1. GENERAL. Medical authorities and rehabilitation specialists agree that most temporarily disabled employees benefit both psychologically and physically from returning to work at the earliest feasible date. The concept of returning injured employees to work early under a temporary modified work assignment is an underlying philosophy of the Workers’ Compensation system. Supervisors demonstrate interest in disabled employees and recognize the importance and contribution of these employees by arranging meaningful work at the earliest medically feasible date. Injured employees can quickly recognize when they are being ignored by supervisors who do not want to be bothered. Such experiences are humiliating and could directly contribute to extended recuperation periods.
  2. OBJECTIVES. The objectives of returning occupationally disabled employees to work as early as medically feasible through modified work assignments are to:Respond to medical opinion that modified work activity, in most cases, is therapeutic and can effect a faster recovery for a temporarily disabled person.
    1. Prevent deterioration of basic work skills, loss of self— confidence, and associated despondency that frequently results from prolonged absence from work.
    2. Demonstrate concern for disabled employees and recognize their valuable contributions as members of the work team.
    3. Minimize the loss of human resources and reduce disability costs.
  3. POLICY. It is the policy of San Mateo County to return employees with temporary disabling occupational injuries and illnesses to work in temporary modified work assignments as soon as medically feasible. Temporary modified work is distinguished from permanent modified work in that the injured employee is normally able to return to his/her full duty in the same position or a like position occupied prior to the injury. Permanent modified work contemplates a permanent change of assignment which could involve a different classification and a different department than pre—injury.
  4. RESPONSIBILITIES.
    1. Departments. The principal responsibility for implementing the Temporary Modified Work Program rests with the departments of the County. This includes:
      1. Appointing a departmental Modified Work Coordinator to coordinate the department’s efforts to provide modified work for qualified employees wherever possible within the constraints imposed by legal and medical authorities, and by departmental considerations.
      2. Informing employees and their physicians of the Temporary Modified Work Program, and requesting Physicians’ Statements concerning occupationally disabled as appropriate.
      3. Developing an inventory of temporary modified work assignments available in each respective department.
      4. Developing Temporary Modified Work Plans for qualifying disabled employees where there is no objection to modified work on the part of the attending physician.
      5. Assigning temporarily disabled employees to temporary modified work.
      6. Adjusting, extending, or terminating temporary modified work assignments in the best interests of employees and the County.
      7. Coordinating, as necessary and appropriate, with those other elements of the County involved in the Temporary Modified Work Program, and with the County’s Workers’ Compensation Administrator.
    2. Personnel Department.
      1. Assisting departments in the temporary restructuring of jobs to conform with County personnel policies and procedures.
      2. Reviewing Temporary Modified Work Plans to assure there are no job content problems in temporary modified work assignments.
      3. Attempting to find suitable temporary modified work assignments outside of the responsible department, where this is desirable.
    3. Vocational Rehabilitation Services.
      1. Assisting, as requested by the Risk Management Division, in:
      2. Identifying those capabilities and limitations of temporarily disabled employees which relate to modified work assignments. Normally this would include the individual’s work skills and physical and psychological condition.
      3. Developing suitable Temporary Modified Work Plans in conjunction with responsible departments, agencies providing the work, and attending physicians.
      4. Providing counseling and other rehabilitative services to employees assigned to temporary modified work.
    4. County’s Workers’ Compensation Administrator.
      1. Assisting, as requested by the Risk Management Division, in those cases where temporary modified work is available and appears appropriate, but there is an objection to such work by the employee and/or attending physician. This may include:
        1. Informing physicians concerning the Temporary Modified Work Program and eliciting Physicians’ Statements concerning occupationally disabled employees, as appropriate.
        2. Reviewing Physicians’ Statements for suitability and advising concerning employee capabilities for undertaking temporary modified work assignments.
        3. Securing independent medical examinations to better ascertain individual capabilities for performing temporary modified work when such action is considered appropriate.
      2. Monitoring long—term occupational disabilities and initiating modified work proposals when the employee appears capable of such work.
      3. Advising with regard to the adjustment, extension, or termination of temporary modified work assignments.
      4. Processing and modifying Temporary Modified Work Plans, as necessary, to secure appropriate concurrences and supporting medical opinion to validate them.
