Table of Contents

Your Ultimate Guide to Mastering Workers’ Comp Costs

Chapter 1: Workers’ Compensation Insurance Basics………………………………..………………………….…………………. 1 Purpose of Workers’ Compensation……………………………………………………………………………………………......... 1 Who Pays for Workers’ Compensation................................................................................................……………………….. 1 Parties Involved in Workers’ Compensation……………………………………………………..………………………………….. 2 Benefits for the Employer…………………………………………………………………………...………………………....... ....... 3 Independent Contractors.…………………………………………………………………………………..…………………………. 4 Benefits for the Employee………………………………………………………………………..….………………………………... 5 Injuries Covered……………………………………………………………………………................…………………………..…... 6 Determining Compensability…………………………………………………………………...................………………………….. 7

Aggravation vs Exacerbation…………………………………………………………………………….………………………....... 7

Standard Defenses………………………………………………………………………………………….…………………............ 8

Types of Workers’ Compensation Insurance….……………………………………...................………………………............... 9

How Losses Are Categorized….……………..…………………………………………..………..………………………………… 12

How Losses Are Reported.. ……………………………………………………………….................……………………………… 13

Reducing Your Premium…………………………………….……………………………………………………………………….. 14

Calculating Your Premium……………………………………………………………………………………….…………………… 14

How Mod Affects Your Premium……………………………………………………………………………..………………………. 14

Good/Bad Mod Examples……………………………………………………………………………………….………………….... 14

Ways to Reduce Your Mod…………………………………………………………………………………………………………... 15

Unit Statistical Date………………………………………………………………………………………………………………….... 15 Types of Insurance Structures…………………………………………………………………………..…………………………… 16

Voluntary Markets……………………………………………………………………………………………..…………………….... 16

Alternatives to Voluntary Markets……………………………………………………………………………….…………………... 17

Collateral Requirements………………………………………………………………………………………..………………….... 18

Chapter 2: Fundamentals of Cost Containment………………………………………………………………………………………. 19 Reasons Workers’ Compensation Costs Are High…………………………………………………………..……………………... 19 Who Is in Charge…………………………………………………………………………………………….......…………………….. 19 Work Ability Form Properties……………………………………………………………………………….…..…………………….. 20 Who Is Responsible for Managing Workers’ Compensation Claims.…………………………………….……………………….. 20 Who Is Responsible for Managing Workers’ Compensation Process.. ………………………………….…………………….. 21 Hidden (Indirect) Costs of Workers’ Compensation……………………………………………………….....…………………….. 21 Additional Costs……………………………………………………………………………………………….....…………………….. 21 Calculating Workers’ Compensation Costs…………………………………………………………………….……………………. 22 External Obstacles to Cost Control…………………………………………………………………………….…………………….. 22 Internal Obstacles to Cost Control……………………………………………………………………………………………………. 23

Chapter 3: Training and Building Commitment……………………………………………………………..……………………….... 25

Implementing a Workers’ Compensation Program…………………………………………………………………………………. 25 Key Training Responsibilities………………………………………………………………………………….………………….….. 26 Management Awareness………………………………………………………………………………………………………….….. 26 Presenting to Supervisors……………………………………………………………………………………..……………………... 27 Conflicting Roles of Supervisors……………………………………………………………………………….…………………….. 27 Supervisors Must Be Involved…………………………………………………………………………………………………….….. 27 Develop Supervisor Guide……………………………………………………………………………………..………………..……. 27 Building on Success…………………………………………………………………………………………….……………………... 28 Consider Use of Tools………………………………………………………………………………………….……………………... 28 Bringing Employees on Board………………………………………………………………………………………………………... 28 Your Company Message……………………………………………………………………………………….……………………... 28 Workers’ Compensation Implementation Timetable………………………………………………………………………………… 29 Facilitator’s Training Agenda………………………………………………………………………………………………………….. 30

