Key interactions between injured workers, health care providers and insurers in workers’ comp systems

key-interactions-workcover-study

The Institute for Safety Compensation and Recovery research (ISCRR) has recently undertaken some useful research into the interactions between injured workers, health care providers and insurers in workers’ compensation. Overarching themes which were of greatest concern for injured workers included psycho-social consequences and the issue of legitimacy, whilst adversarial relations featured in interactions between all parties. We could not agree more.

Key interactions between injured workers, health care providers and insurers in workers’ compensation

Key interactions between injured workers, health care providers and insurers in workers’ compensation systems: A systematic review of qualitative research

Beth Kilgour (1,2), Alex Collie (1,2), Agnieszka Kosny (3), Donna McKenzie (3)
From: (1) Department of Epidemiology and Preventive Medicine, Monash University, (2) Institute for Safety Compensation and Recovery Research, (3) Monash Centre for Occupational and Environmental Research

Background

Substantial research evidence indicates that injured workers who have compensation claims have a slower recovery than non-compensable clients.
Mental health plays an important role in recovery and can be compromised by the difficult relations injured workers experience with both health care providers and insurers. There is little research into the interactions between these parties.

Aim

To identify published qualitative research on the interactions between injured workers, health care providers and insurers, in workers’ compensation systems.

Findings

The most frequently occurring first order concepts and the subsequent secondary interpretative themes are detailed in the tables below:

injured-worker-healthcare-provider

interactions-between-injured-workers-insurer

interactions-between-insurers-health-care-providers

Discussion and Conclusion

Synthesis of the studies revealed difficult and stressful interactions for injured workers interwoven with both health care providers and insurers.

Overarching themes which were of greatest concern for injured workers included psycho-social consequences and the issue of legitimacy, whilst adversarial relations featured in interactions between all parties.

These themes have a cyclical and pathogenic relationship which contradicts the aim of rehabilitation.

In every study, injured workers also reported mental health issues, yet there was little research into mental health care providers’ perspectives and experiences. This review sets the agenda for further qualitative research to examine the role and experiences of psychologists in Australian workers’ compensation systems.

View the ISCRR’s poster on this research here: http://www.iscrr.com.au/news/events/achr-forum-presentaions/beth-kilgour-achrf-poster.pdf

This research was also published on 16 May 2014 in the Journal of Occupational Rehabilitation

J Occup Rehabil. 2014 May 16. [Epub ahead of print]

Interactions Between Injured Workers and Insurers in Workers’ Compensation Systems: A Systematic Review of Qualitative Research Literature.
Kilgour E1, Kosny A, McKenzie D, Collie A.

Abstract

Introduction: Work-related injury is a major public health problem and a worker’s recovery can be shaped by their interactions with employers, healthcare providers and the workers’ compensation system. Most research on the effects of compensation has concentrated on examining outcomes rather than considering the compensation process itself. There has been little attention paid to the interactions between stakeholders and only recently has the client’s view been considered as worthy of investigation. This systematic review aimed to identify and synthesize findings from peer reviewed qualitative studies that investigated injured workers interactions with insurers in workers’ compensation systems. Method A search of six electronic library databases revealed 1,006 articles. After screening for relevance, 18 articles were read in full and a search of those bibliographies revealed a further nine relevant articles. Quality assessment of the 27 studies resulted in a final 13 articles of medium and high quality being retained for data extraction. Results Included studies focused mainly on experiences of injured workers, many of whom had long term claims. Findings were synthesized using a meta-ethnographic approach. Six themes were identified which characterised the interactions between insurers and injured workers. The majority of interactions were negative and resulted in considerable psychosocial consequences for injured workers. Positive interactions were less frequently reported and included respectful, understanding and supportive communication and efficient service from insurers.

Conclusion: Findings from this synthesis support the growing consensus that involvement in compensation systems contributes to poorer outcomes for claimants. Interactions between insurers and injured workers were interwoven in cyclical and pathogenic relationships, which influence the development of secondary injury in the form of psychosocial consequences instead of fostering recovery of injured workers. This review suggests that further research is required to investigate positive interactions and identify mechanisms to better support and prevent secondary psychosocial harm to injured workers.

Healthcare provider interactions in workers’ compensation schemes-Implications for injured workers

Discussion

The roles that HCP’s perform in compensation systems are numerous and complex, with competing demands from both injured workers and insurers.
In the review studies, injured workers experienced both therapeutic and non- therapeutic encounters with HCP’s.
HCP’s positively influenced injured workers rehabilitation through respectful, and supportive patient-centred therapy. Provision of guidance on injury management strategies, and practical support from HCP’s, were also
considered to be important therapeutic components.

Non-therapeutic encounters with HCP’s were described by injured workers who experienced stereotyping and suspicious attitudes and poor quality service. Injured workers could attend multiple IME’s which were painful or hostile and resulted in conflicting opinions about diagnosis and treatment. Negative interactions could have long lasting consequences for the injured worker who could lose entitlements for medical and rehabilitation services or income benefits, creating further financial difficulties and adding emotional stress to physical injury.

Insurer and compensation system requirements intrude in the therapeutic relationship. Insurers could use IME’s to challenge both the HCP and the injured worker.
HCP’s could become frustrated with administrative demands and delays, and be less willing to see compensable patients. Studies in non-compensable settings have demonstrated the importance of patient-centred care and physician job satisfaction for psychological well-being, improved treatment adherence and health outcomes for
patients.
It is likely that the same factors could influence injured workers recovery

interaction-healtcare-providers-workcover-insurers

interaction-healtcare-providers-workcover-insurers2

This review demonstrates that in many instances, injured workers with long-term complex injuries experience
difficulties when receiving health services in the context of workers’ compensation systems.
IME’s were a source of contention for both injured workers and HCP’s, and likely exert a negative influence on the therapeutic relationship.

Healthcare providers experience problematic interactions with insurers, and injured workers bear the brunt of HCPs’
frustration as some HCP’s offer poorer quality service or refuse to treat compensable clients as a result.

Supportive patient-centred interaction with HCP’s who have high job satisfaction is important for injured worker
recovery.

Reduction of organisational pressures and improving communication between insurers and service providers could result in increased job satisfaction for HCP’s and ensure that providers are more amenable to operating in compensation systems.

Improved HCP participation and job satisfaction will more than likely have a corresponding positive influence on injured workers’ recovery and return to work.

Further research into experiences of distinct healthcare professions with workers’ compensation systems is warranted.

View the ISCRR research paper here: http://www.iscrr.com.au/news/events/achr-forum-posters/poster-10-achrf13.pdf



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One Response to “Key interactions between injured workers, health care providers and insurers in workers’ comp systems”

  1. It is quite amazing to think that workcover (and TAC) are spending large amounts of money on this kind of ‘research’ -research that is reviewing past research and, frankly, “overarching themes” that any more seriously injured worker (longer term on the system) can tell you right off the bat. Whilst it is good to have all this on an Australian ‘research’ paper, wouldn’t it be better if actual Australian injured workers were interviewed (researched)? Even the stories gathered on this and like minded sites would be a good starting point to define the critical “themes”. The above research also does not specify at which ‘workers compensation’ schemes they looked at (neither which countries?). Most importantly I would like to see something done about the findings of this research, sooner rather than later., especially to prevent further ongoing harm on the injured worker(s) trapped in this adversarial and dysfunctional workcover system.
    However it is good to have our issues put to ink.

    Just my 2 Cents worth…

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    Workcovervictim3 August 17, 2014 at 11:25 pm