Each year, millions of U.S. workers, many with long job tenures, experience the onset of or a change in a medical condition that challenges their ability to work. Many of these workers are at risk of leaving the labor force, especially if they do not receive timely and effective stay-at-work/return-to-work supports. Staying connected to the workforce has a positive effect on individual and family health and well-being, quality of life and standard of living. Conversely, when workers exit the labor force, federal and state tax revenues are lost, and public programs such as state workers’ compensation programs, Social Security Disability Insurance, Supplemental Security Income, Medicare and Medicaid often foot the bill in terms of income support and health care services.


Click on the map above to see the corresponding policies.


SB 1079

H 1404

S 218

SB 188

H 7032
SB 164

H 145

H 41

HB 2837
SB 1449

HB 204

H 448
HB 680

HB 288

AB 128

New Jersey
SB 844

New York
A 7473

North Dakota
SB 2124

S 1027
HB 2211

HB 2234

According to research conducted or reviewed by the U.S. Department of Labor Office of Disability Employment Policy (ODEP) Stay-at-Work/Return-to-Work Collaborative, the following positive outcomes are achievable when workers are able to stay in the labor force or return to work after experiencing illness or injury:

      • Workers are able to continue earning money and enjoy the self-esteem and other advantages that come from employment
      • Employers can benefit from the experience of long-tenured workers, less money and time spent on hiring new workers and less spent on workers’ compensation benefits and premiums for private disability insurance
      • State Governments and the Federal Government can benefit by helping workers and their families retain economic self-sufficiency and quality of life, expanding state economies and fiscal health by increasing tax revenues from wage earners and lowering liabilities for state and federal social welfare and social security programs

In addition to Stay-at-Work/Return-to-Work policies, states are recognizing the importance of helping businesses and individuals with disabilities navigate the complexities of federal and state benefit programs by adopting benefits counseling, adopting earned income tax credits and allowing tax deductions for Achieving a Better Life Experience or ABLE Accounts (tax-advantaged savings accounts for individuals with disabilities).

The 2016 report Work Matters: A Framework for States on Workforce Development for People with Disabilities identifies strategies that many states are adopting to implement stay-at-work/return-to-work policies, benefits counseling and ABLE account policies and practices. In December 2018, CSG published the Stay-at-Work/Return-to-Work Toolkit, which provides additional background information, state examples of policy options and best, promising and emerging practices.


The federal Rehabilitation Act of 1973 and subsequent updates allow state vocational rehabilitation (VR) agencies to provide job retention (maintenance) services to individuals with disabilities as documented in the state VR plan, even if they are not among the priority groups eligible for services. Services include vocational counseling, specialized assessments, on-site job assessment, identification of accommodations, modifications to work environment, job analysis to identify specific functions of a job, individual employee training regarding use of technology, communication with employees and employer about modified work schedules and transitional work options. Learn More in the Work Matters Framework


Alabama and Arkansas, for example, expanded the provision of retention (maintenance) services for workers with medical conditions by state VR agencies. In 2018, Virginia enacted SB 560, which requires the Department for Aging and Rehabilitative Services to administer Long Term Employment Support Services and Extended Employment Services to assist individuals with disabilities with maintaining employment.

West Virginia


Some states, including Delaware, Maryland and West Virginia are recognizing that work disabilities may develop and intervene early through stay-at-work/return-to-work programs for their own employees. For example, West Virginia provides state agency employees with an opportunity to continue as valued members of their respective teams while recovering from an injury or illness. The opportunity may include gradually returning employees to their pre-injury job utilizing transitional duty work during the recovery period, when medically approved.


