Working Papers

Return-to-Work in California

Listening to Stakeholders' Voices

For many injured workers with permanent disabilities, workers’ compensation benefits alone are insufficient to replace lost wages. Returning to work in sustained employment, therefore, is probably the best way for injured workers to avoid significant financial losses. In addition, scientific evidence shows that returning to medically suitable modified-duty work aids healing and recovery. Many obstacles, however, hinder successful and sustained return-to-work, including communication problems and financial disincentives of important stakeholders in the workers’ compensation system.

This study examines perspectives and insights from five interest groups and strategies suggested by the study participants to overcome problems that hinder return-to-work in California. Focus groups of injured workers, claims administrators, union representatives, management representatives, and health care providers were conducted to discuss medical practices, employer programs and policies, and workers’ compensation claims programs that can help injured workers return to long -term, sustained employment. The participants also discussed problems that make it difficult for injured workers to return to work and possible methods to overcome those problems.


The focus group findings revealed widespread distrust of others’ motives and blaming of others for injured workers not being able to return to long-term, sustained employment. These feelings and beliefs appear to pervade the workers’ compensation community.

Participants in the focus groups identified “best practices” of treating physicians, employers, and claims administrators that they believed help injured workers return to sustained employment. Participants in three of the groups said that it is important that treating physicians know how to write useful medical reports and formulate clear and specific work restrictions. However, no other specific practice of treating physicians, employers, or claims administrators was identified as beneficial by participants in most or all of the groups. Participants either disagreed about some practices, or they did not have a chance to comment on practices identified by participants in the other groups.

Participants also expressed views about overall problems in the workers’ compensation system that hinder return-to-work, and they offered ideas on strategies to overcome some of the problems. Education for workers, employers, treating physicians, and unions was one approach that was suggested by participants in all of the focus groups. Cultural, attitudinal, economic, and legal problems were also discussed, but no commonly favored strategy emerged for dealing with those kinds of problems


The project team recommends that the Commission consider undertaking further discussions in the workers’ compensation community and further applied research to follow up on this study. These recommended activities are listed below and discussed more fully later in this report.

  1. Information About Roles and Responsibilities
    To help ameliorate some of the blame and distrust in the system and to improve our understanding of what can be expected of persons who provide important services to injured workers and employers, it is recommended that informational materials about these providers of services be developed. The materials would describe the providers’ roles and responsibilities, their training, how they are paid, and how they are regulated. The Commission could establish a cooperative, multipartite task force to assist in developing these materials.
  2. Respectful Attitudes Towards Injured Workers
    Previous research has documented the serious losses experienced by many injured workers and the disrespectful treatment they face in trying to navigate the workers’ compensation system. This study also shows that injured workers often face suspicion and negative stereotyping, which can hinder recovery. It is recommended that the Commission develop methods and plan activities to promote respectful treatment of injured workers. This could be accomplished in consultation with the task force described above.
  3. Model Practices of Treating Physicians, Employers, and Claims Administrators
    It is recommended that the Commission develop a set of model practices of treating physicians, employers, and claims administrators that are based on ethical “codes of conduct” and, where possible, evidence-based standards of care. As a starting point, the Commission could consider some of the “best practices” that were identified by participants in the focus groups. The Commission could develop the model programs in consultation with the task force described above. In addition, the Commission could establish and consult with an academic advisory body possessing expertise in the relevant fields of business, health, and law.
  4. Strategies To Overcome Problems in the System
    The focus group participants and members of the Project Advisory Committee have begun to identify possible strategies to overcome system-wide problems that prevent injured workers from returning to long-term, sustained employment. Education was one approach that was suggested by participants in all of the focus groups. In addition, some of the participants made recommendations to reduce delays in medical treatment and create incentives for employers to accommodate injured employees. It is recommended that the Commission hold follow-up meetings to evaluate the participants’ suggestions, identify feasible and desirable strategies, and plan specific activities to improve methods for helping injured workers return to sustained employment. Discussions could be held with the task force described above.