Reform needed for work injured people


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.

Case managers (in every state that we know of since the inception of this site) – who wouldn’t know the difference of a brain from a toe- are simply freely allowed to identify and dictate ‘reasonable’ medical management, overruling the best specialists in our country.
The workcover insurers’ imperative, like any commercial organisation, is simply profit and not  prioritisation of healthy outcomes for injured workers. And then “they” whinge about “poor return-to-work” rates? Oh funny – NOT!


Reform needed for work injured people

Work Injured Reform Needed

Written 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…

…psychiatric symptoms are a greater contributor than the physical injury itself to disability one year after a serious car or workplace accident and that early intervention to address this aspect would result in significantly less disability.
However, we have yet to see any insurance medical assessment that has included a psychosocial risk of chronicity measure such as the Orebro score, anxiety and depression questionnaire scores (such as the DASS 21), or screening tools for Neuropathic or Inflammatory contributory components.

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….

These are injured workers who have developed persistent pain enmeshed with psychological dysfunction; this dysfunction is escalated by a frequently highly adversarial workers compensation environment.

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.

WorkCoverWA’s existing legislation (which differs significantly between the Australian states), empowers insurance claims managers to identify and dictate ‘reasonable’ medical management. However, the insurers’ imperative, like all commercial organisations, is profit and not necessarily prioritisation of healthy outcomes for injured workers and their employers.

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.

In WA, individual pain specialists have called for changes over the past few years (or decade) to align clinical management with the Eastern States and embrace the biopsychosocial model and CBT-based interventions.

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.



9 Responses to “Reform needed for work injured people”

  1. What’s really rotten, is that the Workover knew they were going to harm injured workers in these ways, and the anti-justice lawmakers exempted “secondary” injuries from the claims process! . Forward looking, intentional activity I think.

  2. Why is it we can get endless media reports about getting rid of ‘Bad teachers’ and yet NOTHING on getting rid of ‘Bad doctors’? Any doctor who is not familiar with recent developments in medicine should have their licenses removed. And case managers???? Oh please, most are sychophantic corporate wannabes still living in the Thatcher Greed is Good era or are the offspring of that toxic ideology. The system is at fault and the only way to stop that is to get another system, anyone ever heard of Worker Co Ops? As long as people tolerate what we have on the false assumption that it will never happen to me, we are doomed to suffer it.

    • That’s a good thought Bunny.There’s a whole state in the Basque region (between France and Spain) where all the industries, and state services are managed by worker co-operatives. I think there may still be some worker co-ops surviving in Victoria……there were loads in the late 70’s early 80’s, just as there were many credit co-op gaining traction against the banks.

      • Mondragon are an excellent organisation and a great model for those who want to set up Worker Co Ops. It is a pity more people don’t know about them as anyone setting up a business would do very well if they considered this kind of structure.

        • In the late 70’s and 80’s I worked for a youth and community focussed unemployment centre. We set up a couple of co-ops as job creation projects. There was actually money available for funding co-op development for a few years there, a pet project of Race Matthews. Mostly crushed since I would think. But it’s a great way to go if the energy is there amongst the workforce.

  3. It is good to see doctor organisations involved in the Workover starting to criticise the processes that we Injured Workers have been screaming about for a while.

  4. The level of peer research and avaliable teatamonies into the adverse affects caused by case managers impersonating Drs is adequent for government intervention. They are Employed by privatised multi national insurance companies contracted to the government. There are no specialised medical degrees in those offices. That level of pretense in a hospital would have the ordinary individual behind bars. Yet there are hospitals kissing their brains goodbye to follow the reccomendations of frauds. In good faith I might add. Guilty of malpractice? Interesting debate.
    The research continues. One of the best in the world I would say. A couple of thousand injured lab rats being legally abused in the name of research. There’s even enough information of the affects of stress and cruelty on pharmaceuticals. Every discipline conceivable. Well the research is there. The question is when are the injured lab rats going to have this research benefit them to stop the abuses?

  5. Yes so true, when the pollies go out they get full pay for the rest of their lives! Gee, we were in the wrong jobs!

  6. the only reform politicians are interested in is giving it all to big business and this won’t include doing anything for the injured BOOF has wiped his hand of us or so he thinks small wins one at a time.
    he has all his entitlements when he leaves his job and injured go on struggling all because of a review