Three Ways Case Managers Can Influence Return-to-Work Outcomes



In 2019, there were 105 million workdays lost and $171 billion spent on workplace injuries, inclusive of wage and productivity losses, medical expenses and administrative expenses.1 With figures this daunting, it may be difficult to see how you, as just one case manager, can make a positive impact.

But you have great influence over return-to-work outcomes. You have the benefit of seeing and treating the whole person—looking beyond the physical injury to account for the stress and practical implications at play, such as the impact to family, potential financial hardships and acceptance of realistic recovery outcomes.

The Occupational Safety and Health Administration has a “three points of contact” safety rule. This rule indicates that when performing tasks, such as climbing a ladder, there should be three points of contact with the equipment at all times. Similarly, case managers should follow a “three points of contact” rule when managing injured workers.

With a biopsychosocial approach as the foundation, these three points of contact will help you position injured workers for success:


When someone gets injured on the job, there is a lot to coordinate for a successful return to work. Physicians and physical therapists are busy creating treatment plans and identifying work-related limitations, while employers may be focused on establishing timelines and transitional job roles. With so many moving parts, injured workers are often left with many questions.

This is where the case manager comes in. You sit at the center—collaborating with all parties throughout the recovery journey so everyone is aware of, and working toward, the same goals. And your constant communication is a vital component of an injured worker’s success, resulting in:

  • Positive Outlook—When engaged in the process, injured workers are more likely to have a more positive outlook, which sets them up for a quicker recovery.
  • Satisfaction—As recovery milestones are achieved, injured workers maintain a good impression of their care experience, thus minimizing the need for legal intervention.
  • Cost Savings—Communication among all stakeholders creates more efficient claims management, minimizing unnecessary spend and optimizing return-to-work time frames.


As a case manager, you are an injured worker’s trusted confidant. They lean on you to manage all stakeholders involved. With that in mind, it’s important to:

  • Actively listen to their concerns, fears and personal goals.
  • Communicate appropriate, accurate and attainable goals.
  • Assure them there is a pathway to recovery.
  • Celebrate recovery milestones.
  • Prepare them for return-to-work.


Prior to the return to work, case managers should collaborate with the entire care team to review the injured worker’s job responsibilities, identify any limitations, create ideal working conditions and reinforce the education provided by the physical therapist to the injured worker on how to perform job duties without getting reinjured.

From there, partnership with the employer is key to creating a transitional placement plan that enables the injured worker to return to full-time work while still recovering.

To illustrate the importance of this partnership, think about a delivery driver who’s suffered a lower back injury but has been cleared to return to work under modified duty. Without direction from the case manager, the employer might assume it’s best to place this individual in a desk role while recovering. Only the case manager might realize that doing so could actually delay recovery. Remaining stationary for an eight-hour workday could aggravate the injury, reduce muscle mass and expose the worker to risk of reinjury. The case manager in collaboration with the physical therapist can identify more appropriate work modifications. Just as a professional athlete wouldn’t sit at home until fully recovered, the same logic applies to injured workers.


Throughout the process, I encourage you to rely upon the Clinical Guidance to Optimize Work Participation After Injury or Illness: The Role of Physical Therapists—a 102-page compilation in the Journal of Orthopaedic & Sports Physical Therapy, the journal of the largest academy of the APTA, the Academy of Orthopaedic Physical Therapy (AOPT).

These clinical guidelines bring together the highest quality research in one place, available for reference at any time. They outline delayed return-to-work risk factors and ways to mitigate them, such as:

  • Engage Early—Identify any risk factors from the onset of injury, so they can be addressed in the recovery plan. The longer risk factors are left unaddressed, the greater the chance of delayed return to work.
  • Progressive Activity—Slowly increase an injured worker’s activity throughout the recovery plan. This could possibly include intense, work-related activities to build up strength needed for the job.
  • Job Descriptions—It’s important to truly understand the ongoing physical demands of each job. Employers can evaluate demands by creating job descriptions for each role. From there, they can intelligently modify processes, policies and equipment to relieve physical stressors.
  • Evaluate the Job Site—Employers should consider inviting the physical therapist to review the job site. The physical therapist will more clearly be able to pinpoint risk factors for the injured worker.

The above points just scratch the surface in terms of how the clinical guidelines can influence and drive your return-to-work efforts moving forward.

Another thing to pay close attention to is whether your injured worker is suffering from an injury that others in the company have also experienced. When patterns of injuries occur in groups of workers, an ergonomics assessment can help identify risks associated with administrative controls, behavioral controls or personal protective equipment. Once identified, these issues can be resolved, further setting the stage for successful return to work.


When everything is considered, it’s clear to see the great responsibility case managers carry throughout the recovery process. This responsibility should be viewed as an opportunity—one by one, it’s an opportunity to positively impact injured workers, and over time, it’s an opportunity to shift workplace injury trends for the better.

Learn more about how you can optimize return-to-work outcomes by contacting Michelle Despres at .

michelle despres

Michelle Despres, PT, CEAS II, REAS, CETSvice president of physical therapy at One Call, is a leader within the world of PT, discussing everything from virtual PT to PT as an opioid alternative. With a focus on delivering better outcomes, she encourages injured workers to take an active role in their recovery and mentors clinicians to provide the best services possible.


1. National Safety Council. (n.d.). Work Injury Costs and Time Lost. NSC Injury Facts.

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