Chapter 4: Injury Management Best Practices Roles and Responsibilities…………………………….…………………….….. 33

Injury Coordinator Best Practices……………………………………………………………………………….……………….….... 33 Supervisor Best Practices……………………………………………………………………………………….…………………..... 38 Employee Best Practices………………………………………………………………………………………...………………….… 40 Middle Manager Best Practices………………………………………………………………………………………………………. 41 Risk Manager Best Practices…………………………………………………………………………………………………………. 42 Medical Department and Medical Director Best Practices…………………………………………………...……………………. 43 Senior Management Best Practices………………………………………………………………………….………………………. 44 Special Investigation Unit Director Best Practices…………………………………………………………………………………. 45 Legal Department Best Practices……………………………………………………………………………….……………………. 46

Chapter 5: Reporting the Claim…………………………………………………………………………………….…………………...... 47

Immediately Report All Losses…………………………………………………………………………………..…………………... 47 Critical Issues………………………………………………………………………………………………………………………..…. 47 Reporting Procedure…………………………………………………………………………………………………………………... 47 Intake Procedures……………………………………………………………………………………………………………………... 47 Essential Intake Considerations………………………………………………………………………………….……………….….. 48

Injury Triage………………………………………………………………………………………………………..…………………... 48 Employer’s First Report of Injury……………………………………………………………………………………………………... 49

What Is Included on the FROI………………………………………………………………………………………………………... 50

Completing the FROI………………………………………………………………………………………………………………….. 51

Penalties…………………………………………………………………………………………………………….………………….. 51 Chapter 6: Post-Injury Response Procedure …………………………………………………………………………………………. 53

Post-Injury Response Procedure Guidelines…………………………………………………………………..……………………. 53 Benefits of a Consistent Post-Injury Response………………………………………………………………..……………………. 53 Post-Injury Response Worksheet……………………………………………………………………………….………………….... 53 Implementing Post-Injury Response on the Road…………………………………………………………….………………….... 54 Sample Post-Injury Response Procedure…………………………………………………………………………………………... 55 Summary Steps and Format……………………………………………………………………………………..…………………... 57

Chapter 7: Communication with Employees……………………………………………………………………..…………………….. 59 Proactive Communication………………………………………………………………………………………..……………………. 59 Reactive Communication………………………………………………………………………………………………………………. 59 Keep Complete Record…………………………………………………………………………………………..……………………. 59 Two Types of Communication…………………………………………………………………………………...……………………. 59 Employee Brochure……………………………………………………………………………………………….……………………. 60 Meeting with Your Employee…………………………………………………………………………………….……………………. 60 First Day Phone Call…………………………………………………………………………………………………………………... 60 Weekly Contact…………………………………………………………………………………………………………………………. 61 Weekly Meeting Guidelines……………………………………………………………………………………………………………. 61 Scheduling Weekly Meetings…………………………………………………………………………………….……………………. 61 Reducing Attorney Involvement………………………………………………………………………………………………………. 61

