The workers compensation system, supposed to serve as a safety net for injured or sick workers, may actually lead to worse health outcomes for some injured workers (aka compensable cases). However, the complexity of the identified reasons makes it rather clear that there is no single, easily isolated cause of poorer health outcomes for injured workers.
Causes of poorer health outcomes in injured workers
Quite a few of the factors that may affect poor(er) health outcomes in injured workers (or compensable cases) have been identified by research. However we believe it is very likely that it is a complex interaction of (all or a combination of) these factors that lead to poor((er) health outcomes in injured workers.
There are a number of potential causes for poorer health outcomes in injured workers. Below are listed the main research-identified factors which may contribute to poorer health outcomes.
The factors that are fully or partly implicated in research literature can be summarised as follows:
The psychosocial environment of the injured worker at the time of his/her injury – examples include: low job satisfaction, poor social networks, lack of purposeful use of time. This also includes societal attitudes towards injury and compensation.
The psychosocial environment of the injured worker after the time of his/her injury – examples include: a workplace that not prepared to adapt to a return to work program, family members/friends and even co-workers unsupportive of rehabilitation programs
The psychological vulnerability of the injured worker (this will also be affected by pain and by psychosocial factors)
The initial response to injured workers by workcover insurers – for example, acting as though injured workers are automatically assumed to be fraudulent, thus pushing injured worker into a defensive attitude “‘I’ll show them I’m really sick/injured”
The management of initial treatment of the injured worker – for example, in common, non-specific musculo-skeletal injuries, not identifying psychosocial risk factors [the so called important ‘yellow flags’], not (really) encouraging resumption of normal behaviours as far as possible, not encouraging return to work or normal activities, etc.
The handling of case management by workcover insurers– for example, not developing appropriate return to work programs, not monitoring return to work programs, not providing injured workers with good, evindence-based 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 (i.e. excessive imaging, medication), 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 workcover insurers (think IMEs) and also by the injured workers’ lawyers (e.g when litigating). The adverse effect of these appears to be twofold: to entrench illness behaviours and to prejudice the injured worker further against the workcover insurance company.
The length of time away from work. It is well known that unemployment is, in itself, a risk factor for poor(er)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), etc. Long-term unemployment is notoriously hard to break. Also, where unemployment is caused by injury or illness, 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.
Other factors that have been identified through interviews and/or discussions with stakeholders can be summarised as follows:
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 worker
Encouragement from some injured workers’ lawyers to remain ‘inactive’ in order to ensure the highest possible settlement
The length of time between injury and settlement. Legal cases are often ‘dragged out’ unnecessarily, particularly by workcover insurers’ lawyers (defense 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; it has been suggested that systems with no or limited compensation for pain and suffering may produce better outcomes. (Why this is so has not been fully explored, but many of the points listed above may be relevant.)
The complexity of these lists makes us believe that there is no single, easily isolated cause of poorer health outcomes for injured workers/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.
What do you think has contributed to your poor(er) health outcome?
Some related articles
- workcover is so stressful it is linked to poorer health
- Key interactions between injured workers, health care providers and insurers in workers’ comp systems
- Workcover is bad for your health
- Workcover compensation schemes impede recovery from injury
- Being on workcover leads to serious negative side effects
- Recent study indicates negative interactions with workcover insurers affect injured workers recovery
- Are injured workers less likely to recover well after surgery?