Of the thousands of people I’ve had as clients over the years nearly 100% expressed an optimistic view of returning to work “someday.” The thought of “not working” is as unAmerican as it gets. And yet, despite the longing to return to work, as time goes on, it often becomes clear that it’s not physically or mentally possible. The truth is, we can only manage disability day by day. “Return to work optimism” often places claims at risk.
However, insureds who have decided to give return to work a try need to know there is a protocol in doing so. As odd as it may sound, it is a WRONG move to inform the insurance company “I’m going back to work tomorrow” and just do it. But, I’m getting a bit ahead of myself here.
At some point, all insureds need to address the difference between the psychological guilt desire to return to work versus the realistic physical functional capacity to be able to do it. Sometimes the need to “let loose” of the sadness and guilt of not working powerfully persuades the insured to “just go do it” regardless of whether it is actually physically possible for not.
Therefore, the first step in preparing for a return to work is for you and your physician to discover exactly what your realistic functional capacity really is. I have always recommended a “work hardening program” where insureds volunteer somewhere on a regular basis for a period of time and then increases their hours periodically. It may be possible to arrange such a program with an employer, but all insureds should have some program whereby their actual physical functional capacity can be defined and determined.
As everyone should know, the capacity to return to work involves much more than the ability to perform work tasks. Returning to work involves having to be someplace at a certain time each day, stressful driving, day care arrangements, stress on the job, changes in daily routine, the need to rest or take breaks during the day, performance management, and a great deal more. In fact, actually doing a job is the least of it.
From a disability claims perspective there are several considerations that also need to be considered. Returning to work in your own occupation with the same employer full-time gives you rights under the “Recurrent” provision of your group Plan. If a claimant is unable to remain at work for 6 months, he/she can come back on claim without meeting another Elimination Period. You must return to work full-time before this provision comes into play.
If, however, the claimant returns to work in another occupation with a new employer then the old LTD Plan from the former employer is terminated, and the claimant is covered by a new LTD Plan of a new employer (if they have one.) This would, of course, involve 12 months of a pre-existing period where no future claim could be filed under the new LTD plan for a period of 12 months.(There are many different versions of preexisting provisions, so it’s wise to check the new Plan’s provisions before filing a claim under a new Plan.)
As I’ve already alluded to, the worst possible thing claimants can do is return to work prematurely, go out on disability, return to work, go out on disability etc. Employers and insurers both lose patience with this pattern and will deny claims eventually.
My message here is not to discourage insureds/claimants from returning to work, but to be certain of their physical capacity to remain at work once they do so.
Returning to work part-time is an entirely different protocol where the insured and physician document specific restrictions to work activities. For example, a treating physician might document, “This patient is released to part-time work defined as 3 hours per day, twice per week with employer accommodations of frequent rest periods and alternative sitting/standing in her occupation.” No insured should ever return to work part-time without some restriction regarding what the part-time work entails, and for how long.
In addition, there should also be some statement by the treating physician that defines what happens if the insured fails at part-time work such as, “If the patient is unable to maintain restrictions as written, he/she should cease work immediately and be considered totally disabled.”
The subject of returning to work includes emotional as well as physical or mental considerations. Then, too, there is SSDI status to consider. Although SSA has a generous program for returning to work while receiving SSDI benefits, as defined in its “Red book”, full-time returns to work and other work exceeding the SGA (gainful limitations) will result in loss of benefits. This is also a financial consideration of returning to work.
Returning to work isn’t just a matter of thinking “I can do it”, and then jumping off the bridge with both feet. It requires planning, restriction setting, and thinking about “what will happen if I just can’t do it?”
There are many more considerations to returning to work, and if you need help, ask your questions, or contact me directly. My recommendations are to be very certain that you can physically return to work, and that when you do, you are able to stay there. Returning to work prematurely is never a good thing, and clearly needs to be well thought out and planned accordingly.
