Causes of poorer health outcomes in injured workers

workcover-poor-recovery

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?

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3 Responses to “Causes of poorer health outcomes in injured workers”

  1. Ahhhhh, I stayed at work, on the recommendation of my physio, the Dr also said remaining at work was better for my health.
    The only problem was I had to modify my duties… COmputer work is just that, I also file, copy etc. I couldn’t even use a normal stapler, lift a ream of paper sit for long periods and then I get the run around from the insurer. In the end, some 6 months post accident I sought the advice of a lawyer. I couldn’t cope with the insurer anymore.
    This then slowed down the case, the insurer, or even the whole system says that legal proceedings are not good for recovery….
    I would argue that very loudly, my recovery was not impeded by legal action, it saved me from committing suicide, as if I had had to continue battling these mongrels by myself, I would have totally lost it…
    So what have I learned from my case…
    I should have had some time off to rest the battered and bruised body. In my first MVA I had a soft collar and I had no long lasting effect, or nothing that caused continual pain… I wasn’t given a collar this time. I have more pain than I can deal with if I don’t take a bucket load of pills, and or go through this procedure or have cortisone injections… I had planned my next 15 years to include more travel, increasing my investments and moving house to something bigger in house but smaller yard, or a town house…. Now I can’t do much for myself nor my children… a Grandparents right is to be able to do things with the Grand children… not this one… If I take him anywhere I have to have someone with me, that can push the swing, chase him around the play park and pick him up. That makes me sad… every day. My daughter is trying to better her life, and I just can’t help her the way my Mum helped me when I was doing the same…
    So for me, poorer outcomes have been due to the insurer or legislation, not giving me what I need to recover. Placing a limit on costs and time. I have worked since I was 14, I have put a lot into raising my children and remaining at work. I retrained myself, after I hurt myself at work in 1990, I didn’t want to be a statistic… I don’t want this now, but I really don’t see any other options.
    I want to be well, so I can play with my grandson, work to earn my future gains, and be proud of what I have achieved… at the moment, it feels like all that has been taken away by our workcover system. (and the idiot that caused the accident)

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    • Woowoo, I am quoting what you wrote on our previous article:

      I think if we were allowed to get the treatment we need when we need it, we would make leaps and bounds to recovery, having to fight for everything is tiring and un-beneficial for us injured lot…

      I believe this is a biggie when it comes to many injured workers’ poor(er) health outcomes. The needless delays, denials and disputes by insurers about basic medical (and like) treatment is often ridiculous and causes much harm. There are for example many injuries such as tendon tears/ruptures etc that can only be optimally treated with required surgery in a window period of 3 weeks (evidence based), yet by the time many injured workers obtain their ‘approval’ for surgery, months have gone by… By then many injured workers are stressed, worn out, depressed, etc, all adding to a poor(er) recovery.

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  2. EMPLOYERS AND INSURANCE COMPANIES NEED TO CARE AND THAT IS WHY INJURED WORKERS HAVE HAD POOR HEALTH SO THEY NEED TO FIND THAT THEIR EMPATHY AND GIVE THE INJURED WORKERS TOP PRIORITY INSTEAD OF WASTING THERE MONEY ON USING SLY TACTICS TO AVOID THE LIGITAMENT CLAIMS AND STOP WASTING IT ON THE CORRUPTION IN THE SYSTEM AS THE SAY MONEY TALKS AND BULLSHIT WALKS AND ALSO TALKS ALL LANGUAGES SO TAKE CARE OF THE INJURED AND STOP WASTING MONEY ON BYING DOCTORS SILENCE,
    I REST MY CASE !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

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