This page outlines best practices for primary treating providers to support Stay at Work (SAW) and Return to Work (RTW) outcomes. These approaches are designed to support recovery, improve function, and help injured employees safely return to work.
Providers are encouraged to use these practices as part of a collaborative, individualized approach to care.
Involve the injured employee to increase recovery expectations
Recovery expectations are closely linked to return-to-work outcomes. Providers can help improve recovery expectations by actively engaging the injured employee in their care.
Consider asking:
- Do you expect to return to work?
- What part of your job can you do today? What part of your job can’t you do today?
- If you had to estimate your timeframe for returning to work, what would it be and to what extent?
Use a “work as therapy” approach
“Work as therapy” is based on the principle that many injured employees can safely perform some level of productive work during recovery. This approach helps prevent and reduce psychosocial barriers that may delay recovery.
| Psychosocial Barrier to Recovery | Mitigating Factor Related to SAW/RTW |
|---|---|
| Financial insecurity | Normal pay and benefits |
| Fear of movement | Supported confrontation of feared movements |
| Isolation and depression | Support of normal social contacts |
| Low motivation for RTW | Maintain normal work routine and environment |
| Focus on pain and disability | Distraction of work and active social environment |
| Decreased activity/deconditioning | Maintain work level activity at appropriate level |
| Avoidance of work relationships | Maintain relationships with colleagues and supervisor |
| Loss of self or self-worth | Maintenance of vocational and societal role |
| Perceived injustice | Minimize financial and social losses |
Include a WSI nurse case manager or WSI vocational case manager in an office visit to support collaboration and coordination of care.
WSI case managers can:
- Assist with coordinating treatment recommendations
- Help monitor recovery progress
- Answer questions about the SAW/RTW process
A provider may bill WSI for these visits. Refer to the WSI Medical Provider Fee Schedule for billing code descriptions and current payment amounts.
The following job options may support a safe Stay at Work or Return to Work:
- Original job
- Modified original job – Includes some, but not all, regular job tasks
- Transitional work – Temporary work in a modified or alternate position
- Alternate work – Different job duties when the employee is unable to perform regular job tasks
Work Conditioning / Work Hardening
Work Conditioning and Work Hardening are specialized therapy programs designed to assist injured employees who have reached Maximum Medical Improvement (MMI) but still have functional limitations.
- Work Conditioning focuses on restoring physical capacity and function through exercise and conditioning
- Work Hardening is more comprehensive and uses real or simulated work activities to improve productivity, safety, and physical tolerance
Functional Capacity Evaluation (FCE)
A Functional Capacity Evaluation (FCE) is an assessment consisting of tests that measure an injured employee’s safe and dependable physical abilities and limitations for work activities.
A primary treating provider may refer an injured employee for an FCE to determine whether permanent restrictions apply.
References
1.Carrière, J. S., Donayre Pimentel, S., Bou Saba, S., Boehme, B., Berbiche, D., Coutu, M.-F., & Durand, M.-J. (2023). Recovery expectations can be assessed with single-item measures: findings of a systematic review and meta-analysis on the role of recovery expectations on return-to-work outcomes after musculoskeletal pain conditions. Pain, 164(4), e190–e206. https://doi.org/10.1097/j.pain.0000000000002789
2. Thumula, V., & Negrusa, S. (2022). A primer on behavioral health care in workers compensation. Workers Compensation Research as cited in Select Medical Outpatient Division Injury Management Update. (2024). Work as a Treatment for Musculoskeletal Injuries.