Americans are awfully fickle. What’s hot one day easily can fall out of favor the next, often for no apparent reason. That’s true for clothing styles, restaurants, celebrities, TV shows–and approaches to disability management.

The Americans with Disabilities Act has played to mixed reviews.

Social Security has invested heavily in a program called “Ticket to Work” that has had what appears to be only limited success.

Private insurers have made considerable efforts to rehabilitate disabled workers and return them to an active lifestyle using return-to-work programs.

Effective RTW programs can help employers improve morale and cut workers’ compensation expenses, medical costs and the costs associated with work force replacement. The employees themselves benefit from faster recovery speeds, wage continuation, higher morale and less reinjury.

However, RTW programs have fallen out of favor with many employers in recent years. If employers aren’t interested in using these programs, brokers aren’t interested in promoting the concept.

One big question is what went wrong?

Another question is when will the aging of the American work force make employers take another look at return to work and other efforts to accommodate mature, experienced employees?

12 weeks

In recent years, many employers have decided that they will take an employee who is trying to return from a long disability leave only if the employee can come back at 100% and without any restrictions.

Meanwhile, many employers have experienced significant increases in the incidence of short- and long-term disability. Between 2003 and 2004, long-term disability incidence rates increased at 27% of employers surveyed and decreased at just 5% of employers, according to JHA Inc., Portland, Maine.

Today, a growing number of employers hold employees’ positions open only 12 weeks–just long enough to comply with the federal Family and Medical Leave Act. If employees want to return from disability after 12 weeks, they have to apply for open positions.

These employers’ reluctance to take back experienced workers after an injury or extended illness is surprising in light of the evolving work force. The changing demographics and the aging of our society will produce shortages of workers at all skill levels. By 2012, our economy may have three million to five million more jobs than workers.

Employers who think ahead are recognizing the cost of finding and training new employees, especially for higher skilled positions. These employers already are trying to persuade older employees to work past retirement, either full time or part time. If this trend grows as quickly as expected, employers will have to deal with more employees with disabilities and more need for accommodations.

Of course, renewing employers’ interest in helping workers return to work would be good for the workers and for the insurers.

Many disabled workers are capable of returning to work in some capacity fairly soon after their injury or illness occurs and are eager to do so. But they may linger on disability much longer when they fail to get the necessary rehabilitation services or employer support to return to work.

When employees return to work in a productive capacity, the savings in disability costs for every dollar spent on RTW services is substantial.

A formal employer-sponsored RTW program gets employees involved early and steers disabled workers through the rehabilitation process so they can re-enter the work force as quickly as possible.

An employer that is willing to make a few simple, inexpensive accommodations can be especially effective at getting an employee back to work. According to the Job Accommodation Network, 70% of accommodations cost less than $500, and 20% of accommodations cost nothing at all. Accommodations could range from offering a worker a light-duty position during a transition period to something as easy as spending a few hundred dollars on a standing desk to accommodate an employee with back problems.

In some cases, proactive efforts to accommodate workers with health problems could keep those workers from filing disability claims in the first place. Most large and midsize employers now use disease management programs to maintain the health of employees with conditions such as diabetes and hypertension.

The work retention assistance provision found in many disability plans will reimburse an employer for job modifications that will keep an employee on the job.

Although the effectiveness of a work retention assistance benefit will be limited at an employer without a formal RTW program, the benefit can be an important element in a comprehensive absence management program

Returning RTW to duty

Two strategies for reviving employer interest in RTW may be streamlining oversight and educating employers about the value of retaining experienced workers.

One reason a company won’t–or can’t–take full advantage of RTW programs is the company’s organizational structure. Many employers put workers’ compensation RTW programs in the hands of their risk managers and sick leave, short-term disability and long-term disability under the jurisdiction of employee benefits managers. The risk managers and benefits managers may operate independently, with different budgets and goals. The managers don’t coordinate or integrate RTW, and RTW falls through the cracks.

Today, employers and their benefits advisors are starting to overcome this problem by aligning medical coverage, disability coverage, FMLA administration and the workers’ comp program.

Simply getting all of these operations to feed RTW data into one clear report can help.

When employers and brokers can see for themselves what worker retention and return-to-work programs are doing to control direct labor costs and increase productivity, they will pay attention.