Reviewing a Client's Return-to-Work Policy: A Broker's Checklist

A client hands you their return to work policy at renewal and asks, "Is this any good?" You are not their employment lawyer and you should not rewrite it. But you can read it with a trained eye, spot what is missing, and send the right questions to the right people. That is a real service, and it is one most commercial accounts never get from their agent.

This checklist is built for that review. It walks through what a written policy usually contains, gives you section-by-section checklists you can use in the meeting, and ends with red flags that belong with employment counsel or the carrier. A sample review worksheet you can adapt is included near the end.

What a Written Return-to-Work Policy Usually Contains

Policies vary in length from one page to a full handbook chapter, but most solid ones cover the same ground:

• Purpose and scope. Who the policy covers (all employees, or work injuries only) and the employer's intent to return employees to work as soon as medically appropriate.
• Injury reporting. How and when employees report injuries, and who reports to the carrier.
• Roles and contacts. A named coordinator, plus the roles of supervisors, HR and the carrier.
• Modified duty. How offers are made, based on what restrictions, for how long, at what pay.
• Medical documentation. What the employer asks for, when, and how it is kept confidential.
• Coordination with leave and accommodation laws. How the policy works with the FMLA, the ADA and state leave laws.
• How often the employer stays in touch with an employee who is off work.
• A statement that the policy is applied the same way to similarly situated employees.

If a client's policy covers all eight, your review is mostly about details. If it covers two or three, your review is about connecting them with help.

Checklist: Reporting, Contacts, and Timelines

• [ ] Does the policy tell employees to report any work injury or illness promptly, and to whom?
• [ ] Does it say what happens with minor injuries (first aid only) so that they are still recorded?
• [ ] Is there a named coordinator, by title, with a backup?
• [ ] Does it say who reports the claim to the carrier, and how (phone, portal, agency)?
• [ ] Does it reference the carrier's and state's reporting requirements rather than an internal deadline that conflicts with them?
• [ ] Does it say how supervisors on other shifts or at other locations handle reports?
• [ ] Does it say how often the coordinator contacts an employee who is off work?
• [ ] Does it say who communicates with the adjuster, and who receives copies of work status notes?

What to listen for: a policy that says "report within 30 days" when the carrier wants claims within a day or two, or a policy with no named coordinator. State filing deadlines vary, so do not quote one; ask the client to confirm with the carrier and the state workers' comp agency.

Checklist: Modified-Duty Offers, Duration, and Pay

• [ ] Does the policy say the employer will try to offer temporary modified work within the treating provider's restrictions?
• [ ] Are offers made in writing, listing tasks, location, schedule, pay and start date?
• [ ] Do offers refer to the current restrictions and say the employee will not be asked to work outside them?
• [ ] Does the adjuster get a copy of each offer and the employee's response?
• [ ] Is there a maximum duration or a review interval for modified-duty assignments?
• [ ] Does the policy say how pay is set for modified duty (regular rate, the rate for the new tasks, or another rule)?
• [ ] Does it say what happens when restrictions change, and who updates the assignment?
• [ ] Does it say what happens if an employee declines an offer, without promising a benefit outcome?

What to listen for: "light duty is at the supervisor's discretion" (inconsistent treatment risk), open-ended assignments with no review, and language that tells employees their benefits will stop if they refuse. The effect of a refusal on benefits is set by state workers' comp law and decided by the adjuster, and for employees on FMLA leave, a declined light-duty offer does not end FMLA job protection, though it may affect comp wage benefits (29 CFR 825.220(d) and 825.702(d)(2)).

Checklist: Medical Restrictions, Fitness-for-Duty, and Confidentiality

• [ ] Does the policy rely on the treating provider's restrictions, not supervisor judgment?
• [ ] Does it say how restrictions get from the provider to the coordinator and the supervisor, sharing only what the supervisor needs to know?
• [ ] If the employer requires a fitness-for-duty certification before return from FMLA leave, does the policy say it is applied uniformly to similarly situated employees?
• [ ] Does the policy (and the employer's FMLA paperwork) reflect that the fitness-for-duty requirement must be stated in the FMLA designation notice?
• [ ] Is the FMLA fitness-for-duty certification limited to the particular health condition that caused the leave?
• [ ] Are other medical exams or inquiries of current employees limited to what is job-related and consistent with business necessity?
• [ ] Are medical records kept separate from personnel files and treated as confidential?

Background you should know. Under the FMLA regulations (29 CFR 825.312), an employer may require an employee returning from leave for their own serious health condition to provide a certification that they can resume work, but only as part of a uniformly applied policy, and only with regard to the particular health condition that caused the leave. The employer must give notice of the requirement with the designation notice. With that notice, the employer may delay restoration until the certification is provided; it may contact the provider to clarify the certification but may not delay the return to do so. The same section says the ADA still applies: any medical examination the employer requires after the employee returns must be job-related and consistent with business necessity. Under the ADA, medical information must be kept confidential and in separate files. You are not checking legal compliance, but these points tell you which questions to send to counsel.

