Purpose <p>To determine the effect of implementing a care pathway on return-to-work (RTW) levels and identify prognostic factors among workers filing their first shoulder injury claim.</p> Methods <p>This retrospective cohort study included 5075 workers with a first claim for shoulder injury: 2593 workers (2004–2008) received standard of care consultations, while 2482 workers (2014–2018) underwent specialized shoulder assessments through a care pathway that also included collaborative planning for RTW. Multinomial logistic regression determined the effect of implementing a care pathway on RTW levels and identified demographics, injury, occupational and program factors associated with RTW.</p> Results <p>The most common injuries were traumatic (92.4%) and sprains/strains (64%). Median claim duration was 114&#xa0;days (IQR = 140), with 80.6% receiving wage replacement benefits. The care pathway cohort was younger with shorter claim duration than the pre-care pathway cohort. They had 1.8 times (95% confidence interval (CI) 1.4; 2.3) greater risk of returning to modified duties than the pre-care pathway cohort. Days receiving wage replacement benefits 12-month post-claim closure were similar between cohorts (<i>p</i> = 0.8). RTW outcomes were impacted by demographics, injury, occupational, and program factors, with interpreter use, prolonged claims, poor compliance, and delayed treatment most strongly associated with failure to RTW at pre-accident levels.</p> Conclusions <p>The findings demonstrate that the care pathway cohort was associated with quicker return to modified duties without compromising long-term RTW outcome. This underscores the importance of proactive intervention strategies like care pathways in optimizing workplace rehabilitation outcomes and minimizing long-term disability.</p> <p><i>Clinical Trial Number</i> Not applicable.</p>