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Are you ready?There’s been a great deal of talk lately from insureds looking for advice about returning to work after a disability, and that’s a good thing. I am of the opinion that it is physically and emotionally healthy to return to work after a period of disability, and all those who CAN work SHOULD work.

While in the past the disabled might have found themselves left out of a sluggish economy, new opportunities are on the horizon for those looking to re-enter the job market. However, the decision to return to work should not be forced, unplanned or the result of pressure placed upon you by an insurance company. Rather, a return to work after a disability should be part of a planned work hardening program that you and your physicians construct as part of a viable medical treatment plan that prepares you physically and/or emotionally for that purpose.

Rushing (for whatever reason) to return to work usually results in claimants back out on disability after only a few weeks. Remember, “recurrent” provisions in your Plans and policies only apply to full-time returns to work; filing new claims for STD over and over again is a disaster denial in the making.

Doesn’t it make sense that if only doctors can TAKE YOU OUT  of work, they are the only ones that can PUT YOU BACK IN? Insureds often miss this basic rule to disability claims. And then, there are insureds who, when they accept a position to return to work, are the next second on the phone to their insurance company “informing them of it.”

From a personal level, returning to work part or full-time after a disability claim requires planning since  returning to work involves more than just being able to do a job. It involves having to be somewhere each day at a specific time and place, the ability to deal with stress and social interaction, dealing with day care, fatigue, and transportation. Sometimes it’s necessary to buy whole new sets of business attire, and that takes money.

But, what I’m concerned about is insureds not knowing that they can’t just “go back to work” when they have a disability claim – it needs to be planned and coordinated with a physician, particularly if the work is part-time. Assuming discussions with physicians concerning return to work have already taken place, documentation must be obtained clearly specifying maximum levels of work with specific work restrictions and limitations. 

Insurers have a tendency to allege insureds can work full-time, if part-time accommodations and restrictions aren’t documented. Clearly, work restrictions limiting insureds to part-time work need to be officially documented by physicians before insureds ever set their feet back in the work arena.

The best way to have a permanent successful return to work is to plan it. Do you need to get re-certified or update licenses? Or, perhaps enroll in CEU courses to bring you up to date. Do you need to buy new clothes? Arrange for Day Care? Do you have reliable transportation?

Finally, discussions need to take place between insureds and their physicians regarding restrictions and work accommodations. And, this is where it gets a bit tricky. Most treating physicians will allow patients to return to work if they are persuaded to do so by their patients. Here you are, overly and unreasonably optimistic about your work capacity, nagging your physician to sign the paperwork allowing you to return to work. And, of course, he does.

Nope, not the plan I’m talking about. Discussions should take place between insureds and their treating physicians about “realistic” work capacity and perhaps the need for a “work hardening” program easing the patient back into the workforce a little at a time. After all, if you’ve been out on disability for awhile, walking back in to full capacity may not be doable, even if you think it is.

A good example is for the doctor to document, “Patient is released to return to work part-time to a schedule of no more than 1-2 hours per day up to a maximum of 15 hours per week with employer accommodations of frequent rest periods, and alternative sitting, standing, walking allowed.” These restrictions would of course be unique to each claim, but the point is they should be specifically documented in a precise manner.

Finally, insureds are not required to report returns to work until such time as they receive their first paycheck. Then, the new APS statement along with your first pay stub can be submitted to the insurance company and benefits can be calculated to determine how much you should be paid.

If you can go back to work, you should go back to work. But, doing so requires planning, and specific documentation.


Consulting 4If you are having difficulty about this, or any other claims issue, please contact me for a free cosultation about coming on board as a DCS, Inc. client.

DCS is a national consulting organization that provides expert claims management services to those with private insurance. I offer free initial consultation and I’m happy to discuss how you can become a DCS client.

If you need assistance with filling out your update forms or questionnaires, please feel free to give me a call.

If you are interested in becoming a DCS client, please feel free to visit my website at: http://www.disabilityclaimssolutions.com