Flashcards in Return-to-Work Services Deck (20)
When should an adjuster make a referral for the RTW consultant to get involved in the claim?
When the worker beings missing time from work or when there is an expectation that the worker will soon begin missing time from work
Elements of a formal job offer (also known as a bona fide job offer)?
- The attending physician is notified of physical tasks to be performed.
-The attending physician agrees with the proposed modified work and that the commute is within the worker’s physical capabilities.
-The employer provides a written offer to the worker with the following information: start date and time, duration of the modified work, statement that the AP has approved the modified work, a description of physical requirements, the place/location of the modified work, the hours and days to be worked, the wages for the modified work
Elements needed to stop or prorate time loss benefits when a worker has been terminated?
- The employer has a written return-to-work policy.
-The attending physician has approved the modified job description.
-A memo to the file provides the following information:
The hours and days the modified work would be available, The wages for the modified work, The start date and time, A statement that modified work would have been available if the worker had not been termination
In what situations can a worker refuse modified work without facing a reduction or termination of time-loss benefits?
- The commute to the modified work is beyond the physical capacities of the worker.
-The worksite is more than 50 miles from worksite-at-injury or the worker’s residence at time of injury.
-The modified work is not with the employer at injury
- The modified work is not at worksite belonging to the employer at injury.
-The modified work involves a shift different from what the injured worker usually works.
purpose of the Employer-at-Injury Program (EAIP)?
to encourage early return to work of an injured worker by offering financial incentives to employers.
What is the goal of vocational assistance?
The goal of vocational assistance is to return the worker to suitable work at a wage as close to 100 percent of the adjusted weekly wage as possible.
How many days does the insurer have to begin a vocational eligibility determination?
The insurer must begin a vocational eligibility within five days of learning that the worker is likely eligible. They then have 30 days to make an eligibility decision.
Four main conditions an injured worker must meet in order to qualify for vocational assistance.
- authorized to work in the US
- not able to return to regular work or other suitable work with the employer at injury.
-not been suitably employed for more than 60 days.
- has a substantial handicap to employment.
What information from the worker’s work history form may alert you the worker may be eligible for vocational assistance?
-Sporadic work history/short tenures/multiple employers
- Long tenure with one employer
- Physically demanding job
- Misspellings and legibility of writing
- Gaps in employment
- Limited education
- Limited English language skills
- Discussion of special education courses, “modified” diploma, or difficulty in school
- Limited or no computer skills
What is the definition of a suitable wage (before eligibility is determined)?
At least 80 percent of the adjusted weekly wage.
If a worker is found ineligible for vocational services and her average weekly wage is subsequently increased, is she entitled to a new eligibility evaluation?
Yes (even if the AWW increases by $1.00/week!).
What are the two types of vocational services an eligible worker may receive?
-Direct Employment Plan
- Authorized Training Plan.
When would vocational services end?
- The worker has been suitably employed for more than 60 days.
- The worker has had the maximum vocational services allowed.
- The claim is settled by a CDA.
- The worker has failed to cooperate with the vocational process after written warning.
Examples of optional services?
GED classes; ESL classes; Career exploration or job development.
When should you consider using optional services in a claim?
-The injured worker lacks a GED or English language skills.
- It is likely the injured worker will have permanent sitting, standing, or walking limitations.
- The injured worker is likely eligible for vocational services.
- The worker is reporting boredom, weight gain, and/or marital/family problems from being at home.
What is the definition of likely eligible?
The injured worker is unable to return to regular work or other suitable work with the employer at injury, or the injured worker is unable to perform all of the duties of the regular or suitable work, and it is reasonable that these barriers are due to the accepted conditions.
What is a substantial handicap to employment?
The worker lacks the knowledge, skills, and abilities to make a suitable wage without assistance.
Purpose of the Preferred Worker Program?
It encourages the reemployment of workers whose on-the-job injuries result in a disability which may be a substantial obstacle to employment by providing assistance from the Workers’ Benefit Fund to eligible injured workers and to the employers who employ them.
What are five incentives of the PWP to help return injured workers to work?
- Wage subsidy
- premium exemption
- claim cost reimbursement
- employment purchases (such as tools and equipment)
- worksite modifications.