A second stay-at-work/return-to-work approach is the provision of private sector employer incentive and grant programs that include wage subsides for returning employees, subsidies and incentives for accommodations, insurance premium discounts and grants for transitional work programs. Washington is a leader in this respect. Learn More in the Work Matters Framework


Profile of State of Washington

Stay-at-work/return-to-work programs succeed by returning injured and ill workers to productive work as soon as medically possible during their recovery process and often provide interim transition work and accommodations as necessary. Washington state offers an example of a stay-at-work/return-to-work program that recognizes the roles of different stakeholders in a workers’ compensation system. The stay-at-work/return-to-work approach includes:

      • Centers of Occupational Health and Education
      • Early Return-to-Work and Vocational Recovery
      • Stay-at-Work Program (incentives for the employer of injury)
      • Preferred Worker Program (incentives for any hiring employer)

These programs operate within the state workers’ compensation system and are available only to individuals experiencing work-related injuries or illnesses. However, they offer models for how to improve  stay-at-work/return-to-work outcomes for individuals with both occupational and non-occupational injuries and illnesses. Learn more in the Work Matters Framework

Core intervention strategies reflected in these programs include:

      • Health Services Coordinators coordinating health service delivery and assisting employers and workers to support the employee in returning to or staying at work
      • Training participating healthcare providers in best practices for occupational health, including alternatives to opioids for pain management
      • Incentivizing participating healthcare providers to use best practices
      • Communicating early with all stakeholders to return the worker to the workplace as soon as possible
      • Engaging and activating injured workers to achieve return-to-work outcomes
      • Developing and testing best practices for vocational professionals to reduce work disability
      • Workplace-based interventions (including accommodations such as lighter and/or modified duties, as well as adjustments to work schedules, tasks and the physical worksite, if necessary, including transitional work)
      • Providing risk management consultation for employers to understand the financial benefits of return-to-work
      • Retraining/rehabilitation for workers who can no longer perform their prior job or other available suitable alternate work
      • Tracking and monitoring the medical and employment progress of participating workers

Centers of Occupational Health and Education

 The Washington State Department of Labor and Industries funds the Centers of Occupational Health and Education(COHE), which provide guidance for medical providers to apply occupational health best practices for individuals with work-related health conditions. There are six centers across the State of Washington, most of them housed in large medical systems. Each center recruits and trains healthcare providers in its area. Some treat large numbers of workers’ compensation patients. COHE began as a small pilot in two regions and has grown to include about 3,500 healthcare providers who initiate more than half of all workers’ compensation claims for Washington’s state fund. Injured workers effectively choose whether to use COHE services by receiving their care from a center-affiliated provider.

Healthcare providers affiliated with COHE receive training in four specific occupational health best practices to use with workers’ compensation patients who are at risk of labor force separation due to their illness or injury. Best practices include:

      • Submitting timely and complete forms for initiation of a claim and a complete report of accident in two business days or less
      • Developing an activity plan, which communicates the worker’s ability to participate in work activities, activity restrictions and the provider’s treatment plans
      • Communicating directly with  center staff and employers when injured workers are off, are expected to be off work or have restrictions
      • Assessing the injured worker’s barriers to return-to-work and partnering on a plan to overcome them with the Washington State Department of Labor & Industries’ claim managers and others

Health Service Coordinators are integral to the success of the Centers of Occupational Health & Education model. Coordinators work directly with injured workers, employers, healthcare providers and other program participants to coordinate care for injured workers. They monitor real-time data on all center cases and identify cases that are at risk of long-term disability. For cases needing assistance, they frequently contact injured workers, employers, providers and workers’ compensation agency staff to facilitate additional resources needed to support the  return-to-work process

Stay-at-Work Program

Washington’s Stay-at-Work Program is a financial incentive program modeled after Oregon’s programs, which encourage employers to bring their injured workers back to light-duty or transitional work quickly and safely. These programs reimburse a portion of the employer’s expenses. Eligible employers may be reimbursed for 50 percent of the base wages paid to the injured worker and may be reimbursed for some of the cost of training, tools, or clothing the worker needs to do the light-duty or transitional work.

