My colleague David DePaolo titled one of his recent blog entries, “Stop Return to Work.” To him, return-to-work programs are overhyped. The worker’s motivation is decisive. Maybe she’s fed up with the job, the employer or coworkers. DePaolo cautions, stick to providing good health care for the claimant. She can choose if and where to work next. And don’t mix up RTW for the injured worker with other human resource functions.

He wrote, “This industry's obsession with return to work as an end goal is misguided. Return to work has nothing to do with workers' compensation or the recovery of the injured worker. Return to work is a nice outcome, but it cannot be a goal because the only person who can determine whether there will be a return to work is the injured worker!”

What a nice gift: a challenge for me to consider why, to me, return to work is an integral part of workers' comp, more now than before.

David makes or implies four assertions:

Assertion 1: Return to work for injured workers should be kept apart from corporate HR functions.   

Such it was until the disability rights concept penetrated every corner of the country. The Feds and some states say that employers have a global obligation to all of their employees who experience some kind of disability. The worker may not wish to return, but the employer must be ready to make accommodations.

Compliance with ADA is easier if an employer uses the same basic approach to all RTW cases. The Feds have in effect pushed RTW planning into corporate headquarters.

Assertion 2: RTW motivation drives claimant behavior and work outcomes.

I’m not sure if most injured workers can tell you in a coherent way what their motivation is. As Ralph Waldo Emerson wrote, “We live amid surfaces and the chief art of life is to skate well on them.” But even if they did, behaviors may influence motivation as much as the reverse.

A behavioral scientist I know classified the forces of human behavior. Carl Binder, who lives on an island in Puget Sound, says that employers can influence employee behavior through “expectations and feedback,” “tools and resources” and “consequences and incentives.” (See the Six Boxes model on his website for more detail.) Those I’ve met (adjusters, worksite staff, case managers) who appear to understand RTW know about these levers.

Assertion 3: Medically treat the worker without setting RTW as the primary goal; return of function is good enough.

Pain specialists might not object, but occ med doctors uniformly disagree. They can’t separate treatment from RTW planning. The best place for a final phase of functional recovery may be in limited work assignment. Even a worker with a permanent impairment from injury gains function while back at work.  

Severe, fully disabling injuries are extremely rare. I estimate that some 90% of lost-time claimants can return to work with no to modest permanent job accommodations. Temporary assignments are routine.  

Assertion 4: Don’t confuse the workers’ comp benefit system with a job recovery system.

David proposes, as I understand him, that the grand bargain of the 1910s was essentially a master deal between two entangled parties: employer and worker. Workers’ comp included a big improvement in resolving their disputes. Fine, but this leaves out society’s enormous stake in the matter.

The pioneering researcher Crystal Eastman captured society’s stake in 1910 by characterizing Pittsburgh as a “little city of cripples.” The key challenge the workers’ comp system was designed to solve was how to reduce the number of cripples, broadly defined, not just how to resolve disputes.

Four decades after the creation of the modern workers’ comp system, scholars conceptualized the legal-economic rationale for the system. Clothed in new terminology, the employer, its insurer and the doctors it pays are the most appropriate parties to be accountable for reducing work disability. They are the “cheapest cost avoider,” a term coined by Guido Calabresi. Workers’ comp is set up to minimize the societal risks of industrial injuries in the least burdensome manner after all parties are considered, and the four key solutions, avoidance, prevention, mitigation and insurance, are optimized.  

David Moss, a Harvard Business School professor, in his book, “When All Else Fails,” explains Calabresi’s concept clearly. The concept works for worker’s comp, personal injury, unemployment, pollution, defective commercial products, industrial disasters, anywhere the legal system needs to be customized to solve large-scale problems. Assign accountability to the party most competent to manage the risk.  

As an end goal, one can define RTW in several ways. I'm defining it here as not only regaining the marketable skills to earn at the pre-injury level but also to in fact bring home a paycheck. Getting back to work is the only good proof of successful recovery and of a successful workers’ comp system.