Checklist: Coordination With FMLA, ADA, and State Leave Rules

• [ ] Does the policy say a work injury may also qualify for FMLA leave (for covered employers and eligible employees), and that FMLA and workers' comp leave can run concurrently?
• [ ] Does it route leave questions to HR or a named adviser?
• [ ] Does it say that when restrictions become permanent, the employer will consider reasonable accommodation under the ADA and state law, rather than ending employment automatically?
• [ ] Does it avoid blanket "100% healed" or "no restrictions" return requirements?
• [ ] Does it mention state leave or disability laws that may give employees more protection, where they apply?
• [ ] Does it say that a collective bargaining agreement or state law controls where it sets different return-to-work rules?

For refreshers on how these laws touch insurance work, see our articles on FMLA basics for insurance professionals and ADA compliance for insurance agents.

Red Flags to Refer to Employment Counsel or the Carrier

Some findings go straight to someone else. Refer these to the client's employment counsel or HR adviser:

• A "full duty only" or "100% healed" rule for returning employees
• Automatic termination after a set period of leave, with no accommodation review
• Fitness-for-duty demands that apply to some employees and not others
• Supervisors collecting or storing medical details
• Discipline for reporting an injury, or language that discourages reporting
• No mention of FMLA, ADA or state leave laws in a policy for a covered employer

Refer these to the carrier or adjuster:

• Statements about when benefits stop, start or change
• Offer-letter wording the policy treats as standard for the state
• Questions about whether a specific job fits a restriction
• Requests for nurse case management or risk control help building the program

Sample Review Worksheet (Adapt Before Use)

The worksheet below is a sample for agents and account managers. Adapt it to your agency's practices and the client's state. It is a review aid, not a legal compliance review; the client should have its policy reviewed by employment counsel or an HR adviser for its state.

Return-to-Work Policy Review Worksheet

Client: ____________ Date: ____________ Reviewer: ____________

Policy date / version: ____________ Locations covered: ____________

> 

1. Reporting procedure present and consistent with carrier instructions? Yes / No / Unclear. Notes:
2. Named coordinator and backup? Yes / No. Name/title:
3. Written modified-duty offers with copy to adjuster? Yes / No / Unclear
4. Duration or review interval for modified duty? Yes / No
5. Pay rule for modified duty stated? Yes / No
6. Restrictions come from the treating provider? Yes / No
7. Medical records confidential and separate? Yes / No / Unclear
8. FMLA, ADA and state leave coordination addressed? Yes / No / Unclear
9. Red flags found (list):
10. Referred to: Employment counsel / HR adviser / Carrier risk control / Adjuster
11. Follow-up date:

Leave a copy with the client and keep one in the account file. More resources are collected on our return-to-work programs page.

Build the Knowledge Behind the Checklist

A checklist tells you what to look for; training tells you why it matters. The Return-to-Work Training & Certification program covers FMLA return and restoration rights, modified duty and restrictions, fitness-for-duty documentation, ADA reasonable accommodation, consistent procedures and coordination with workers' comp and leave administration. It is online and self-paced with one year of access, and it is professional training, not state insurance CE. An optional exam leads to the Certified Return-to-Work Administrator designation.

Frequently Asked Questions

What should a return to work policy include?

A solid return-to-work policy usually covers purpose and scope, injury reporting, a named coordinator, how modified-duty offers are made and for how long, how pay is set for modified work, medical documentation and confidentiality, coordination with FMLA, ADA and state leave laws, communication with employees who are off work, and a commitment to consistent application. The employer should have it reviewed by employment counsel or an HR adviser for its state.

Can an insurance broker write a client's return-to-work policy?

A broker can share carrier templates, point out common elements and review a draft for gaps using a checklist. Writing the policy and confirming it complies with employment law is the employer's job, with its HR adviser or employment counsel. The policy touches the FMLA, the ADA and state laws, which are outside an agent's license and expertise.

Can an employer require a fitness-for-duty note before return to work?

Under the FMLA regulations, an employer may require a fitness-for-duty certification from an employee returning from leave for their own serious health condition if it is part of a uniformly applied policy, it is limited to the condition that caused the leave, and the requirement was stated in the designation notice. Under the ADA, any medical exam or inquiry of a current employee must be job-related and consistent with business necessity.

Is a "100% healed" return-to-work rule a problem?

It is a common red flag. A rule that bars any return until an employee has no restrictions can conflict with the ADA's reasonable accommodation obligations for employees with disabilities, and it can lengthen time off work on comp claims. An agent should not judge the legal risk but should refer the client to employment counsel or an HR adviser if the policy contains that kind of language.

Does a return-to-work policy need to address FMLA?

For employers covered by the FMLA, yes, it should at least acknowledge how the two interact. A work injury may also be a serious health condition, FMLA and workers' comp leave can run at the same time, and an employee on FMLA leave may decline light duty without losing FMLA job protection. The client's HR adviser should confirm how the policy handles these points.

How often should a client update its return-to-work policy?

Review it at least at renewal and whenever operations, locations or laws change. Leave and accommodation laws change at both the state and federal level, and new job tasks can create new modified-duty options. A renewal meeting is a natural time for the agent to ask when the policy was last reviewed and by whom.