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People Factors
On being stuck in the system and how to get out of it

At a glance:
For employees, the workers compensation process can be hard to negotiate. There is not always sufficient information available to give participants a good understanding of the system they are involved in. Problems with communication make this problem worse.
This study focuses on people who have been involved in the claims system for many years. The study was undertaken a number of years ago, and most systems have improved since then. Frustrations, however, remain.

Bureaucratic systems allow lots of cases to be handled at once, but they sometimes make the individual's experience more difficult. Making a worker's compensation claim automatically makes you part of a bureaucratic system.

Understanding how the system works can help an individual by:

Reducing their frustration
Helping them work out positive ways to deal with their situation
Being prepared for problems, which can reduce their impact

Problems can be reduced by:

Learning about the system and how it works

Following up on issues. Case managers have to deal with many cases and they often deal with negative situations. Work in a positive way with them and outcomes will improve.

Develop relationships with people. Let them know a little bit about yourself, what you want to achieve, and how you can positively contribute.
Being part of a bureaucratic system can be an intensely frustrating experience. Delays, lack of understanding about the process, frustrations about getting treatment and uncertainty all contribute to distress
Severe suffering, pain, anxiety or sorrow
 and negative outcomes.

Encourage people to be part of the solution, and to develop positive relationships with their insurer and case manager. Help them identify ways they can lessen their frustration, contribute to decisions and create a way forward.

Bureaucratic systems disempower people. An empowered employee is likely to have a better return to work outcome.
Workers compensation can be frustrating for all parties, including the employee. Sometimes it can be hard to understand what happens and how the process works. The treating practitioner
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 can also be frustrated.

Talking to the case manager, encouraging the employee to follow-up, and encouraging the employer to offer positive solutions can all be helpful courses of action.
Workers compensation systems are bureaucratic. To succeed, these systems have to deal with a large number of cases and different situations. The downside of such a system is that it is often associated with frustration and a lack of individual care.

When bureaucratic systems are focused on process, concern for people and their individual issues can be forced to take a back seat. It does not take much extra time to interact positively with people, and the goodwill developed makes a huge difference.

Ways of improving goodwill and developing trust include:

Being respectful of the person

Being clear and open about the process and the system

Following up

Completing actions by the agreed time

Offering positive suggestions

A small proportion of people do not wish to return to work, and some of these will try to misuse the system to their advantage. This has a powerful impact on the whole community. A small number of cases like these create negative beliefs in the community about the whole system and its participants. Tightly managing return to work in all cases is important, because this reduces the social stigma for the vast majority of people with valid work injuries.
Original Article, Authors & Publication Details:
William S. Shaw1,2 & Yueng-Hsiang Huang1

Concerns and expectations about returning to work with low back pain: Identifying themes from focus groups and semi-structured interview. Disability and Rehabilitation: An International, Multidisciplinary
Utilizing multiple treatment approaches at the same time. e.g. combined treatement with psychology, physiotherapy and hydrotherapy
 Journal. Vol 27(21) Nov 2005, 1269-1281.

1Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, USA
2University of Massachusetts Medical School, Department of Family Medicine and Community Health, 55 Lake Avenue North, Worcester, MA 01655 USA
Background, Study Objectives, How It Was Done:
This paper discusses some of the practical problems that arise from claims and injury management processes, and the impact they can have on an injured employee. The focus is on the experiences of those with complex, long term problems who have been in the system for some time. The author hoped that an understanding of these problems could inform recommendations for changes to the system, preventing others from being affected.

Previous research has suggested that workers with an injury can experience:

Loss of self-esteem, self-worth and sense of identity

Financial loss

Exposure to a large range of professional stranger

Grief, feelings of shame and loss of control

Anger, stress, guilt, anxiety, self blame and depression

An inability to manage emotions

A feeling of alienation

Loss and change in many areas of life

The study was conducted in South Australia. Employees with a work injury were referred to the researcher by a network of employers, advocacy groups, treating medical practitioners, and other contacts. Employees were generally referred because of a complex situation and long term involvement in the workers' compensation system.

