Ideal RTW Determinations

Principles and Process

Patricia Owens, Member

Board of Directors, National Academy of Social Insurance

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Ideal RTW Determinations

• Presentation Outline

• Background

• Principles and Assumptions

• A Separate Pathway

• Program Features

• A New Information Gathering Approach

• Claimant

• Medical

• Vocational

• Process

• Conclusion

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Ideal RTW Disability Process

• Background

• Historically, Sequential Evaluation

• To Yes or No you get benefits

• RTW continues to be elusive despite many efforts

• Conflict with definition

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Ideal RTW Determinations

• Principles and Assumptions

• Can work around definition

• RTW possible even when definition met

• New medical treatment

• Removing barriers

• Employment Supports

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Ideal RTW Determinations

• Principles and Assumptions (Continued)

• RTW process is possible

• Can find right and right number people

• Need Separate Pathway

• Set Expectations

• Provide Services

• Tracking, Evaluation and Change are essential

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Ideal RTW Process

• A Separate Pathway

This will set expectations and must be in place and understood by stakeholders; requires educational process in community.

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Ideal RTW Determinations

• Program Features

• Certain Key Concepts

• Impairment/Function

• Maximum Medical Recovery

• Supported Employment

• Setting Expectations

• Claimant Responsibility

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Ideal RTW Determinations

Program Features (Continued)

• Interventions

• Case Management

• Income Supports

• Job Placement and Supports

• Medical Treatment

• Integrated Support Team

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Ideal RTW Determinations

Program Features (Continued)

• Tracking and Monitoring

• Ongoing Program Evaluation and Improvement

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Ideal RTW Determinations

• A New Information Gathering Approach

• From Claimant

• Motivation, Self Selection, Health and Disability Insurance

• Medical

• Maximum Medical Recovery, Restrictions and Limitations, Treating Physician Involvement and Incentives

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Ideal RTW Determinations

• A New Information Gathering Approach

• Employment

• Most Recent Employment, RTW Potential, Insurance Interaction, Local Job Market, Self Employment Option

• Will require new forms and interviewing skills

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Ideal RTW Determinations

• Process

• Education

• Application

• Initial Screening

• Fast Pay, Regular Adjudication or RTW Track

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Ideal RTW Determinations

• RTW Track

• Perfect Evidence

• Planning and Case Management

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Education Regarding RTW Track Option

(Community Medical Employers Insurers)

Outreach

Initial Application

Screening

Medical - Other

"Regular Adjudication"

RTW Track

Fast Pay

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RTW

Gather Information

Medical and Vocational

Plan and

Case Management

Cash Benefits

Monitoring

and Evaluation

Service Delivery