’S ROLE IN RETURN TO WORK (LIMITED DUTY AND PERMANENT JOB OFFERS)

2. OBJECTIVES • Identify supervisor’s role and responsibility in returning injured worker to suitable work • Discuss components of an acceptable work statement and use in affording suitable assignment to injured worker • Recognize the difference between a limited duty assignment and permanent job offer • Identify necessary components of a limited duty offer and permanent job offer • Explore methods and options to afford an injured worker suitable work

3. SUPERVISOR’S ROLE • Advise employee of responsibility to : • Keep supervisor advised of work status-written • Provide SPECIFIC written limitations, if any, and duration • Return to work when work capacity exists • Advise of next follow-up appointment • Request permission to be absent due to injury/condition • Supervisor is responsible for: • Instructing employee of above responsibilities • Affording suitable work to the injured worker – in writing • Ensuring work status is obtained following EACH medical visit • Acting on related leave/LWOP requests

4. LIMITATIONS • Must be from the attending physician • Must be in writing • Must be specific • Should not be open-ended • Should have a “to” or “end” date • “indefinite” as end date is not acceptable

5. WHAT IS A LIMITED DUTY ASSIGNMENT? • Normally not a permanent, long-term assignment • Does not always result as permanent job (but may) • Not an assignment to a graded and classified position description or functional statement • Must be in writing • Verbal offers allowed but must be offered in writing within 2 business days of verbal offer • Assigns duties commensurate with physician’s recommended limitations • May or may not be in same unit, same tour, same schedule, same position…

6. What if… • Limited duty is not on same tour or schedule and employee loses pay? • If eligible for COP, COP will cover loss of pay to the extent otherwise prohibited by law. • If no COP, employee may claim loss of wages with OWCP by filing a CA-7 through the WC Office. • Supervisor will need to provide tours and work schedule for employee to reflect what these would have been “but for the injury”

7. WHY OFFER LIMITED DUTY ? • Employee is injured, not totally incapacitated for all work • Regulation requires when work capacity exists, employee must seek work • If employer fails to offer suitable work, employee may receive COP and eventually compensation until suitable work is offered. • Decreases chargeback and COP costs to the employing agency • Studies show improved recovery period • Improves moral of employee(s)

8. WHEN TO OFFER LIMITED DUTY? • Work status indicates existence of work capacity • Employee indicates desire to return to work* • Nature and severity of injury is not consistent with recommendation of total disability* • Immediately (if any of the above exist)* * In absence of work status or release to work with limitations, coordinate list of tasks with WC Specialist to submit to attending MD for review and approval.

9. HOW DO I OFFER LIMITED DUTY? • Determine specific limitations (work status) • Offer in writing (or if verbal, follow in writing) • Include beginning date, tour and work schedule • Include tasks to be performed • Re-state specific limitations recommended by MD • Include contact for instruction and leave request • Acceptance/Declination by employee and signatures • Duration of assignment • Indefinite vs. • Specific ending date (“temporary”)

10. SAMPLE-LIMITED DUTY MEMO Date: May 29, 2013  To: Employee Name (118) From: Supervisor’s Name, Nurse Manager (118) Subject: Limited Duty Assignment In reference to your traumatic injury (or occupational condition if applicable) on April 3, 2013, the following limited duty assignment is offered to you in Nursing Service based on your physician’s recommendations dated May 28, 2013. Your tour of duty will initially be 7:30am-4:00pm, Monday through Friday. This assignment will be effective today, Wednesday, May 29, 2013. Your duties will consist of:  -answering and referring phone calls -monitoring residents north and south end -documentation in CPRS -assisting in feeding all residents -vital signs using electronic devices -passing medications/treatments such as passing ointments, creams, etc. from med cart. (Note: Push/pull force for med cart is 12 pounds on tile) These duties are within the restrictions as specified by your Attending physician of lifting/carrying, pushing/pulling up to 20 pounds. It is also noted by the physician to keep trying to reach above the shoulder but not in excess of 1 repetition per minute throughout the workday.  If you encounter any problems or difficulties in relation to your injury/condition, please advise your supervisor immediately and contact your physician as soon as possible if needed. Your assignment will be continuously re-evaluated following any medical visits and/or receipt of additional medical information. This is to assure compliance with your physician’s recommendations and to meet the needs of the medical center. This assignment does not affect your employment status. you remain employed as a Nurse, VN-0610, Level 3, Grade 1, currently step 21 with salary of $55,363 per annum. Your assignment will continue until such time as additional restrictions are imposed or modified. If you have any questions, please contact your supervisor or the FWCP office (ext. 9991 or 9996.) ________________________ ___________ Supv Name, title Date  ------------------------------------------------------------------------- Initial one: ____ I accept the above assignment and will adhere to my restrictions and observe safe work practices. ____ I decline the above assignment because (specify reasons): _____________________________________ ____________________________________________ ________________________ ___________ Employee Name Date 

11. WHAT IF… • the employee accepts the offer? • the employee declines the offer? • the employee refuses to sign with acceptance or declination? • the employee doesn’t agree with all the tasks assigned? • the employee doesn’t want to change tour or work schedule? • the offer is not appropriate; not suitable?