    5. Risk Management Division.
      1. Monitoring the implementation of the Temporary Modified Work Program by all elements of the County, and assessing program effectiveness as measured by injury severity rates and costs.
      2. Assisting and advising departmental Modified Work Coordinators.
      3. Developing Temporary Modified Work Plans when so requested by responsible departments and when there is an objection by an employee or an attending physician. This will be done in consultation with the responsible departments, agencies providing the work, and appropriate medical authorities.
  5. PROCEDURES. Procedures for implementing the Temporary Modified Work Program are described below:
    1. Responsibilities. Principal responsibility for implementing the Temporary Modified Work Program rests with the departments of the County, particularly for short term and less serious occupational injuries and illnesses. For longer term and more serious occupational disabilities, however, the Risk Management Division and the County’s Workers’ Compensation Administrator exercise several technical responsibilities to insure compliance with pertinent laws and conformance with best risk management and medical practices. The procedure for handling short term temporary modified work assignments is informal.
    2. Departmental Action: Where an employee has incurred an occupational injury or illness that does not preclude that employee from performing an available and suitable temporary modified work assignment, and there is no objection on the part of that employee or an attending physician, the responsible department may immediately and informally assign that employee to such modified work within the department. Temporary modified work assignments outside of the responsible department shall be assigned formally. An employee informally assigned to modified work shall continue in that capacity pending return to full duty when ready or to a permanent modified work program if found appropriate.
    3. Refused Modified Work. If a validated temporary modified work assignment within prescribed medical limitations is offered, but the employee refuses it, the employee may no longer be entitled to either Disability Leave benefits or Workers’ Compensation temporary disability benefits. Benefits may be terminated in writing in conformance with established County policies after consultation with the Risk Management Division and the District Attorney’s office. If an employee has attempted a temporary modified work assignment and medical problems result from that assignment, or he/she believes such assignment detrimental to his/her safety or welfare, that employee should immediately so inform his/her supervisor and the attending physician. Every employee has the right to appeal the loss of Workers’ Compensation benefits to the Workers’ Compensation Appeals Board.
    4. Disputed Medical Opinions. The Risk Management Division shall review those cases where the attending physician does not approve temporary modified work, or where there is any question concerning a Physician’s Statement. When a physician’s opinion is believed questionable, independent medical examinations, as necessary, may be obtained to sustain the original medical opinion, or to dispute it.
    5. Developing Modified Work Plans. Care must be exercised in the development of Temporary Modified Work Plans to ensure such work does not exceed the individual’s work skills or physical and psychological limitations. Employees may be reluctant to discuss personal lack of skills or feelings of inadequacy with regard to proposed modified work assignments within their respective departments. Where an employee objects to a modified work assignment, or appears reluctant to undertake such assignment, counseling by a rehabilitation specialist should be considered. Every Modified Work Plan must follow the recommendation of an appropriate medical authority.
    6. Monitoring Long—Term Disabilities. Monitoring longer term and more serious cases of occupational disability to assess the suitability of and proper timing for initiating temporary modified work, is the responsibility of the County’s Workers’ Compensation Administrator. The Administrator has the authority to request a Physician’s Statement at any time to determine an employee’s capability for work and shall promptly furnish the Risk Management Division with copies of Physicians’ Statements, and such other appropriate information that will assist the Division in conducting its functions and monitoring the program.
    7. Eventual Capability for Full Duty. Temporary modified work may only be provided to an employee whose medical prognosis indicates that he/she can progress to full duty in either the employee’s regular work assignment or in a disability transfer assignment.
    8. Part-Time Modified Work. Temporary modified work may be provided on a part—time or full—time basis.
    9. Payment for Modified Work. Payment for temporary modified work shall be at the base pay of the employee. Modified work which is less than full time shall provide base pay for the time worked and disability leave with pay and/or Workers’ Compensation temporary disability benefits for the time not worked.
    10. Notification of Change in Work Status. The responsible department shall notify Risk Management of each change in every employee’s work status with regard to commencement and termination of disability leave and temporary modified work, as well as return to regular work assignment. The Change in Work Status Form will be used for this notification.

Suggestions for changes to this procedure should be forwarded in writing to Risk Management, Pony No. HRD 163.