As we recently discussed in our article “Injured workers who have drawn out workcover cases recover more slowly“, a new study suggests that the stress from being on workcover, including engaging a personal injury lawyer, could be linked to a poorer recovery.
Those who litigate (i.e. frequent disputes, common law etc.) also tend to have much worse long term health outcomes than those who don’t. Whilst any injured worker who has been on the adversarial workcover system would be able to tell you that, it seems researchers from Stanford University studying our workcover (and TAC) claim history found that the stress of filing a workcover (or TAC) claim may actually increase the severity of disability over the long term. We’re pretty confident their results are indeed correct, but -importantly- this formal study should give those in the workcover industry another reason to look at their highly adversarial and protracted procedures and processes, as they may be costing them much more than they think!
Workcover is so stressful it is linked to poorer health
Stress of filing injury claims linked to poorer health later
Based on article in Reuters 12 Feb 2014
A recent survey of Australian workcover and accident (TAC) victims found that claims stress often comes from confusion about the process, delays and related medical assessments.
Study author David M. Studdert of Stanford University in California said past studies have compared people who filed for compensation to people who did not, but those groups might have different types of injuries to begin with.
Another aspect to consider is that people who file claims have an incentive to exaggerate their symptoms to receive more compensation for longer.
“The novelty of this study was to look within a group of claimants to test whether those who reported experiencing the most stress also had the slowest recoveries,” Studdert said. “They did.”
He and his colleagues polled a random selection of more than 1,000 patients hospitalized in Australia for injuries between 2004 and 2006. Six years later, 332 of the patients who had filed for workers’ compensation or another accident claim told the researchers how stressful the process had been. Claims can take four to five years to conclude, Studdert noted.
A third of the claimants reported high stress from understanding the claims process and another third were stressed by delays in that process. A slightly smaller proportion said repeated medical evaluations and concern for the amount of money they would receive were sources of stress.
Negative attitudes from doctors, friends, family or colleagues, on the other hand, did not seem to be common sources of stress.
People with the most stress tended to score higher on a disability scale and have higher levels of anxiety and depression and lower quality of life, the researchers reported in JAMA Psychiatry.
“While it’s intuitive that the compensation process is going to be stressful for some claimants, what is less clear is whether that stress has a substantial impact on recovery many years after the injury,” Studdert said. “We were surprised by the size of the compensation effects on outcomes like level of disability and quality of life – they were fairly strong,” he told Reuters Health.
When the researchers took into account that some patients seemed to be more vulnerable to stress from the start, the link between claims stress and long-term recovery was similar but not as strong.
“There is much debate at the moment about the role of ‘systems,’ in this case ‘compensation systems’ on health outcomes,” said Michele Sterling, who studies injuries and rehabilitation at the University of Queensland in Herston, Australia. She was not involved with the current study.
“If it can be established which parts of the process cause stress and/or poor outcomes or recovery then the system could look at targeting these specific areas and improve them,” Sterling told Reuters Health. “Some insurance regulators are already trying to do this in some areas.”
This study deals with severe injuries that require hospitalization, and her own research focuses on more minor injuries, she noted, but the relationship between stress and health is likely the same, she said.
She has found that post-traumatic stress symptoms predict poor recovery, and that could be worsened by stresses in the claims system, she said.
It is still worthwhile for patients who have sustained a serious injury to file a claim, Studdert said.
“Compensation serves an important function, especially for people who must drop out of the workforce for a period of time,” he said. “The financial support can be critical.”
“Our study joins many others that show the rate of mental health problems among people who are injured is astonishingly high,” he said, adding that medical systems are excellent at treating physical injuries but not as good at treating mental conditions.
“I think the point that needs to be made is that those managing these systems, insurers or workers’ compensation boards, or no fault automobile compensation schemes, should realize that they are undermining their own mission of getting workers back on their feet if the process is unnecessarily stressful,” said Katherine Lippel, who studies occupational health and safety law at the University of Ottawa in Ontario, Canada and was not involved in the study.
The authors suggest that compensation schemes could be redesigned to get the process over with quicker and make it easier for patients to understand, which could alleviate some sources of stress.
SOURCE: bit.ly/1boZNiZ JAMA Psychiatry, online February 12, 2014.
This study (funded by workcover and TAC) should give those in the workcover industry another reason to look at their (highly adversarial and protracted) procedures and processes, as they may be costing them much more than they think!
Surprise, surprise… ! We can’t help but wonder if those working in the workcover industry (i.e case managers, insurers) are really not aware that their very expensive (yes!) and misguided attempts at controlling costs have no ramifications on the injured worker? Delaying vital medical treatment (and like), delaying claim approval, any other form of approval, be it for an MRI, surgery, home help, psychology treatment etc, putting the injured worker through conciliation after conciliation, IME after IME… Helloo? Are these morons that far removed from reality? Do they live on another planet? Don’t they see that any unnecessary delay causes enormous stress and pressure on someone that has been injured and is worried sick about their condition and the impact it has on their lives, incl financially? Don’t they keep a running balance sheet and see how much they actually spend in order to attempt to deny a perfectly legitimate benefit? $800-$1000 per IME, $5000 flat fee for a medical panel, about $2000 for a conciliation… Easily K10 wasted on for example $500 worth of home help!
We were also struck by one study quote : “A slightly smaller proportion said repeated medical evaluations and concern for the amount of money they would receive were sources of stress.” While the researchers repeated medical evaluations (as in IMEs) as a point of stress, they also implied that injured workers did not focus on the quality of care or restoration of function. Instead, they focused, at least to these researchers’ questions, on the amount of money they would receive. This is utter crap! We ask, how on earth is the injured worker to focus on their recovery when every step is barricaded? Our own treating specialist’s opinions are routinely questioned, case managers play God, and we’re sent to countless known hired guns for “assessment”. Requests for surgery, medical treatment, physio, psychology, home help etc are routinely denied and the injured worker (and his/her treaters) are left to fight for every scrap. It is extremely difficult to get better within this adversarial system! And no, injured workers don’t so much care about money (compensation) but start to become obsessed by how much medical and like services they can obtain, so they can get better!
As we’ve mentioned several times before workcover should not be called workcover or workers compensation, but work recovery or workers compensation recovery. Case managers should perhaps be replaced by skilled and trained “recovery specialists”, who would work together with the injured worker and his / her treaters with one goal, namely restoring whatever function possible to the injured workers’ lives. This would inevitably also greatly improve our return to work rates! Point being those managing our workcover (and TAC) systems should indeed realise that they are undermining their own mission of getting injured workers back on their feet if the process is unnecessarily stressful.
Surely many insurers and their employees (i.e. case managers) have known for decades that denial, delay and complexity (i.e. disputes, bureaucracy, IMEs etc) have been working against the yielding of better results/outcomes for injured workers?! If not, well now they have a formal study that gives a bit of definition to what’s causing all the insults to injured workers.
The workcover drawn-out, bureaucratic and highly adversarial “processes” are simply unnecessarily stressful to injured workers.
It is the workcover insurers (and their employees) who now need to fix this problem, and stop aggravating it. And that, folks, must surely be a very stressful thought to workcover et al!
[Post dictated by WCV and manually transcribed on behalf of WCV]