Chapter 8: Working with Your Insurance Adjusters or TPA………………………………………………….…………………….. 63 Claims Adjusters……………………………………………………………………………………………….….……………………. 63 What Is a TPA……………………………………………………………………………………………….………………………..... 63 Adjuster File Assignments……………………………………………………………………………………....…………………….. 64 Dedicated vs Designated Claims Units……………………………………………………………………………………………… 64 Bundled and Unbundled Services………………………………………………………………………..…….…………………….. 64 Deductible vs Control……………………………………………………………………………………….….……………………… 64 How to Select a TPA……………………………………………………………………………………………...…………………… 64 Learning About Your Claim Partners…………………………………………………………………………...……………………. 66 Preparing for the TPA Visit……………………………………………………………………………………………………………. 66 Meeting with Your Claims Handler……………………………………………………………………………...……………………. 66 Chairside Visits…………………………………………………………………………………………………………………………. 67 Doing a National Rollout……………………………………………………………………………………….………………………. 67 Vendor Day………………………………………………………………………………………………………..……………………. 67 Account Handling Instructions…………………………………………………………………………………..…………………….. 68 Reviewing Open Claims with the TPA……………………………………………………………………….………………………. 68 Reserving Practices……………………………………………………………………………………………………………………. 69 Information Needed to Establish Reserves…………………………………………………………………….……………………. 69 Reserve Calculation Worksheets……………………………………………………………………………….…………………….. 69 Reasons Reserves Are Higher Than Expected……………………………………………………………..……………………… 70 Verifying Reserves Accuracy…………………………………………………………………………………….……………………. 70 Plan of Action (POA)…………………………………………………………….. …………………………………………………… 70 How to Evaluate a TPA………………………………………………………………………………………..………………………. 72 Medical Management Quality Review………………………………………………………………………….……………………. 73 Quality Control File Audit……………………………………………………………………………………………………………… 74 File Reviews and File Audits………………………………………………………………….………………………………………. 74 Audit Timing…………………………………………………………………………………………………………………………….. 74 File Review Procedures……………………………………………………………………………………….………………………. 74 File Audit Procedures…………………………………………………………………………………….………………………….… 75 File Audit Participants…………………………………………………………………………………………….……………………. 75 MD Participation……………………………………………………………………………………………..…………………………. 76 How to Control Leakage………………………………………………………………………………………….……………………. 77 What Is Leakage……………………………………………………………………………………….……….…………………….... 77 Types of Leakage………………………………………………………………………………………………………………………. 77 Causes of Leakage……………………………………………………………………………………………….……………………. 77 Leakage Claim Audits…………………………………………………………………………………………….……………………. 78 Leakage Identification Checklist……………………………………………………………………………………………………… 78

Chapter 9: Safety and Loss Control…………………………………………………………………………....................................... 79 How to Develop an Effective Safety Program……………………………………………………………….............................. .... 79 Initial Assessment………………………………………………………………………………………………................................. 79 Assignment of Roles and Responsibilities…………………………………………………………………................................... 80 Record Keeping……..………………………………................................................................................................................. 80 What OSHA Requires………………………………………………………….............................................................................. 80 Select Safety Committee, Chairman, and Recording Secretary…………………………………………................................... 81 Safety Committee Responsibilities……………………………………………………………………………................................. 81 Safety Committee Meetings………………………………………………………………………………….................................... 81 Communication Methods………………………………………………………………………………………................................. 81 Conduct a Thorough Workplace Assessment……………………………………………………………….................................. 81 Hazard Correction/Safety Work Order Tracking System…………………………………………………................................... 82 Develop Written Policies, Procedures, and Programs…………………………………………………….............................. ..... 82 Accident Investigation Program………………………………………………………………………………................................. 82 Education and Training: Employees, Supervisors, and Managers……………………………………….............................. .... 82 Who Receives Training………………………………………………………………………………………................................... 83 Safety Equipment Required Signs…………………………………………………………………………………………………... 83 Communicate Safety Often………………………………………………………………………………….……………………..… 83 Safety Awareness Posters………………………….……………………………………………………….……………………..… 83 Safe Days Posters……………………………………………………………………………………………..…………………….... 83 Safety Recognition and Incentive Programs…………………………………………………………………………………..…… 84 Employee Screening………………………………………………………………………………………………………………….. 85 Hiring Safe Employees……………………………………………………………………………………………………………….. 85 Job Analysis…………………………………………………………………………………………………….……………………... 85 Screening Tools……………………………………………………………………………………………………………………….. 85