12. BEST PRACTICE PROCESSES-Limited Duty • WC Office receives copy of work status • Sends email to supervisor and next level of need to offer limited duty • Includes copy of work status and/or states limitations • Includes template or sample to follow • Indicates date required (immediate) • Follow-up after deadline • Next follow-up to next level supervisor and so on…

13. No Limited Duty Available? • Supervisor replies as such with reason(s) to all on email • Service Chief or Service Line Manager certifies no limited duty exists in service. • Notification is forwarded to HR staffing (et al) to coordinate limited duty across organizational lines with copy to facility leadership. • Identified limited duty is provided to supervisor and limited duty offer is made in writing. • “Home” service incurs cost of employee while assigned to another service

14. REASONABLE ACCOMMODATION AND WORK COMP • Two (2) separate programs for permanent conditions • Reasonable Accommodation • Separate from workers’ compensation • Does not retain the pay of injured worker • Permanent Job Offer • Separate from Reasonable Accommodation • May protect the pay and benefits of the injured worker • Cannot share information between 2 programs without specific written release from employee

15. Permanent Job Offers • Employee has work capacity but cannot perform the full scope of DOI (Date of Injury) position • Attending MD (or in some cases OWCP) has identified permanent limitations • Compare permanent limitations with physical demands of DOI position • Determine if adjustments can be made to tailor the duties and demands of the position to comply with recommended limitations….

16. CONTINUE IN DOI JOB? • Revise position description or functional statement to comply with limitations • Ensure physical demands re-state recommended limitations or are clearly compliant with recommended limitations. • Ensure description of duties or functions are void of any possible interpretation of being noncompliant with limitations. • Request review of revised description/statement by WC Specialist • Request review and classification by Classification Specialist (include OF-8 if applicable) • Do NOT identify position as limited duty or OWCP position. • Identify position as “incumbent only” • Following classification, WC Spec will prepare permanent job offer letter for presentation or mailing to employee

17. Needs a Different Job? • Follow same process as with non-availability of limited duty. • WC and HR staffing will coordinate identification of appropriate position • Offer existing vacant position compliant with limitations • Offer existing vacant position with adjustment of duties/demands to comply with limitations • Create new position • Following identification and classification of position, WC will prepare job offer letter for presentation or mailing to employee.

18. Permanent Job Offer-Loss of Pay or Grade • Permanent job offer can be developed to afford pay retention • Indefinite • Protects employee’s salary-based benefits • Pay is set at less of DOI pay or 150% of top step salary of grade of position offered • Any remaining pay loss can be claimed by employee with OWCP – known as an LWEC (Loss of Wage Earning Capacity) • Paid to employee tax free • May result from loss premium pays such as night differential, Saturday, Sunday, Holiday and/or on-call pay that cannot be included in pay retention calculation.

19. REQUIREMENTS • Must offer classified and graded position • Must be same employment tenure as when injured • Temporary job offer is not suitable for an injured permanent employee • Temporary job offer may be suitable for an injured temporary employee (time limit must be appropriate) • Location of job offered must be within 50 miles of employee’s geographic location • Must consider other conditions/limitations that may have occurred or changed since DOI

20. REQUIRED INFORMATION IN A JOB OFFER LETTER • Description of duties of position (i.e., Position Description) • Physical requirements of the duties • Work schedule (include tour) • Organizational and geographic location of the job • Date on which job offer will first be available • Date by which employee is to notify employer of decision to accept or refuse offer • Provide pay/position information (Title, Pay Plan, Series, Grade, Step and Salary )

21. USEFUL INFORMATION TO INCLUDE • Assigned Service of Position • Person to report to, where and what time and day. • Effective date of job change or re-employment

22. EMPLOYEE RESPONSE ACCEPTS REFUSES • Notify WC and HR staffing of decision immediately. • Prepare SF-52 to effect job change • Advise WC on effective date of employee’s actual return or report for new position. • No response is considered a declination • Notify WC and HR staffing of decision immediately. • If employee is working, make every effort to continue current work assignment pending suitability decision by OWCP.

