Opening/Closing IRB Exposures
What is the standard IRB Exposure amount that we should be initially opening?
$10k
When is the first time we should be initiating RTW discussions with the customer?
Initial Call
Do you have to be fully recovered in order to RTW?
No
Should we follow up with the customer regarding RTW after they have returned on modified duties or GRTW/part time hours?
Yes. Frequent discussions are essential to ensure RTW is going well and to address any barriers.
What section of the OCF-3 includes recovery timelines?
Part 6
When should we initially open the IRB exposure?
When we are notified they are off work, when we suspect they have gone off work, or when we suspect they will be going off work.
Name 2 instances where we should continue to have RTW discussions
During update calls with customer, update calls with LR, update calls with provider, etc.
The window of opportunity for re-employment or returning to work is greatest within ____ months and ideally takes place within a few months from the injury.
5 months
Name 2 things that we should be asking the Employer for RTW planning.
Job demands/duties, if they can accommodate modified duties/GRTW, requirements/documents for the customer to RTW, employment status, confirming details of OCF-2, if STD/LTD is available, if they are capable of attending case conferences for RTW planning, if they are able to fund any assistive technology and/or ergonomic/work site assessments.
What tab in Claim Centre do we use to set RTW goals and milestones?
AB Case Management Tab
What forms/documentation do we require (if any) prior to opening the IRB exposure?
We do not need to wait for any forms. We should be opening the exposure as soon as we know customer is off work or suspect they are going off work
Give an example of motivational interviewing question
Typical MI questions are open-ended questions that start with “What, How and Tell Me About”
Try to avoid “Why” questions.
What do you think you can do at work?
How do you believe you can succeed in getting back to work?
If you were to return to work, what would it be like?
What is Best Practice Timeline for RTW?
Within 9 Weeks of the date of loss
What interviewing technique helps move the customer from "sustained talk" to "change talk?"
Motivational Interviewing
When should you assign RTW RCS to a file?
Within 15 days after opening IRB Exposure
Name 2 formats in which we may be notified of a customer going off work
calls with customer, CNRs, provider updates, Legal rep updates, OCF3, OCF1, etc.
What information do we require before we can initiate RTW discussions with the Employer?
Name 2 Internal Resources from the toolbox that we have to aid setting RTW goals and associated Milestones?
ODG tool, CRT, RTW team, critical thinking.
Name 2 alternative methods of communication to be used if the Legal Representative is unresponsive to telephone calls or does not provide sufficient information?
Email, letter, fax. Consider Case Conference with LR/customer.
RTW Plan Detail Template - can be found in the Proactive Case Management Guide page 32.
What is the Best Practice Timeline for closing IRB Exposure after a customer has RTW regular hours and duties?
Approximately 6-8 weeks from RTW date
Frequent RTW discussions help the customer avoid...
The "Disability Mindset"
When should we review and update (if required) RTW Goals and Associated Milestones:
Once we get new/updated information regarding the customer’s recovery and RTW status.
i.e.: new OCF-3, update from employer, new CNRs, discussion with the customer, treatment provider and legal rep, etc.
Who should we involve in the RTW discussions?
Customer, Employer, Treatment Providers, Legal Rep, RTW RCS if needed.
Who should we reach out to in order to draft a graduated RTW plan?
Treatment Provider, GP, Customer, Employer based on functional limitations (And RTW RCS if assistance required)