Chapter 10: Wellness Programs……………………………………………………………………………….………………………... 87 Wellness in the Workplace……………………………………………………………………………………..…………………….. 87 Benefits of Wellness Programs………………………………………………………………………………………………………. 87 Incentives for Wellness………………………………………………………………………………………………………………… 87 Negative Effects of NOT Having a Wellness Program…………………………………………………….….…………………… 87 Types of Wellness Programs……………………………………………………………………………………………………….... 87 Weight Control…………………………………………………………………………………………………..……………………... 87 Smoking Cessation Programs………………………………………………………………………………………………………... 88 Depression/Anxiety Awareness Treatment………………………………………………………………….……………………... 88 Migraine Headache Management…………………………………………………………………………….……………………... 88 Substance Abuse Treatment…………………………………………………………………………………..……………………... 88 Drug, Alcohol, and Substance Abuse Policy………………………………………………………………...……………………... 89 Drug, Alcohol, and Substance Abuse Testing………………………………………………………………..…………………….. 89 Putting Wellness Programs into Practice…………………………………………………………………….……………………... 90

Chapter 11: Return to Work and Transitional Duty……………………………………………………..………………….…….…... 91 Cost Savings…………………………………………………………………………………………………………………………… 91 Measuring Effective of Return-to-Work Programs…………………………………………………………………………………. 91 Transitional Duty Policy Overview……………………………………………………………………………………………………. 92 Benefits…………………………………………………………………………………………………………….……………………. 92 Program Goals………………………………………………………………………………………………….…………………….... 92 Drafting a Transitional Duty Policy………………………………………………………………………………………………….... 92 What to Include in a Transitional Duty Policy………………………………………………………………..…………………….... 93 Characteristics of Transitional Duty Assignments…………………………………………………………..…………………….... 94 Transitional Duty Program Pay Rate……………………………………………………………………………………………….... 94 Estimating the Duration of an Injury…………………………………………………………………………….…………………..... 95 Medical Treatment Guidelines……………………………………………………………………………………………………..….. 95 Medical Treatment and Comorbid Conditions……………………………………………………………….………………….…... 95 Using Medical Treatment Guidelines……………………………………………………………………………………………….. 95 Using Injury Treatment Guidelines to Estimate Cost Savings……………………………………………………………………. 96 Types of Transitional Duty……………………………………………………………………………………….……………………. 97 Modified Duty…………………………………………………………………………………………………………………………… 97 Alternate Work…………………………………………………………………………………………………………………………. 97 Alternative Off-Site Jobs………………………………………………………………………………………………………………. 97 Non-Profit, Volunteer, or Charitable Positions……………………………………………………………………………………… 97 Transitional Duty Tips…………………………………………………………………………………………………………………. 98 Putting Return-to-Work into Action……………………………………………………………………………………………….….. 99 How to Identify Transitional Duty Jobs……………………………………………………………………….………………….….. 99 Employees Who Never Return to Work……………………………………………………………………………………………… 99 Overlapping Benefits…………………………………………………………………………………………………………………... 100 Americans with Disabilities Act (ADA) Key Points…………………………………………………………………………………. 101 Coordinating Workers’ Compensation with Federal and State Leave Statutes…………………………….……………………. 102 Workers’ Compensation, ADA, and FMLA Interactions……………………………………………………..……………………... 102 Case Study……………………………………………………………………………………………………………………………... 104 Working with Unions…………………………………………………………………………………………….…………………….. 105

Chapter 12: Other Indemnity Cost Containment Methods……………………………………………….…………………….….... 109 Work Hardening………………………………………………………………………………………………………………………... 109 Independent Medical Evaluations (IME)……………………………………………………………………... …………………..... 110 Before the IME…………………………………………………………………………………………………..……………………... 110 Customize Medical Inquiries…………………………………………………………………………………...……………………... 110 Timeframes for Scheduling and Obtaining IME……………………………………………………………..…………………….... 110 Functional Capacity Evaluations (FCE)……………………………………………………………………………………………... 111 Retraining Programs………………………………………………………………………………………………………………….... 112 Telephonic Disability Intervention…………………………………………………………………………………………………….. 112 Translation Services…………………………………………………………………………………………….……………………... 113 Transportation Services………………………………………………………………………………………..………………….…... 114 Layoff Planning…………………………………………………………………………………………………..……………………... 115

