12 Months and Beyond
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:
- Have a good NTD who assesses accurately , provides you with good feedback, know which surgeons or specialists offer the best treatments, and who gets the best results
- Have an NTD who has as good an understanding and experience of dealing with psychological injuries and health issues as he/she does treating physical health injuries or illnesses
- Do your own independent research on treatment options for your injury and on which specialists have the best reputations
Unexpected side effects and complications from injury i.e. surgery didn’t achieve result that was anticipated
What you need to consider:
- Discuss with NTD
- Get feedback from surgeon
- Get a 2nd opinion from another doctor
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:
- Have a good NTD who is aware of these issues and helps to provide referrals to therapists who can use alternate strategies that minimise medication problems
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:
- Have a good NTD who is aware of these issues and will teach you preventive strategies to minimise secondary injuries,
- A good lawyer is also likely to be necessary if a second claim needs to be made and there are liability issues.
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:
- Individual or family income levels will have reduced and there will be problems making ends meet financially
- Activities previously enjoyed such as hobbies and sports won’t be able to be carried out as before or at all. Frequently new ones haven’t been taken up
- There are likely to be difficulties with doing at least some activities of daily living such as house work, mowing lawns, gardening, cleaning or food preparation tasks
- There may have been or still is conflict in households about the new roles required to accommodate a person with a disability
- Physical fitness will have decreased and strength loss in areas other than that directly affected by injury
- Chronic and acute pain episodes are likely to dominate or at least influence a person’s general sense of well being
- Sleep problems are likely as a result
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:
- Have an NTD who has an equally good understanding and experience in dealing with psychological injuries and health issues, as he/she should be treating wellness and/or physical health issues
- Consider a referral to a psychologist
- Arrange another treating professional to discuss with your NTD (e.g. a rehabilitation provider, or a treatment provider) if they have concerns about an aspect of your well being that the NTD should acknowledge and address.
- Do you own independent research on treatment options and on what providers have the best reputations.
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:
- Inaccurate diagnosis from NTD
- Inadequate investigations by NTD
- Inadequate or inappropriate referrals by the NTD
- Premature certification of "fit for selected or full duties" resulting in significant injury exacerbation
- Inadequate responses from your NTD, either not picking up or ignoring significant symptoms and then red flags resulting in complications or exacerbation of symptoms. Alternatively an over cautious approach encouraging avoidance of activities of daily living, or avoiding working which may result in the injured worker becoming disproportionally fearful of reinjury and, or becoming further physically and psychologically deconditioned. Both scenarios can result in slower response times to treatment and rehabilitation and reduced work capacity.
- The NTD fails to recognise secondary psychological difficulties that are emerging due to factors such as poor coping with pain management, associated chronic sleep difficulties, family problems, medication issues prescribed and non-prescribed. Treatment responses are frequently affected by issues such as anxiety, agitation, poor decision making and memory problems, impaired motivation, fearfulness of attempting a new treatment or upgrading duties at work.
- The NTD either not identifying psychological and social difficulties (see Red and Yellow Flags) or does not attempt to address the issues affecting his/her patient. They may not adjust medication or treatment regimes or make the necessary referrals. Most injured workers who have a claim that goes over 12 months are likely to be experiencing significant changes in their life and will have found it stressful trying to adjust to managing a long term injury.
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:
- Inappropriate treatment strategies for the symptoms
- Treatment irregularity - appointment schedules too far apart
- Abrupt and inappropriate treatment cessation. Although the emphasis in Worker's Compensation injury management is for “evidence based practices” that are “reasonable and necessary” there is often disagreement between service providers and the Agents paying for the treatments as to what is evidence based, “and what is reasonable and necessary”. There are often no clear guildelines and parameters concerning the time frame required for treatment responses
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)
