Despite overwhelming evidence that injury management practices in the NSW Workers Compensation lead to poor outcomes, the O’Farrell Government decided to attack injured workers benefits and entitlements rather than fix the system. According to The Royal Australasian College of Physicians there is good evidence to suggest that people who are injured at work and claim compensation for that injury have poorer health outcomes than people who suffer similar injuries but are not involved in the compensation process. Its seems obvious from their research report that the system design is hazardous to the health of those unfortunate to be injured at work..
It also seems that under the new laws ( refer New caps on benefits trigger cuts to workers’ comp payments), rather than receive appropriate care and treatment injured workers continue to be routinely dismissed as fradulent malingerers and viewed as a problem to be disposed of. Interestingly WorkCover NSW were stakeholders in this research project.
Summary of causes of poorer health outcomes
There are a number of potential causes. Below are listed the factors which may contribute to poorer health outcomes.
The factors that are fully or partly implicated in the literature are:
◆ The psychosocial environment of the injured person at the time of injury (for example, low job satisfaction, poor social networks, lack of purposeful use of time). This includes societal attitudes towards injury and compensation
◆ The psychosocial environment of the injured person after the time of injury (for example, a workplace not prepared to adapt to a return to work program, family members unsupportive of rehabilitation programs)
◆ The psychological vulnerability of the injured person (this will be affected by pain and by psychosocial factors)
◆ The initial response to claimants by insurers (for example, acting as though claimants are automatically assumed to be fraudulent, thus pushing them into a defensive ‘I’ll show them I’m really sick’ attitude)
◆ The management of initial treatment (for example, in non-specific musculo-skeletal injuries, not identifying psychosocial risk factors [‘yellow flags’], not encouraging resumption of normal behaviours as far as possible, not encouraging return to work or normal activities, etc.)
◆ The handling of case management by insurers (for example, not developing appropriate return to work programs nor monitoring these, not providing claimants with good information about the effects of long term sick leave, etc.)
◆ The handling of case management by treating doctors, including specialists (for example, not reviewing treatment by service providers and continuing treatment which is not helping, providing unnecessary treatment, not giving early referral to pain management programs, not addressing psychological problems such as depression, etc.)
◆ The number and type of medical examinations required by the insurers and by the claimant’s lawyers. The effect of these appears to be twofold: to entrench illness behaviours and to prejudice the claimant further against the insurance company.
◆ The length of time away from work. Unemployment is, in itself, a risk factor for poor health. There are multiple and interrelating effects of being away from work, including loss of sense of identity, loss of social networks, loss of economic control and independence,
loss of social status, loss of financial security (such as loss of the family home), and so on. Long-term unemployment is notoriously hard to break. (Where unemployment is caused by injury, this is exacerbated by employer’s reluctance to employ anyone with pre-existing injuries because of risk to workers’ compensation premiums and the perceived risk of re-injury.)
The factors that have been identified through interviews or discussions with stakeholders but have not been formally tested are:
◆ The adversarial system of managing compensation cases, which encourages parties to take up fixed opposing positions and creates a
climate where getting a result in the court case becomes the goal of both parties, rather than fully rehabilitating the injured person
◆ Encouragement from some plaintiffs’ lawyers to remain inactive in order to ensure the highest possible settlement
◆ The length of time between injury and settlement. In one study, 29 months was the average time to settlement. While some legislation requires that the injury be ‘stabilised’ before settlement, stakeholders suggest that cases are often ‘dragged out’unnecessarily, particularly by insurers’ lawyers. Ordinary delays in the court system are also a problem
◆ The sense of powerlessness engendered by being caught up in ‘the system’; having no control (except by dropping the claim)over when or how there will be a resolution, no control over decisions made about the claim, no control over number and content of medical examinations, etc.
◆ The type of compensation offered; systems with no or limited compensation for pain and suffering may produce better outcomes. (Why this is so has not been fully explored. Many of the points listed above may be relevant.)
The complexity of these lists makes it clear that there is no single, easily isolated cause of poorer health outcomes for compensable cases. Some of the factors that may affect outcomes have been identified by research, but it is very likely that it is a complex interaction of these factors that lead to poor health. Further research