Chapter 13: Directing Medical Care…………………………………………………………….………………………………………… 117 Gain Cooperation from Medical Providers……………………………………………………………………..………………….... 117 Types of Doctors…………………………………………………………………………………………………..………………..…. 118 Remote Health Services………………………………………………………………………………………….…………………... 118 Methods of Doctor Selection……………………………………………………………………………………..…………………... 119 If the Employer Can Direct Care……………………………………………………………………………………………………... 119 If the Employer Cannot Direct Care…………………………………………………………………………….………………….... 119 Ten Considerations for Your Company Doctor…………………………………………………………………………………….. 119 Eleven Reasons NOT to Select a Doctor……………………………………………………………………………………………. 120 The PRIMARY Treating Physician (PTP)……………………………………………………………………….. ……………….… 120 Understand the PTP’s Perspective…………………………………………………………………………………………………… 120 Information You Need from the Doctor………………………………………………………………………….………………..…. 121 Understanding KEY Medical Injury Terms……………………………………………………………………...……………..……. 121 California Medical Provider Network (MPN)……………………………………………………………………. …………….…… 122

Chapter 14: Medical Cost Containment………………………………………………………………………..….………………….... 125 Medical Cost Containment Services………………………………………………………………………….……………………... 125 Utilization Review Accreditation Commission Certification……………………………………………………………………….. 125 Preferred Provider Organizations……………………………………………………………………………..……………………... 126 Injury Triage……………………………………………………………………………………………………..……………………... 127 Telephonic Nurse Case Management (NCM)……………………………………………………………….……………………... 128 Field Case Management (FCM)……………………………………………………………………………………………………... 129 Mental Health Registered Nurses…………………………………………………………………………….……………………... 130 Chronic Pain Programs…………………………………………………………………………………………..………………….... 130 An Aging Workforce…………………………………………………………………………………………….…………………….. 130 Medical Review……………………………………………………………………………………………………………………….. 131 Medical Advisors and Medical Directors……………………………………………………………………..………………….….. 132 Independent Medical Evaluation (IME)……………………………………………………………………….…………………….. 133 Durable Medical Equipment (DME)…………………………………………………………………………... ………………….... 134 At-Home Recovery Services…………………………………………………………………………………..……………………... 134 Medical Bill Review …………………………………………………………………………………..……………………………….. 135 Medical Fee Schedules………………………………………………………………………………………...……………………... 135 Usual and Customary………………………………………………………………………………………………………………….. 135 Hospital Bill Reviews………………………………………………………………………………………………………………….. 136 Using a Diagnosis Related Groups (DRG) Review Company…………………………………………………………………… 136 Cost Savings Using DRG…………………………………………………………………………………………………………….. 136 Medical and Hospital Bill Review Considerations…………………………………………………………………………………. 136 Chiropractic Care ……………………………………………………………………………………………………………………… 137

Chapter 15: Fighting Fraud and Abuse…………………………………………………………………………………………….….… 139 When to Investigate a Claim…………………………………………………………………………………..……………………… 139 Types of Investigation………………………………………………………………………………………….…………………….... 140 Red Flags of Fraud…………………….……………………………………………………………………………………………..... 141 Medical Terminology Used to Identify Malingering………………………………………………………….…………………….... 142 Important Times to Use Surveillance……………………………………………………………………………………………….... 143 How to Use the Results………………………………………………………………………………………..………………………. 143 When Not to Use Investigation………………………………………………………………………………..…………………….... 143 Reviewing Investigation Reports and Videos………………………………………………………………..…………………….... 144 Avoid “Good Day/Bad Day” Syndrome……………………………………………………………………….…………………….... 144 Additional Fraud Controls……………………………………………………………………………………………………………... 145

