The NCSL Blog


By Kristine Goodwin

For the millions of U.S. workers experiencing an injury, illness or change in disability status every year, a rapid and supportive return to work is key to staying connected to the workforce.

Graph on post-injury return to workWhile the likelihood of returning to work is very high for workers experiencing a brief absence, the chances of returning to full employment drops significantly as time goes on (see graph).

Recognizing the potentially adverse impacts to workers, families and employers, state policymakers have adopted numerous policies to strengthen employee ties to their work and the labor force.

Between 2017-19, more than half of states (26) enacted what’s known as Stay-at-Work/Return-to-Work policies, according to NCSL’s June 2020 Work Matters: Making Progress in Employment for People with Disabilities report. Such policies support workers experiencing disability at any stage of their careers or those adjusting to changes in disability throughout their lives.

Benefits of Worker Retention

According to the National Safety Council, at least 4.6 million American workers are injured on the job every year. Keeping employees on the job, if possible, benefits not only the workers and their families, but also their employers, communities and state governments.

Staying connected to the workforce has a positive effect on individual and family health and well-being, quality of life and standard of living. Employers benefit from retaining valued workers and spending less on hiring, training, and workers compensation benefits and private disability insurance premiums. 

In addition to helping workers and their families retain economic self-sufficiency and quality of life, state governments benefit from increased tax revenues from wage earners and lowered expenditures for public programs that often take over to replace lost wages and benefits. Without employment, many individuals exhaust temporary cash benefits from workers’ compensation or short- and long-term disability insurance and turn to federal income-based support programs like Medicaid, the Supplemental Nutrition Assistance Program, Social Security Disability Insurance (SSDI), and the Supplemental Security Income program. 

By retaining, rather than replacing, a worker following the onset of long-term disability, state governments save about $83,000 in net benefits, according to researchers at Mathematic Policy Research.

State Actions to Support Workers’ Return to Employment

Recognizing what’s at stake, state policymakers have adopted numerous policies to foster retention and strengthen a worker’s ties to their work and to the labor force. Through the 35 bills enacted between 2017-19, NCSL found that states addressed a range of issues, including the use of vocational rehabilitation services, paid leave, the creation of Achieving a Better Life Experience (ABLE) accounts, workers’ compensation, and return-to-work programs.

For example, in 2017 California lawmakers enacted SB 731 which expanded access to paid medical leave for veterans with service-connected disabilities. By enhancing access to paid medical leave, such policies allow service members to maintain employment while avoiding a loss in wages as they seek care.

Several state governments have implemented Stay-at-Work/Return-to-Work programs or policies for state employees, a strategy recommended in a 2017 report issued by the National Task Force on Workforce Development for People with Disabilities.

Grounded in research showing the benefits of early intervention, many states intervene early with their own employees through the administration of health insurance, disability insurance and other benefits such as employee assistance programs. For example, Delaware enacted legislation establishing a return-to-work program for its state employees and appointed a return-to-work coordinator tasked with helping state workers stay at work or return to work after injury or illness.

According to the 2017 Work Matters report, three states—North Dakota, Ohio and Washington—with exclusive state workers’ compensation funds have implemented promising job-retention initiatives for workers with work-related conditions. Washington created regional Centers of Occupational Health and Education (COHE) to advise and train health care professionals in treating and rehabilitating injured workers. The centers’ mission is to ensure all stakeholders—injured workers, employers, health care professionals and others—are focused on helping injured workers return to work as quickly as possible.

Through early intervention and coordinated care, COHE has lowered medical costs and reduced the number of injured workers moving onto SSDI benefits by 26%. Washington’s approach has proven particularly effective in treating lower back and neck pain and other musculoskeletal disorders—conditions that account for roughly two-thirds of all years lived with a disability nationally.

For more information and examples about how states are fostering employee retention, see NCSL’s new Work Matters report and disability employment database.

This piece is part of NCSL’s yearlong celebration of ADA30, and ongoing partnership with the U.S. Department of Labor Office of Disability Employment Policy’s State Exchange on Employment & Disability (SEED). SEED partners with intermediary organizations like NCSL to ensure that state and local policymakers have the tools and resources they need to develop and disseminate meaningful policies related to disability-inclusive workforce development.

Kristine Goodwin is a program director in NCSL's Employment, Labor and Retirement Program.

Email contact: Josh Cunningham

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.