Return-to-Work Programs: Modified Duty, Workers' Comp, and OSHA Recordkeeping Connections

The average workers’ compensation lost-time claim costs over $40,000 when you factor in medical, indemnity, and administrative costs, according to NCCI research. Most of that cost is driven by time away from work, not the medical treatment itself. A return-to-work program is how employers cut that number down.

RTW programs exist because of one uncomfortable truth: the longer a worker stays away from the job, the less likely they are to return. At 6 months off work, the return-to-work rate drops below 50 percent for most injury types. That’s not just a cost problem. It’s a human problem. Workers who stay connected to the workplace during recovery have better outcomes.

What a Return-to-Work Program Actually Is

A return-to-work program is a formal process for getting injured or ill workers back to productive employment as soon as it’s medically appropriate. The centerpiece of most RTW programs is modified duty, sometimes called transitional duty or light duty.

Modified duty means the worker comes back to work performing tasks that fall within the restrictions set by their treating physician. If a worker has a 10-pound lifting restriction after a back injury, modified duty puts them in a role that doesn’t require lifting more than 10 pounds. That’s the basic concept.

What separates an effective program from a weak one is preparation. Companies that scramble to find work for each injured employee on a case-by-case basis get inconsistent results. Companies with a written RTW policy, a defined bank of modified duty positions, and trained supervisors get injured workers back faster and at lower cost.

The goal isn’t to punish workers by putting them in unpleasant jobs. It’s to keep them connected to work, maintain their income, and reduce the total cost of the claim.

The OSHA Recordkeeping Connection

This is where RTW programs have a direct impact on your injury metrics, and most companies don’t fully grasp how it works.

Under 29 CFR 1904, OSHA requires employers to record work-related injuries and illnesses that meet certain severity thresholds. Two of the most important categories are lost workday cases and restricted work cases.

A lost workday case is recorded on the OSHA 300 log with a check in the “days away from work” column. A restricted work case, where the worker returns on modified duty, gets a check in the “restricted work activity” column instead. Both are recordable. But they’re not equal.

Your DART rate, which stands for Days Away, Restricted, or Transfer, counts both types. However, the number of days in each category is tracked separately. Lost workday cases drive your DART rate higher and faster than restricted work cases because the days away pile up quickly when a worker is sitting at home.

When you place an injured worker on modified duty instead of sending them home, you’re converting a potential lost-time case into a restricted work case. That directly reduces your DART rate. And your DART rate is one of the key inputs into your Experience Modification Rate (EMR), which determines what you pay for workers’ compensation insurance. Lower DART equals lower EMR equals lower premiums. The math is straightforward.

For more on how OSHA recordkeeping categories work and what counts toward your rates, see the OSHA 300 log recordkeeping guide.

Building a Modified Duty Job Bank

Don’t wait until someone gets hurt to figure out what modified duty looks like at your company. That approach wastes time and produces worse outcomes.

The right approach is to build a job bank ahead of time. A modified duty job bank is a written list of positions or tasks that can accommodate a range of physical restrictions. Each entry should include a description of the physical demands, the maximum weight requirements, the posture requirements (standing, sitting, walking), and any environmental considerations.

Common modified duty positions include:

• Filing, data entry, and document management
• Quality control inspection from a seated workstation
• Training other employees on safety topics or procedures
• Answering phones or handling customer service tasks
• Inventory counting or parts tracking (seated)
• Flagging or traffic control (for construction sites, where standing is acceptable)
• Light assembly work with no lifting requirements

The specific positions available depend on your industry and facility. A manufacturing plant has different options than a construction site. The point is to define them in advance, get them approved by your occupational health provider or company physician, and have them ready to assign.

When a worker comes back with restrictions from their doctor, your supervisor shouldn’t be starting from scratch. They should be pulling from the job bank and matching the worker’s restrictions to an available position.

Physician-Employer Communication

The treating physician controls the restrictions. That means your RTW program lives or dies on how well you communicate with the medical provider.

Send a job description of the worker’s regular job to every medical appointment. This sounds obvious, but most employers don’t do it. When the physician understands exactly what the job demands, they can write restrictions that are specific and workable. Vague restrictions like “no heavy lifting” are less useful than “no lifting over 20 pounds, no overhead reaching, seated work preferred.”

If the physician doesn’t know what modified duty positions you have available, they can’t tell you whether the worker can do them. Some employers include a one-page list of available modified duty options with the job description packet. That gives the physician something concrete to approve or reject.

When restrictions change at each follow-up appointment, you need that information fast. Delayed communication between the physician’s office and the supervisor means the worker sits home an extra day or two waiting for paperwork. Build a process for getting updated restriction forms to the supervisor the same day they’re issued.

An occupational health nurse on staff or on retainer is the single most effective way to manage this communication flow. They know how to read restrictions, how to talk to physicians, and how to match workers to appropriate tasks. In companies with 200 or more employees, a full-time OHN typically pays for itself through reduced claim costs.

RTW Timelines and Defined Endpoints

Modified duty is meant to be temporary. Set a maximum duration in your written RTW policy.

Most programs use 30, 60, or 90 days as the modified duty maximum. The right number depends on your typical injury types. For a soft tissue injury at a light manufacturing facility, 30 days is often enough. For more serious injuries that require surgical intervention, 90 days may be more realistic.

The defined endpoint forces a decision. When the modified duty period ends, one of three things should happen. The worker is cleared to return to full duty. The worker is reassigned permanently to a different role if full duty isn’t possible. Or the case escalates to the workers’ comp carrier for a formal evaluation of long-term disability.

Without a defined endpoint, modified duty cases drift. Workers stay in modified duty roles for 6 months when they should have been cleared at 8 weeks or escalated at 12. That’s not good for the worker and it’s not good for the employer.

When Workers Refuse Modified Duty

Some workers refuse modified duty. The right response depends on why they’re refusing and whether the offer was legitimate.

If the worker refuses because the modified duty offer isn’t actually within their restrictions, that’s an employer problem, not a worker problem. Make sure the position genuinely matches the physician-issued restrictions before offering it.

If the worker refuses a legitimate offer, the workers’ comp carrier needs to know immediately. In most states, an injured worker who refuses bona fide modified duty that falls within their medical restrictions may lose their temporary total disability (TTD) benefits, because they’re no longer unable to earn wages. The specific rules vary by state workers’ comp statute.

From an OSHA recordkeeping standpoint, if you offer modified duty and the worker refuses, the case doesn’t automatically become a lost workday case. Document the offer in writing, including the date, the position offered, the restrictions it meets, and the worker’s response. That documentation protects the employer if the case is ever audited or disputed.

For more on how injury investigations connect to your workers’ comp and recordkeeping outcomes, see the incident investigation guide.

What RTW Program Documentation Must Include

Your written RTW program should have at least these components:

• A policy statement committing the employer to modified duty for injured workers
• The process for notifying the supervisor and HR when an injury occurs
• The physician communication procedure, including what to send to every appointment
• The modified duty job bank with physical demand descriptions
• The maximum modified duty duration and what happens when it expires
• The process for documenting offers of modified duty and worker responses
• Roles and responsibilities for supervisors, HR, the occupational health team, and the workers’ comp carrier contact

Most third-party workers’ comp insurers will review your written RTW program during underwriting. A well-documented program can support a lower EMR modifier. A program that exists only in practice and not on paper offers no underwriting credit.

For context on how workers’ comp and safety programs connect financially, see the workers’ comp and safety connection guide.

The bottom line: modified duty is the single most effective short-term lever you have to control your DART rate and your workers’ comp costs. Build the job bank before someone gets hurt. Train your supervisors on the process. Document every offer and every response.