Co-author “Trinny” kindly shared the following article titled “Work Injured Reform Needed” which she found on a Medical Forum, and which was recently written by two doctors. While the article focuses on WorkCover WA and its gross inadequacies such as depriving injured workers who suffer from pain syndromes of adequate multidisciplinary CBT-orientated pain treatment until they are in the terminal stages, we can’t help it but strongly believe this serious problem is not confined to WorkCover WA, contrary to what the article implies.
How many times have we heard and read terrible stories (and legal cases) about injured workers (from all states) suffering the most unimaginable pain denied pain treatment by their insurer? Whether a general pain programme, a spinal cord implant (implanted nerve stimulator), a pain trial, certain pain medication, salvage surgery (i.e. fusion) or CBT (Cognitive Behavioural Therapy) orientated pain treatment i.e with a clinical psychologist?
Take the case of our Grand Poo for example, who suffers a horrendous shoulder injury accompanied with severe nocioceptive and neuropathic pain (as per her pain specialist), who is at wit’s end and facing an imminent shoulder amputation, followed by a total reverse shoulder replacement, after 7 failed major surgeries. She also suffers from severe primary and secondary psych injuries, confirmed and rated by a Medical Panel. She not only needs to overcome her fear of dying (having nearly died twice during shoulder surgery), but she also needs ongoing CBT to manage her severe pain (as prescribed by her pain specialist, one of the very best in Australia), and then, if successful, learn to live with a bizarre, maiming, fragile and reverse prosthetic . Yet her insurer recently, and again, attempted to cease her psychology treatment, stating that “she’s just having a joint replaced“….WTF.
Reform needed for work injured people
Work Injured Reform NeededWritten by Dr John Salmon and Dr Stephanie Davies. Wednesday, 01 May 2013
The workers compensation system was devised to offer the best possible treatment to enable workers’ return to work and health as soon as possible. But too frequently the opposite occurs with substantially worse outcomes than treatment for the same injuries, which have occurred outside an insurance system.
Work-injured people can become the victims of a feeding frenzy for radiological and interventional medical practitioners, insurance doctors and lawyers. The patients’ sensitised, disordered nervous systems go from bad to worse, excessive imaging of degenerative (normal for age) change and resultant surgeries can create symptomatic pathology where there was none.
The majority of the protracted claimants never return to work, which has devastating effects on them and their families. There is a high prevalence of psychological dysfunction, and in some cases, drug and substance dependence.
This is occurring in an environment of record high levels of employment, unmet demand for workers of all kinds and huge wages. There is clearly no financial incentive to remain off work. Employers should be concerned that they pay such huge premiums for worse outcomes in WA compared to workers’ compensation systems in almost any other jurisdiction in Australia.
The current WA system is entrenched in the solo medical model, implacably defended by insurance claims managers and supported by “insurance doctors” who appear determined to maintain ignorance of advances in medical science during the last decade. Current knowledge of neuroplasticity and capacity for sensitisation to develop in the nervous system of susceptible individuals (‘persistent pain as a disease’) and the complex interaction with the psychosocial environment (‘the biopsychosocial model’) has had a profound impact on our assessment and management of patients disabled by persistent pain.
A recent confirmation of this formulation is a large new study from the Australian Centre for Post-Traumatic Mental Health, recently published in the Journal of Clinical Psychiatry confirmed that…
In the light of current knowledge it must be considered negligent to conduct an assessment of an injured worker without psychosocial risk assessment. Typically insurance reports are 10 or more pages of remarks about imaging and physical pathology when at least 50% of pathology (including severe grades) is asymptomatic.
WorkCover WA statistics indicate that over $600m a year is spent on people with work injures in Western Australia. The majority is spent on about 3000 workers who suffered relatively minor musculoskeletal injuries but who remain off work because of persistent pain and fear of being active with pain….
But in WA these people are deprived of adequate multidisciplinary CBT-orientated pain treatment until they are in the terminal stages, years down the track, when they are practically unsalvageable.
The only privately funded intensive multidisciplinary CBT program treatment for injured workers in WA had to close some years ago because of lack of funding support by insurers and WorkCover WA—despite documenting more than 60% return to work before claim settlement in protracted claimants (averaging more than two years off work).
We need, as a priority, a comparative cost and outcome study comparing WA with workers compensation systems in the Eastern states. Absorbing and implementing information from these other models is also likely to return a higher proportion of injured workers to the workforce. This is supported by evidence-based research.
Recently WorkCoverWA was begun compiling comprehensive return-to-work-outcome and related medical management data.
State Wide Pain Services (WA) has been reviewing the recent studies in Eastern States [the Concorde study in New South Wales and the Network study in Victoria (presented at recent World Pain Congress in Milan) ] which have demonstrated that systematic evaluation of psychosocial risk factors within days of the injury and early individualised CBT intervention integrated with appropriate medical management results in significantly improved work return outcomes and reduced costs (> 25%).
Cost savings should be an irresistible argument even to insurers. However. in WA there appears to be a resistance to the broader integrated multi-disciplinary models which have become the foundation for evidence-based care for people with persistent pain in non-workers compensation cases in WA, and across Australia.
It’s crucial that the dynamic changes between WorkCover WA, the insurers, health care professionals and the people with persistent pain following a work incident.