There are numerous reasons why a patient does not return to alternate/light duty employment:
a. Does the patient believe that they are being incompletely or misdiagnosed and that they are being sent back to work by someone incompetent to know what is truly wrong with them?
b. Does the patient believe that returning to any form of work run the risk of re-injury?
c. Does the patient believe that returning to any form of work will reduce the amount of their cash settlement?
d. Is the patient angered at the employer (and/or coworkers) and feel that not returning to work will punish the employer?
e. Does this light duty work place the patient in a position where they fear they will be resented and ridiculed by harder working coworkers?
f. Will the employer truly comply with the work restrictions or slowly force the patient to engage in tasks that exceed objective limitations?
g. Is the prescribed medication resulting in adverse side effects which make any day time activities physically uncomfortable (sedation, GI upset, etc)
Light duty alternate work may correspond with the treating physicians recommendations, but only the patient knows the real reason/fears/expectancies that underlie the refusal to return. You need to find out what factors are leading to the patient_s decision not to comply.