Work disability is now conceptualized as a function of organizational, jurisdictional and social influences, rather than as primarily medically determined. Return-to-work (RTW) interventions are no longer restricted to clinic-based medical interventions: insurers have become involved through case managers; employers have realized that organizational policies impact RTW outcomes; and providers have become interested in expanding their involvement to achieve better outcomes. There is growing consensus that while attending to the physical/medical aspects of the work disabled employee is important, much of the variability in RTW outcomes is accounted for by what takes place at the workplace. There is increasing evidence of greater effectiveness ofworkplace-based interventions as opposed to interventions provided outside the workplace. Organizational factors are also known to have significant impact on work disability costs. To reduce insurance or disability costs and ensure compliance with a growing number of government regulations concerning workplace safety and disability, employers have been increasingly interested in improving their disability management practices.

This study analyzes the RTW stakeholder interests and suggests that friction is inevitable; however, it is possible to encourage stakeholders to tolerate paradigm dissonance while engaging in collaborative problem solving to meet common goals. We review how specific aspects of RTW interventions can be instrumental in resolving conflicts arising from differing paradigms: calibration of stakeholders’ involvement, the role of supervisors and of insurance case managers, and procedural aspects of RTW interventions.