The Stay-at-Work Program covers 50% of the injured worker’s base wages for the light-duty or transitional work for up to $10,000 and 66 days in which work was actually performed (fewer than eight hours still counts as one day). This applies per claim within a consecutive 24-month period.

The program also covers some expenses. If the employer must make a purchase so the worker can perform the light-duty or transitional work, the Stay-at-Work Program may pay for training fees or materials up to $1,000 per claim, tools up to $2,500 per claim and clothing up to $400 per claim.

Preferred Worker Program

The Preferred Worker Program is another return-to-work incentive program administered by the Washington State Department of Labor and Industries Department staff may certify a worker with permanent medical restrictions that are barriers to employment as a “preferred worker.” This certification enables any employer to receive financial incentives when they hire the worker for a medically-approved, long-term job.

The employer may receive:

      • Financial protection against subsequent claims
      • Premium relief
      • Incentive payment for continuous employment, and reimbursements similar to the Stay-at-Work Program for 50% of the base wages paid to the preferred worker and some of the cost of tools, clothing and equipment the worker needs to do the job

In addition to reimbursements for tools/equipment under the Stay-at-Work and Preferred Worker Programs, employers can be reimbursed for the cost of modifying a job to address an injured worker’s restrictions.

Other state examples include:

North Dakota
Rhode Island


A third  stay-at-work/return-to-work approach is to encourage workers to take advantage of partial return-to-work opportunities by implementing trial periods to minimize employees’ risk of losing workers’ compensation benefits. States that have taken this approach include Maine, North Dakota and Rhode Island. For example, Rhode Island’s Temporary Disability Insurance program includes a partial return-to-work plan that provides benefits to encourage workers to return to their jobs sooner than they might have otherwise. Learn more in the Work Matters Framework

North Dakota


Wellness and injury prevention programs are another policy option for states. Several state Workers’ Compensation programs include incentives to encourage employers to adopt workplace safety programs and illness and injury prevention programs. Incentives include allowing premium adjustments, prospective credits, or premium discounts. Colorado, Massachusetts and North Dakota all have examples of state incentive policies. Learn more in the Work Matters Framework

North Dakota

North Dakota Workforce Safety & Insurance , for example, offers the following Safety Incentive Programs: Safety Management Program  and Safety Action Menu.  The  Safety Management Program assists employers in developing or improving current safety management systems. Employers who successfully participate in the program can receive a premium discount of 10 percent. The  Safety Action Menu program provides employers with options that allow them to choose and implement safety improvement programs that meet their business needs. Employers can receive up to a 15 percent premium discount by successfully participating in the  menu programs. Each individual  Safety Action Menu program can provide a 5 percent discount up to a maximum of 15 percent. Employers are encouraged to enroll in both the  Safety Management Program and  Safety Action Menu as the discounts of each program can be combined in the same premium period for a maximum discount of 25 percent. Note that employers who wish to enroll in  either program must submit an application before the beginning of their premium period.

The  Safety Management Program assists employers in developing or improving current safety management systems. Employers who successfully participate in the program can receive a premium discount of 10%.

The  Safety Action Menu program provides employers with options that allow them to choose and implement safety improvement programs that meet their business needs. Employers can receive up to a 15% premium discount by successfully participating in the menu programs. Each individual Safety Action Menu program can provide a 5% discount up to a maximum of 15%.

Employers are encouraged to enroll in both the Safety Management Program and Safety Action Menu, as the discounts of each program can be combined in the same premium period for a maximum discount of 25%. Note that employers who wish to enroll in either program must submit an application before the beginning of their premium period.

The Risk Management Workers Compensation Program Premium Reduction Program has been designed to reflect loss control practices that reduce the state’s exposure to work injuries. The program focuses on adopting practices that justify discounts by reducing the frequency and severity of worker compensation claims involving state employees.


