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What is happening / should be happening?
It is now more than 12 months since your injury claim was lodged and you still find yourself affected in one way or another by your injury or the results of having had a workplace injury. If you are still affected by the initial injury or still have a workers compensation claim it is likely that there will have been a number of unexpected challenges you have had to face, unexpected setbacks, and inevitably, secondary or tertiary health issues including , social, psychological, financial and employment difficulties.
In the following sections the most commonly experienced challenges are outlined by workers who have been in “the system” for more than a year. Suggestions are made on ways to manage these challenges and where to go to get the advice or support you need.
Workers who are in the system for 12 months or more are likely to have one or more of the following:
More serious injuries – the injury may have required surgery on more occasions
Multiple Injuries - affecting a range of areas of the body
Physical and Psychological Injury Occurring simultaneously -
It was mentioned in the sections Injuries 1 to 3 months that there are some situations where an accident or incident occurs at work where both physical and psychological injuries may result.
What you need to consider:
Unexpected side effects and complications from injury i.e. surgery didn’t achieve result that was anticipated
What you need to consider:
Side effects and complications from treatments such as medications i.e. physical dependence, inadequate pain control , liver and kidney problems
What you need to consider:
Secondary Physical injuries
A significant injury to a left knee or leg may lead to changes in posture that can then result in other problems sucha as lower back strain. It may also result in the injured person favouring the other leg and overuse problems occurring in the knee. This occurs frequently with leg, knee, arm, hand and shoulder injuries. Problems with insurers refusing to accept liability for secondary problems can lead to further problems with getting the secondary injury assessed and treated.
What you need to consider:
Secondary Psychological Injuries
Anyone who is caught up in the workers compensation system for more than 3 months, irrespective of the type and extent of injury is likely to have faced challenges they may have never had to deal with before. Once a claim is lodged and liability is accepted the worker is bound by numerous obligations for claiming workers compensation benefits (see Workers Obligations for Workers Compensation Benefits).
After 12 months it is also likely that:
All these challenges inevitably lead to increased levels of stress even in people who manage the demands of everyday life very effectively. Many of challenges outlined cannot be “solved” easily if at all, and can result in frustrations, anxiety and anger. This can flow on and result in depression, particularly when the life situation does not seem to be improving and there appear to be obstructions occurring on a frequent basis. Secondary psychological injuries or put another way, psychological and social health problems are almost inevitable after 12 months for most people if they do not have the right support and progress isn’t being made.
What you need to consider:
Problems with Diagnosis and Treatment
After 12 months the vast majority of injuries will have healed completely. For those that haven’t it is likely that the pain and functional restrictions from the injury are unlikely to improve significantly, even with a different approach. There are exceptions of course such as head injuries - which may take up to 3 years, and some complex injuries where there were unexpected complications and side effects. There are also situations where the management of the injury has been poor.
Some of the circumstances include:
Treatment and Agent problems
Even at this stage twelve months on, there are a number of potential problems concerning treatment access and responsiveness.
These include:
One of the key roles of Insurers / Agents is to regularly monitor treatment progress and outcomes. Although this is essential, there can be considerable variation between Agents and case manager's concerning their knowledge of specific injuries, their experience levels in claims management, and case management skills generally. Training provided to staff varies in quality, content and emphasis, resulting in agents sometimes having unrealistic expectations about what can and should be achieved and when. Frequently case managers do not have an adequate understanding of all the facts affecting outcomes including the issues affecting their "claimants". To address this, “Independent medical assessments” are often organised around 12 months post claim by the agent to assess treatment progress, liability and future support needs.
It Is Time To Change Your Approach to Managing Your Injury after 12 months
As general rule, by 12 months there need to be an overall change in approach to injury management with most injuries and most workers. The emphasis needs to change from finding the best treatments to one where the focus moves to adjusting to living with permanent residual restrictions and pain. Psychological counselling/ and or pain management counselling is often very helpful with this. (See Pain Management and Injury Adjustment Interventions and Pain Management and Injury Adjustment Interventions)