Occupational-Injury Claims and Return-to-Work Director

The mandate

Injured workers move between site reporting, clinics, insurers, claims administrators, supervisors and union representatives, but no owner manages the full path. Incident reports and claim files use different causes, modified duties are offered without consistent demand analysis and work restrictions reach supervisors late or with too much clinical detail. Repeat injury and delayed return are rising while leaders debate whether claims are medical, operational or behavioural problems. The group needs governance centred on safe recovery rather than claim closure alone.

The deliverables are an injury-and-claim taxonomy, worker journey, role and data boundary map, modified-work standard, provider accountability model, recurrence analysis, control library and implementation roadmap. The design must cover notification, urgent treatment, claim filing, wage replacement, clinical restrictions, rehabilitation, suitable duties, travel to remote sites, recurrence, dispute, appeal and durable return. Diagnosis, causation and benefit entitlement remain with authorised clinicians, insurers and statutory bodies.

Four milestones govern five months: week four accepts populations, jurisdictions and clinical-data protocol; week ten completes pathway and outcome diagnostics; week sixteen accepts target claim and modified-work controls; and week twenty-two delivers simulation evidence, provider remedies, training and rollout sequencing. Billing follows those milestones, and live serious cases remain with existing clinical and statutory decision-makers.

Acceptance requires safety, claims and people owners to reproduce representative worker journeys; supervisors must select safe duties using functional restrictions without receiving diagnosis; insurers and clinics must evidence handoffs and closure; and two simulations must test remote-site recurrence plus disputed capacity. The sponsor will return one combined exception register within seven working days, identifying clinical, legal, system and operational dependencies separately.

The client provides de-identified incident and claim records, restrictions, absence, modified-work offers, recurrence data, provider contracts, insurer correspondence, collective arrangements, counsel guidance and controlled workflow access. The consultant does not diagnose, determine causation or benefit, direct treatment, decide appeals, access unnecessary clinical notes, investigate employee conduct, or certify statutory compliance.

Why this is external work

Safety teams investigate events, clinicians manage health, insurers decide claims and sites need productive work, but the employee experiences one fragmented process. Existing providers measure their own closure rather than safe, sustained return. External claims-governance expertise can reconnect responsibility and evidence without making medical or statutory determinations.

What you will own

• Map the worker journey from incident and urgent care through claim, restriction, rehabilitation, modified work and durable return.
• Classify delay and recurrence by notification, provider, insurer, site, duty design, communication, dispute and travel constraint.
• Define minimum-necessary restriction information, protected data routes, consent boundaries and supervisor accountability.
• Establish modified-work analysis covering functional demand, shift, location, supervision, duration, review and worker voice.
• Set provider standards for referral, report timing, handoff, escalation, dispute support, continuity and closure evidence.
• Run remote-site and disputed-capacity simulations, recording unsafe assumptions, decision gaps and unresolved specialist dependencies.
• Deliver controls, indicators, training, provider remedies, system requirements and phased adoption across sites.

Candidate qualifications

• Has redesigned occupational-injury claims and return-to-work operations in mining, energy, construction or heavy industry.
• Understands incident notification, workers compensation, restrictions, rehabilitation, modified duties, disputes and recurrence.
• Can protect clinical privacy while giving supervisors sufficient functional information for safe work design.
• Has challenged insurers and clinical providers using worker-pathway evidence rather than claim closure rates alone.
• Brings credible collaboration with safety, occupational health, unions, site operations, privacy, legal and claims teams.
• Is independent of claims administration, rehabilitation referrals, insurance placement and clinical-provider sales.

Non-negotiables

• Can work onsite in Vancouver, rotate monthly through sites and participate in both return-to-work simulations.
• Brings direct injury-claims governance; generic absence management or safety investigation experience is insufficient.
• Will not diagnose, decide entitlement, reveal unnecessary clinical information or pressure unsafe return.
• Will disclose ties to insurers, clinics, rehabilitation firms, unions, claims administrators and mining contractors.

1. 49 words maximum. Which functional detail belongs in a supervisor’s modified-work instruction without revealing diagnosis?
2. 49 words maximum. How would you distinguish claim closure from durable return to work?
3. 49 words maximum. What recurrence pattern would trigger a site-control review rather than another individual intervention?