How big is the Elephant in the Research Room?

Elephant

A really effective way to annoy a worker on compensation payments (or any worker for that matter) is to not pay them properly. It is even more effective if the worker is already on legislated step-downs in their weekly payments or if their injury has already caused pain, anxiety or stress.

Source: Dr Peter Sharman, Insult and Injury – How big is the Elephant in the Research Room?

A very effective strategy to change a worker’s focus from recovery to their legal rights is to suggest that they might be dishonest or not entitled to claim compensation. Keep in mind that, contrary to populist belief, most people hesitate to claim compensation because of the associated stigma, particularly if they previously have had a bad experience.

My statements above are based on my experience talking to 100′s (probably 1000′s) of workers over the last 30 years of clinical practice, but I can’t back it up with properly conducted research. Discussions with clinicians who treat patients in compensation systems support my observations.

In 2001 The Australasian Faculty of Occupational Medicine/The Royal Australasian College of Physicians, Health Policy Unit published a report  – ‘Compensable Injuries and Health Outcomes’.

In the Executive Summary the following appears:

“Although most people who have compensable injuries recover well, a greater percentage of these people have poorer health outcomes than do those with similar but non-compensable injuries. There is sufficient good quality evidence to show this to be true, and significant agreement among practitioners in all relevant fields (medical, legal, insurance, government oversight bodies) to support the evidence and to suggest that a complex interaction of factors is responsible for this. However, research into causes of poor health outcomes for these people is fragmentary and inconclusive. Not enough is known of the effects of different types of compensation schemes or different methods of management of cases (by all practitioners involved) to allow the development of a ‘best practice’ model.”

In the report recommendations the following appears:

“Develop a research strategy with the aims of:

◆ identifying key features of compensation design which are likely to impact on health outcomes

◆ determining impacts on health outcomes

◆ developing options for scheme design that optimise health outcomes and are cost-effective.”

WorkCover in Tasmania apparently don’t have a budget for supporting research at present, although in the past I understand they have funded some University of Tasmania research.

The ISCRR in Victoria, jointly funded by TAC/WorkSafe Victoria. apparently have an annual budget of $2-3M for research relevant to OHS and RTW. ISCRR has funded the HECS Study, looking at the health effects of compensation. Here is the link to a summary:

http://www.iscrr.com.au/reports-pubs/research-reports/hecsonepagesummarysept2013.pdf

The study looks at the relationship between stressful claims experiences in compensation systems and, in particular, the role of claimant vulnerability. This is a study of a cohort of hospitalised injury patients, so the findings might not be applicable to workers with a less serious musculoskeletal injury that make up the majority of workers compensation claimants.

The study confirms that a significant number of claimants (53%) found their claims experience to be stressful, including significant numbers finding the number of medical assessments stressful (27%). The study found that the risk of poor prognosis was increased in those with claims-related stress. PTSD suffered were particularly vulnerable. It is encouraging that the authors recommended the need for redesign of claims procedures and processes.

The study is observational rather than an intervention study with a control group. A more comprehensive study with a different design might provide a lot more useful information, but might be more expensive and require the co-operation of insurers or claims agents.

Collie et al make editorial comment on the health effects of compensation:

Evaluation of a compensation claims management intervention for improving recovery from traumatic injury, Injury, vol. 43, no. 9, pp. 1335-6.

The authors state:

“Multiple studies have demonstrated that interaction with the compensation system via the injury claims management process has a substantial impact on the health and well-being of injured persons, particularly in the area of mental health. The anti-therapeutic effects of injury claims management processes has been demonstrated in multiple jurisdictions.

The potential positive impact of system-level legislative change in injury compensation systems on the health and wellbeing of injured persons has been demonstrated. However, the effect of changes to injury claims management processes are rarely studied”

I am unaware about how much is spent on such research in other Australian jurisdictions, but it seems that investment in research into alternative models of claims management is lacking, especially when compared to the amount of money spent in the various compensation systems around Australia (about $20M annually in Tasmania alone)

A useful starting point would be a prospective study of cohorts of injured workers to compare health outcomes with different approaches to claims management.  A cohort subject to current claims management practice could be compared to a cohort where  medical approaches to decision-making for treatment and management are utilised. This would help tease out the impact of the traditional confrontational liability-driven legal model of claims management on health outcomes.

If it was possible to quantify any detrimental effects of claims management practices such as IME assessments, claim disputes and covert surveillance on health outcomes (or duration of incapacity) an objective debate about the best approach to design of our compensation system could ensue. Such information would mean that claims management practice costs could be understood by the financial organisations that administer claims i.e. the insurers and claims agents.

My conclusion:

THERE IS A LARGE, BUT BARELY VISIBLE, ELEPHANT IN THE WORKERS COMPENSATION RESEARCH ROOM – THE IMPACT OF CLAIMS MANAGEMENT PRACTICES ON HEALTH AND FINANCIAL OUTCOMES

Quote for the day (doctors like the example of smoking) :

‘JUST BECAUSE IT IS LEGAL DOESN’T MAKE IT A GOOD IDEA” –

Read Here: http://workcoverobservertas.wordpress.com/2014/05/29/how-big-is-the-elephant-in-the-research-room/