Interviews were conducted in person. Slightly less than half of all participants were interviewed on more than one occasion. Many of the interviews extended for a number of hours. Participants were invited to attend a follow-up session, at which the results of the review were presented for discussion.
Study Findings:
The authors grouped the information provided under the following headings.


Not investing in people:

The participants reported that claims management was process-oriented and did not take their individual circumstances into account. They also felt that the system was focused on cost containment rather than their needs. In some cases, it was felt that professionals discussed their case and made a plan without taking account of their input and needs.

Interviewees wished for a focus on the person and the implementation of genuine support structures. Workers felt the system needed to be commonsense, practical, and based on an understanding of the implications of a work injury. Workers also said that the perception of a process, rather than person-oriented system eroded goodwill.

Problems with the language used in the compensation system:

Workers said that the language used within the system was difficult to understand. Letters often had a legal tone, and the procedural language could be confronting and antagonistic. This was perceived as a controlling mechanism within the system, which took away their understanding and sense of control. This made workers feel alienated.

Availability of information:

Lack of information and understanding of the system were common sources of frustration. Letters were often computer-generated and uninformative, and it was difficult to access basic information on rehabilitation, levels of pay and the claims process.

Participants indicated that their usual information sources (work colleagues, well-meaning friends, other workers with injuries) often provided misleading advice.

Interpersonal characteristics of the process

Relationships at work:

The need to prove the injury to employers, workmates, and friends was a common issue, and the perceived doubts of colleagues caused anxiety and emotional difficulties. A cycle of pessimism, uncertainty, reduced self-esteem, anger and guilt was described by many. Workplace relations were described negatively, and many participants were concerned about losing their job.

Some interviewees said that their relationship with their employer deteriorated after the claim was lodged, after which they felt like an outsider.

Relationships with medical experts:

Some participants felt they had an inadequate understanding of their condition. Diagnostic
Used to identify a medical condition or disease by its symptoms, the findings from a medical examination, and from the results of X-rays, scans, or other tests.
 tests were often frustrating and inconclusive, and sometimes it was hard to get enough time with a medical expert. Doctors' dislike of managing WorkCover made the situation more difficult.

Relationships with case managers:

Payment difficulties were cited as a major problem in the relationship with case managers. Delays in communication, delays in approval for treatments, and delays in reimbursements were all significant concerns.

Negative experiences with case and claims management reinforced the workers perception that an adversarial approach may be necessary. Trust, respect, and open communication were thought to be critical elements of a positive relationship.

Adversarial relationships:

Many workers said they were frustrated by a limited understanding of the process they were involved in. In many cases, disputes increased workers' preoccupation with symptoms, and reduced their motivation to return to work.

Some respondents believed there were claimants who reported ongoing symptoms because they had lost their commitment to return to work. These people were thought to be aiming for a lump-sum payout, rather than meaningful rehabilitation.

Social implications

The stigma of workers' compensation:

A number participants thought that being on WorkCover was the greatest disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 of all, and a major source of stress. People were concerned that they would be stereotyped as a worker who used an abused the system. This perceived stigma was a substantial burden.

Participants suggested that people grieving the loss of a career, status, friendships, and financial security had problems that needed to be understood. Often these challenges were not understood, and difficult behaviour was interpreted as belligerence.

The need for social support:

Many participants said they had not been given adequate preparation for the return to work. They felt that support, compassion and communication were inadequate, preventing them from participating actively in their rehabilitation.

Participants felt they had little control over their situation, and didn't understand how they could best make a positive contribution.

Improving practice: the need for a partnership approach

The author indicated the need for a system that focuses on relationships. Involving the employee in any return to work or management decision was considered very important. A partnership approach to claims or injury management and rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 would enhance open and respectful communication, and reduce the emotional and social impact of work injury.

The provision of clear treatment advice, in simple language, and treatment of the individual were all reported to be important aspects of management.

The way in which communication happened was often more important than the content. Trust and goodwill need to be developed.
These long-term claimants were frustrated with a number of aspects of the system. Understanding the impact of the system should motivate us to improve communication between all parties, and get all players onside.
PubMed Abstract
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