Chapter 16: Rehabilitating the Injured Employee…………………………..……………………..………………………………..… 147

What Is Physical Therapy………………………………………………………………………………………………………….….. 147

What Is Physical Rehabilitation………………………………………………………………………………..………………….….. 147

What is Occupational Therapy…………………………………………………….………………………………………………..... 147

What is Vocational Rehabilitation………………………………………………………………………………………………….…. 147

Provider Differences…………………………………………………………………………………………………………………… 148

Physical Therapy………………………………………………………………………………………………………………………. 148

Physical Therapy Management……………………………………………………………………………….……………………... 148

Determining Rehabilitation Needs…………………………………………………………………………………………………… 148

Reasons for Physical Therapy……………………………………………………………………………………………………….. 148

Measuring Outcomes…………………………………………………………………………….…………………………………… 148

Doctor’s Reevaluation………………………………………………………………………………………………………………… 149

Determining Therapy Outcomes………………………………………….…………………….…………………………………… 149

Physical Therapy Settings……………………………………………………………………………………………………………. 149

Physical Therapy Office Characteristics…………………………………………………………………………………………….. 149

Physical Therapy Cost………………………………………………………………………………………….……………………… 149

Physical Rehabilitation…………………………………………………………………………………………………………………. 150

Physical Rehabilitation Networks and Specialties………………………………………………………………………………….. 150

Medical Assessments…………………………………………………………………………………………………………………. 150

Cost of Physical Rehabilitation…………………………………………………………………………………………………….…. 150

Physical Rehabilitation Facilities……………………………………………………………………………………………………... 150

Measuring Physical Rehabilitation Outcomes………………………………………………………………………………………. 151

Occupational Therapy…………………………………………………………………………………………………………………. 151

Occupational Therapy Management…………………………………………………………………………………………………. 151

Role of the Occupational Therapist………………………………………………………………………………………………….. 151

Use Occupational Therapy When……………………………………………………………………………………………………. 152

Vocational Rehabilitation……………………………………………………………………………………………………………… 153

Use Vocational Rehabilitation When………………………………………………………………………………………………… 153

Managing the Vocational Rehabilitation Process………………………………………………………………………………….. 153

Chapter 17: Managing Prescription Drug Use and Abuse………………………………………………………………………… 155

Pharmacy Benefits Managers……………………………………………………………………………………………………….. 155

Reasons to Use Pharmacy Benefits Management……………………………………………………………………………….. 155

Prospective and Retrospective Components……………………………………………………………….……………………… 155

Proactive Drug Management Techniques………………………………………………………………………………………… 156

Authorized Drug Formulary…………………………………………………………………………………………………………. 156

Narcotics for Pain Control…………………………………………………………………………………………………………..... 157

Cognitive Behavior Therapy ……………………..…………………………………………………………………………………. 157

Pharmacogenetics Testing…………………………………………………………………………………………………………. 157

Addiction Networks…………………………………………………………………………………………………………………. 157

Reviewing Your Program…………………………………………………………………………………………………………...... 158

Key Selection Criteria for a PBM…………………………………………………………………………….................................. 159

