Managing Injuries 12 Months and Beyond

It is now more than 12 months since your worker sustained injury, and a claim was lodged.  If the claim has lasted this long, it is probable that full liability for the claim was accepted for the injury.  Both you and your injured employee would have had to comply with legal obligations of NSW Workers Compensation system.  As an employer, this means providing a safe work place, offering suitable duties as per the medical certificate  and general providing support to your worker to get back to his or her pre-injury role.  You will probably have had to attend or have had return to work meetings at your workplace with your injured worker, yours or the insurer’s appointed rehabilitation provider (unless the worker has chosen a provider of their own).

Generally, much time will have been taken up attempting to accommodate your injured worker and the staff that have been affected by being short staffed.  For very small employers the loss of a significant employee can have a significant effect on the business in terms of lost productivity, the time required to retrain other staff, not to mention the extra costs to the business from having made a claim.  These include such things as the extra costs to use other staff - possibly outsourced labour, potentially lower or less efficient work inputs and premium rises.

If there was a clear breach of occupational health and safety and the worker’s injury was severe you could also be lumped with a hefty fine from Workcover.

If your worker is still in the system, it is probable that their life hasn’t been at all that easy over that time. It is likely that there will have been a number of unexpected challenges they 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 facing workers, and indirectly employers who have been in “the system” for more than a year. Suggestions are made on ways you or your staff can manage these challenges. Advice is offered on where to go to get the advice or support needed. 

The injury itself

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.  These occur typically where there is significant traumatic event.  Some of these include a significant injury such as a loss of limb or major fracture in an industrial accident, an assault at work, or a significant motor vehicle accident – Although the initial physical symptoms may have been the priority for treatment, in subsequent weeks and months the psychological symptoms of post-traumatic stress and depression are likely to become increasingly significant in determining overall treatment response and work readiness,

What the worker need to do:

1. Have a good NTD who assesses accurately , provides good feedback, know what surgeons or specialists offer best treatments services and get the best results,
2. Have a NTD who has an equally good understanding and experience in dealing with psychological injuries and health issues as  he/she is at treating physical health issues
3. Do their own independent research on treatment options and who has the best reputations

What you the employer needs to do:

a)    Support your worker

b)    Give constructive feedback to your employee if they see unaware of difficulties or are unable to manage.

c)    Speak with the appointed rehabilitation provider about your concerns.

Unexpected side effects and complications from injury , i.e. surgery didn’t achieve result that was anticipated

What the worker need to do :  

1. Discuss with NTD
2. Get feedback from surgeon
3. Get 2^nd opinion from another doctor

Side effects and complications from treatments such as medications -  i.e. physical dependence, inadequate pain control , liver kidney problems

The worker need to consider having 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 -  For example a significant injury to a left knee or leg may result in changes of posture -  leading to back problems  - it may also result in the injured person favouring the other leg and overuse problems occurring in that knee.  This occurs frequently with leg, knee, arm, hand and shoulder injuries. -  Resulting insurer liability and subsequent treatment problems can be a significant challenge.

What the worker needs to consider:

1. To have a competent NTD who is aware of theissues and to help to provide preventive strategies to minimise secondary injuries
2. To have a realistic solicitor to determine if a second claim needs to be made liability issues challenged

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 and their life circumstances will have change. 

One 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:

1. Individual or family income level will have reduced and workers will have had difficulties making ends meet
2. 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
3. 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
4. There will have been or still is conflict in households about new roles required to accommodate a person with a disability
5. Physical fitness will have decreased and strength loss in areas other than that directly affected by injury
6. Chronic and acute pain episodes are likely to dominate or at least influence a person’s general sense of well being
7. 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, this 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 that there appears to be obstacles and 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 the worker needs to consider:

1. Have a NTD who has an equally good understanding and experience in dealing with psychological injuries and health issues as  he/she is at treating physical health issues
2. Obtain a referral to a psychologist
3. Obtain another treating professional to discuss with your NTD - i.e. rehabilitation provider, of they make suggestion, or other treating specialists such as physiotherapist, chiropractor.
4. Do you own independent research on treatment options and who has the best reputations

What you need to consider

Secondary psychological difficulties, problems with pain management, sleep loss, and functional restrictions all significantly affect work capacity and productivity.  If the issues don’t appear to be getting addressed with the current treatment team discuss (tactfully with your worker). Also consider discussion with the rehabilitation provider and if all else fails your Agent.  The agent may need to get an independent assessment of treatment strategies and goals and get further feedback from key service providers.

What the employer can do

• Be aware of these issues
• Have genuine empathy and supportive practices
• Instil and support a workplace culture of fairness
• Make sure you, as the employer do not contribute to the stress. That said there may come a time when suitable duties can no longer be offered because of the effect on other staff and the bottom line of the business.  Injured workers who have had positive experiences with their employers are much better able to accept the loss of a job and adapt more quickly to needing to retrain and or job search for a new job than those that have had bad experiences.

Support your worker to get a good team.

The Workers compensation system has many stakeholders with vested interests and opinions about the way things should be done.  Some of these are enshrined in legislation or “Workcover Guidelines”. Many of the attitudes and practices of stakeholders however are not so much determined by the rules, but by beliefs, culture,  training (or lack)  of decision makers such as insurers NTD,  specialists.

The healthiest environment for progress is one of team work and collaboration where all parties manage to agree upon and work towards common goals.  The injured worker has some input into this in terms of:

• Who they choose as their NTD
• Who they choose as their solicitor
• How they communicate  to  their support  team-  i.e. advising of problems or difficulties rather than wait until they are overwhelming
• How they attempt to deal with difficulties  that arise  -  i.e. with agents -  by staying patient, communicating  concerns and problems, knowing when or when not to escalate a problem

Rights and Responsibilities

It is important that the worker knows their rights and responsibilities and these are supported by all parties. In recent years there has been a growing emphasis on responsibility and accountability with less emphasis on rights. This is driven by a need for accountability and cost saving, in part due to some stakeholders having exploited the system for their own ends. Unfortunately this has resulted in many instances where reasonable entitlements - such as being paid on time or being able to access best practice treatments has either been refused or there are extensive delays.  Extensive delays in accessing treatment and in accessing medical or rehabilitation expertise ultimately leads to a blow out in costs.  It also fosters mistrust and hostility between stakeholders and passive resistance when one or other party feels they are being ignored or their needs addressed. 

Basic Rights of an Injured Worker

The basic rights of an injured worker include the right of the worker to choose their:

• NTD
• Treatment provider
• Rehabilitation provider
• Claim for necessary travel expenses to and from appointments made via their NTD or organised by the agent
• medication and other treatments expenses reimbursed
• a request for assessment of their home or workplace to identify aids or support services that can assist them to recover
• Reasonable costs associated with retraining,  i.e. courses, some mandatory equipment

Workers obligations

These include:

• Attending appointments organised by their NTD or agent
• Attending  appointments on time
• Notifying agents, employers , rehabilitation and treatment providers of changes in circumstances -  i.e. part time work,  change in number of dependents
• Their inability to attend an appointment in advance of a scheduled date

Where a worker needs to go get more support

A number of suggestions are made in the corresponding sections – “12 Months And Beyond A Guide For Injured Workers. “

Where you as an employer need to go to get advice and support

Although there are overlaps in the types of information an employer needs to know concerning their injured employee 12 months down the track, particularly in view of supporting the worker and understanding and dealing with the problems he or she may be experiencing there are some specify needs you as an employer are likely to have. These include:

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