In this keynote to the Ohio Bureau of Workers' Compensation, Margaret Spence reflects on the state’s unique incentives that encourage employers to return injured workers to duty. She recounts how a visionary district leader tasked her with creating a return‑to‑work (RTW) program despite expected resistance. Spence describes specific challenges—such as bus drivers who lose summer pay and physicians who were never asked about an employee’s functional capacity—and how the district instituted policies that paid the first 30 days of disability, held doctors accountable for functional recommendations, and emphasized employee ability. Central to her message is the need to cultivate a "tribe of believers"—a culture where accountability, ability, and shared purpose drive successful RTW outcomes, keeping workers productive and engaged.
Chapters
Thank you so much for inviting me to Ohio. Thank you to the BWC. Sometimes when you're in the throes of workers' comp, you're not always getting recognition for what you're doing, and sometimes we don't pat ourselves on the back enough, and we don't say, you know, we're really doing a great job. I came to realize that you are actually on the cutting edge of a lot of things. You're one of the few states that incentivizes employers to bring injured workers back to work. That's unique. I want to tell you a little bit of a story, and I'm always talking stories, and I want to give you a sense of how I arrived at the return-to-work table, um, what brought me here, and an experience that I had earlier this year that also— that all confirmed a lot of my feeling. Several of those claims were open longer than I had been born. And for me, I was like, are you kidding me? I can't believe that this is a reality. But I had a boss who was a visionary, and she said to me one morning, Margaret, we are going to create a return to work program here at the district. And people are not gonna like us. In fact, they're going to hate us. So I want you to get comfortable with people not liking you. One of the challenges that we had at the district was bus drivers. Because they didn't get paid in the summertime, they got injured in January. We had a policy where we automatically paid the first 30 days of the injured worker being off work. The other challenge that we had was the physicians that we— that treated our injured workers were given a pass. We never challenged those doctors to say, "What can the employee do?" And we never, ever, ever focused on the employee's ability. We created a system of accountability and we created a system of ability. But one of the things that I know also is that it doesn't happen unless you create a tribe of believers. And so my concept, my perception has changed. I want to tell you that we have a system that doesn't always work for the injured worker. So today what I want to present to you is the side of making it work. How do we build a tribe of people who make return to work the best thing that we can accomplish, that the end result is keeping employees feeling productive, keeping them feeling that they can contribute to their success, and continuing them to work.