Prescription Drug Monitoring Programs…………………………………………………………………………………………… 160

Toxicology Screening…………………………………………………………………………………………………………………. 160

Implementing the Program…………………………………………………………………………………………………………… 161

Chapter 18: Claims Resolution and Settlements…………………….……………………………………...................................... 163 When and How to Settle a Workers’ Compensation Claim…………………………………………………................................ 163 Action Plan…………………………………………………………………………………………………….................................... 163 Disability Rated Losses………………………………………………………………………………………................................... 163 Disability Scheduled Losses…………………………………………………………………………………................................... 163 Jurisdictional Issues……………………………………………………………………………………………................................. 163 Local Influences………………………………………………………………………………………………….............................. .. 164 Include Future Medical in the Settlement……………………………………………………………………................................. 164 Selecting Physicians to Obtain a Fair Disability/Permanency Rating………………………………......................................... 165 Challenging Impairment Ratings………………………………………………………………………………................................ 165 Medical Issues………………………………………………………………………………………………….................................. 166 Disputed Issues…………………………………………………………………………………………………................................ 166 Offsets Against Other Payments…………………………….……………………………………………...................................... 167 Social Security Disability Benefit Offsets…………………………………………………………………….................................. 167 Social Security Reverse Offsets………………………………………………………………………………................................ 167 States With Reverse Offset……………………………………………………………………………………................................ 167 Prior Injury Offsets……………………………………………………………………………………………................................ ... 168 Subrogation……………………………………………………………………………………………………................................ ... 168 Pre-existing Conditions and Second Injury Funds………………………………………………………….................................. 168 Availability of Future Employment in the Marketplace……………………………………………………................................... 169 Voluntary Resignations………………………………………………………………………………………..................... .............. 169 Strengths and Weaknesses of Both Sides……………………………………………………………….................................. .... 169 Negotiations…………………………………………………………………………………………………….................................. 169 Waivers and Releases………………………………………………………………………………………................................ .... 170 Include Medicare in Release………………………………………………………………………………….................................. 170 Medicare Set-Asides……………………………………………………………………………………………................................ 171 Conditional Payment and Final Demand…………………………………………………………………….................................. 171 Pharmacy Component of Medicare Set-Asides…………………………………………………………….................................. 171 Structured Settlements and Annuities………………………………………………………………………................................ .. 172

Structured Settlement Benefits………………………………………………………................................................... 172

Structured Settlement Vendor Selection Criteria……………………………………………………………………….. 172 California Settlement Process……………………………………………………………………………………………………….. 173

Chapter 19: Federal Employees Compensation Act……………………………………………………………………………….…. 175 Federal Employees’' and Workers’ Compensation………………………………………………………………………………….. 175 Paying for FECA Costs……………………………………………………………………………………………………………….. 175 Administering FECA Claims…………………………………………………………………………………...……………………... 175 Selection of Medical Providers………………………………………………………………………………...……………………... 175 Medical Benefits………………………………………………………………………………………………...……………………... 175 Lost Wages Federal Employees Receive…………………………………………………………………………………………… 175 Permanent Disability or Death……………………………………………………………………………………………………….. 176 Registering as a Federal Medical Provider…………………………………………………………………..……………………... 176 Challenges in Controlling Costs……………………………………………………………………………….……………………... 176 Traditional Cost Control Techniques………………………………………………………………………….……………………... 176 Independent Medical Examinations…………………………………………………………………………………….……..…….. 177 Cost Containment Vendors and Services…………………………………………………………………………………………... 177 Gaining Management Commitment…………………………………………………………………………..……………………... 177 Return-to-Work Programs……………………………………………………………………………………..……………………… 177 Federal Employees Return-to-Work: Transitional Work (before Maximum Medical Improvement)…….…………..………… 178

Defining and Determining Maximum Medical Improvement………………………………………….……………………... 178 Transitional Duty Work and Assignment……………………………………………………………….....…………………... 178 Transitional Duty Barriers Checklist…………………………………………………………………………………….……… 178 Role of the DOL in Transitional Work……………………………………………………………………...…………….…….. 179

Federal Employees Return-to-Work: Alternative Work (after Maximum Medical Improvement)…….. ……………..………. 179 Alternative Employment…………………………………………………………………………..……………………………... 179 Vocational Rehabilitation and Retraining…………………….………………………………………………………………... 179 Difference Between an Impairment and a Disability…..……………………………………………………………………… 179

Appendix A: Glossary of Abbreviations……………………………………………………..………………………………… 180 Appendix B: Documents Referenced in Book….………………………………………………………………………………. 181 INDEX…………………………………………………………………………………………………………………………………... 182