SAW RTW Provider Role

The primary treating provider plays a key role in supporting SAW/RTW through the following:

Assess Injury

• Utilize a clear description of the physical job duties to safely assess functional capabilities.
      ▪ Contact the WSI Claims Adjuster or WSI Nurse Case Manager if there are questions about an injured employee’s job duties.
      ▪ See below for more detailed information on the assessment of capabilities.

• Establish objective physical limitations that only pertain to the body part(s) for which WSI has accepted liability.

Provide Treatment and Care

• Create a treatment plan to promote optimal functionality.
      ▪ The plan should incorporate a message about the importance of work.
      ▪ The plan should consist of best practices and be evidence-based when possible.

• Discuss expected healing and recovery time and the importance of an early and gradual increase in activity.

• As the injured employee progresses through the treatment plan, establish timelines to set an expectation of recovery times, for example,
      ▪ The earliest date an injured employee can safely return to temporary modified duties.
      ▪ The date an injured employee can safely resume full-time duties.

• Discuss the timeline for reassessment of physical capabilities.

Communicate with Employee, Employer, WSI

• Communicate the capabilities assessment findings and recommendations of every visit with the injured employee, employer and WSI. Objective and early communication is vital because it may influence an injured employee’s own assessment of their functional status and ability to SAW/RTW successfully.

• Include the WSI Nurse Case Manager or WSI Vocational Case Manager in an office visit.
      ▪ A provider may bill WSI for these visits.
      ▪ Refer to the WSI Medical Provider Fee Schedule for the billing code descriptions and current payment amounts.

• Call or have a face-to-face visit with the employer.
      ▪ A provider may bill WSI for these activities.
      ▪ Refer to the WSI Medical Provider Fee Schedule for the billing code description and current payment amount.

The primary treating provider's assessment of an injured employee's physical capabilities is an essential part of SAW/RTW.

General

• The provider evaluates which activities the injured employee can safely perform at home and at work.

• The assessment should occur at every visit with expected capabilities should gradually increase.

Documentation

• The provider may use WSI’s Capability Assessment Form (C3) form or a form unique to their facility to the assessment.

• The provider should ensure the injured employee and WSI receive a copy of the assessment form at every visit. This assists the employer in developing a successful SAW/RTW plan.

Workability Assessment

• The provider may refer an injured employee to a physical or occupational therapist to conduct a workability assessment when a more objective measurement of functional capabilities is necessary.

• The workability assessment includes physical performance testing or measurements to evaluate an injured employee’s ability to complete specific tasks.

• The workability assessment must be within 2 days of a scheduled office visit. It is optimal for the workability assessment to occur prior to the injured employee’s office visit, as it is the treating provider’s responsibility to review the therapist’s recommendations and assess the injured employee’s capabilities.