23. Reasons for Declination Potentially Valid Potentially Not Valid • Working elsewhere • Condition has worsened • Medical information was not current • Physician submits position is not within physical capacity • Agency withdraws offer • Position no longer available • Tour of duty/work schedule • Does not wish to relocate • No promotion potential • Receiving constructed LWEC • Is retired or elects to retire or separate • Personal dislikes of offer

24. Continue Limited Duty Pending Suitability • Upon notification to OWCP of employee’s declination: • OWCP must determine suitability of position offered • If suitable, OWCP will afford the employee 30 days to reconsider their decision or face possible termination of benefits for failure to accept suitable work. • If NOT suitable, OWCP will advise employee and employer requiring the job offer to be revisited. • During 30 day period, make every effort to continue to afford the employee suitable limited duty • Following 30 day notice from OWCP, if employee provides no medical evidence or valid reason(s) to support declination of offer , final 15-day notice to employee will be issued by OWCP to allow employee to ACCEPT position offered.

25. FAILURE TO ACCEPT SUITABLE WORK • Loss of employment-Removal/Termination • Management has the right to assign work • Employer is not required to offer another position the employee would prefer • Loss of compensation benefits • Compensation for wage loss is terminated at the end of 15 day notice if employee fails to accept suitable permanent job offer • Medical benefits may continue • Employee may wish to pursue retirement or voluntary separation

26. LET’S LOOK CLOSER… LIMITED DUTY AND PERMANENT JOB OFFERS

27. EXERCISE 1 Jane Smith, Food Service Worker in Nutrition & Food Service slipped in hot syrup that had been spilled on the floor, fell and injured her right ankle. She has been off work, per doctor’s orders since the injury. Her claim was accepted for Right Ankle Fracture. She has had surgery and the physician has released her to return to work with the following limitations: • Sedentary work only • Limited walking • No prolonged standing Follow-up appointment indicated on work status as “4 weeks”

28. EXERCISE 2 On 1/10/13, an LPN filed a traumatic injury claim for right rotator cuff tear and is placed off work at time of injury. Claim is accepted for same and surgically repaired in November 2010. Claimant is released to return to work 7/15/13 with limitations of: • No pushing, pulling or lifting greater than 25 pounds • No reaching above the shoulder Follow-up appointment on work status states: “PRN”

29. EXERCISE 3 Joe D. (RN) provides a return to work statement from MD indicating the following restrictions due to an accepted back injury: • No lifting greater than 2 pounds • No pushing or pulling • No overhead reaching The supervisor offers the following written limited duty: • Answering telephones • Clerical duties • Charge Nurse with no direct patient care

30. EXERCISE 4 Clarification was requested from attending MD and received regarding MD’s recommended limitations for Jane Smith (Food Service Worker with right ankle fracture). • No lifting greater than 20 pounds • No pushing or pulling greater than 10 pounds • No standing or walking more than 30 minutes at a time

31. EXERCISE 5 Jane Smith (Food Service Worker with right ankle injury) was offered limited duty by her supervisor in a telephone conversation on Monday 6/18/12, to return to work Tuesday 6/19/12. She agreed and accepted but did not return to work until Monday, 6/25/12. She has filed a CA-7 requesting compensation for loss of pay for 6/19 through 6/24. A Report of Contact from the supervisor dated 6/18/12 was provided to the workers’ compensation office to document the limited duty offered via telephone.

32. EXERCISE 6 Peter Piper provides a work status from his MD indicating release to return to work with limitations: • Sitting up to 4 hours continuously • Walking up to 2 hours/ standing up to 1 hour • Reaching above shoulder 1 hour • Climbing ½ hour • Pushing, pulling, lifting up to 25 pounds • No twisting, bending, stooping, squatting or kneeling The following duties were stipulated in the written limited duty offer: • Sedentary duty to include clerical work in support of service • Receiving patients/visitors and referring to appropriate office • Picking up mail twice daily • Answering phone, messaging and referring callers

33. EXERCISE 7 Tommy Tonka provides work status indicating restrictions of no climbing more than 4 feet; no kneeling, squatting or crawling. May occasionally walk up to 50 feet at a time, may lift up to 30 pounds as tolerated. The supervisor lists the following tasks in the written limited duty offer: • Normal duties minus what your physician stated • Light duty tasks • Complete all installation work orders • All other duties as tolerated

34. EXERCISE 8 Xander, Nursing Assistant, was offered & accepted a written limited duty assignment 2/7/13 compliant with his physician’s recommended limitations of: • No lifting, pushing or pulling over 30 pounds • Standing and walking limited to1 hour alternating minimum 15 minutes sitting • Bending limited no more than 15 minutes per hour He provides the supervisor with a work status dated 8/12/13 indicating same limitations as permanent.

35. QUESTIONS

36. CONTACT INFORMATION Jacqueline “Jackie” Wiser VISN 9 FWCP Product Line Manager MidSouth Healthcare Network 210 Glenis Drive Murfreesboro, TN 37129 615-225-6981 (o) 615-898-6594 (f) jacqueline.wiser@va.gov