State agencies around the country have developed policy guides that describe best practices for designing, implementing and evaluating  stay-at-work/return-to-work programs. These state agencies also provide outreach, education and technical assistance to employers and other stakeholders. Learn more in the Work Matters Framework

Below are links to guides developed by a sampling of states:

State policymakers can enhance their working knowledge of best practices by reviewing these guides. Below is a summary of some of the best practices identified in the guides.
      1. Ensure commitment from top management.
      2. Develop a written policy and procedure for returning injured workers to the workplace. This information should be part of the employer’s new employee orientation, so all employees know what to do if an injury occurs.
      3. Designate a return-to-work lead and implementation team. Ideally, this person would accompany an injured worker to the initial doctor’s visit and support the injured worker through the return-to-work process.
      4. Establish stay-at-work/return-to-work committees responsible for developing individual stay-at-work/return-to-work plans.
      5. Train supervisors and managers on the stay-at-work/return-to-work process.
      6. Inform employees of their rights and responsibilities in the process and provide relevant training, making sure employees know how stay-at-work/return-to-work benefits them.
      7. Establish a strong safety program (prevention).
      8. Write job descriptions for all positions, including specific delineation of essential and nonessential functions.
      9. Research and evaluate possible accommodations. For example, select a reasonable accommodation that would allow an employee to stay at his or her original job or reassign the employee to a vacant position in a job the employee is qualified to perform and provide reasonable accommodations, if needed.
      10. Develop transitional return-to-work opportunities, routinely assess stay-at-work/return-to-work assignments and make adjustments to conform to the inured worker’s abilities, as medically released.
      11. Be prepared to act quickly if an injury occurs.
      12. Report injuries to the return-to-work lead in a timely fashion.
      13. Provide union representatives with information about the purposes of the stay-at-work/return-to-work program and, where appropriate, include the union in the development and implementation of the program.
      14. Implement and monitor the accommodations program.
      15. Clearly define the roles and responsibilities of all stakeholders.


States may want to consider helping businesses and individuals with disabilities navigate the complexities of benefits. Learn more in the Work Matters Framework

Note: The federal Work Incentives Planning and Assistance grants provide states with resources that enable people with disabilities to know their options for maintaining SSI and SSDI benefits while working. The Social Security Administration has awarded 95 cooperative agreements throughout every state, the District of Columbia and the U.S. territories of American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the Virgin Islands.

Examples in action

Some states, including Arizona, Ohio, Oregon, Texas, Virginia and Wisconsin provide a state funding source (vocational rehabilitation agency or general fund) to expand benefits and counseling to include individuals who currently are not on the SSI or SSDI rolls but are considering whether to apply for benefits or receive employment-related services and supports and choose to work. Other states use vocational rehabilitation funds to pay for benefits counselors.


States may want to explore opportunities to supplement existing financial incentives to target disability employment supports.

Suggested Strategies:

      1. Adopt a state earned income tax credit to increase income supports for low-income workers with disabilities.
      2. Adapt state earned income tax credits to reduce the age from 25 to 18 and enhance the credit for single filers who are Social Security beneficiaries with disabilities.
      3. Allow tax deductions for a percentage of contributions to state ABLE accounts.

Examples in action

ABLE National Resource Center provides a comprehensive source of information about state-related ABLE programs and activities.

The Council of State Governments Stay-At-Work/ Return-to-Work Webinar was held on Friday February 15th, 2019 from 10am-11am. The webinar focused on  how policy makers can use the CSG SAW/RTW Toolkit as a resource to initiate the development of state policy frameworks aimed at assisting workers in transitioning back to or staying at work following disability or injury incurred on the job. The panelists included Dr. Chris McLaren from the Department of Labor’s Office of Disability Employment Policy, Senator Becky Massey from Tennessee, Maryland’s Delegate Sheree Sample-Hughes, Beth Kuhn from the Kentucky Cabinet for Health and Family Services, and Mr. Bobby Silverstein of Powers, Pyles, Sutter & Verville.