Months 1 to 3 - What is happening / should be happening?
It is a month or more after your employee was injured
and many things should have happened and be happening to assist them to recover
from their workplace injury or illness. About 85% of injuries being relatively
minor and uncomplicated should have resolved and your worker will be either fully recovered or
nearly recovered. Those workers
back at work on full or selected duties should have had their wage entitlements
paid, (see tables for entitlements at various stages under the new and previous
Workers Compensations Legislations),
money owing for medications and travel to medical appointments should
now be claimed, and should soon be reimbursed. All going well you and your
agent should have a copy of the latest Workcover Medical Certificate and your
previously injured worker should now be certified as fully fit or partially
fit for their pre-injury work.
The other 15% - There are many reasons why the remaining 15 or so
precent of injured workers may be still off work and some of these reason are
outlined below.
The injury itself
- The injury may be more
serious or complex. For
example a construction worker for a small company may have had a fall and
broken a leg, arm and sustained fractured ribs. Surgery may have been required
and more surgery is pending in coming weeks. With smaller employers
no suitable duties such as clerical or administration work is available
even if the nominated treating doctor (NTD ) certified the worker as fit for “Selected
duties - administrative work”-
- There may be uncertainty
about what is actually wrong -
Despite time having passed and no “red flags “initially assessed the injury is not improving as
expected despite rest and
conservative treatment. The
injured worker may be complaining of severe pain and restrictions, yet there is
no obvious organic basis for the symptoms identified at this stage. The investigative procedures at this
stage are likely to have been basic and relatively low cost ” – i.e x rays,
blood tests - More comprehensive
and expensive tests such as MRI’s, bone scans , and nerve conduction tests may not have not been considered or approved.
- Physical and Psychological Injury Occurring
simultaneously . 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 armed hold up and assault, a significant motor
vehicle accident - whilst
travelling from one job site to another.
With these types of incidents the consequences in terms of injury,
particularly psychological injury, may not be experienced immediately, or are
overshadowed by the need for urgent treatment to stabilise a physical
injury. For example in major industrial
accident, where several workers may have been injured significantly, the focus
initially will be on managing a life threatening physical trauma. It is only at a later stage, days,
weeks or months later that it
becomes apparent that significant trauma has occurred and this has a become a
barrier for the worker returning to the same workplace setting.
Problems you the Employer can cause
Occasionally industrial and workplace issues may be prove a
major barrier to an injured worker returning to full or near full capacity in
his or her preinjury job. Some of
the specific issues that can occur include:
- An employer being reluctant to accept an injury is work
related (despite liability being partially or fully accepted by the insurer)
and is therefore also
reluctant to support the
restrictions made on the medical certificate.
- An employer not being aware or being unwilling to
accept their obligations to provide suitable duties for an injured worker
- An employer agreeing to provide but then not
accommodating the restrictions or hours of a medial certificate.
- Lack of management and co-worker support - an attitude
that the injured worker is a malingerer, weak or not pulling their weight and “dragging
the chain”.
- Subsequent problems with the injured worker being
fearful of returning to work
Problems
with Diagnosis of Injury/injuries
Unless an injury is relatively
minor and it heals completely with little or no medical or other treatment
input, a comprehensive assessment
of the injured worker is essential.
The model that is supposed to be used and accepted in general health,
medicine, and rehabilitation is
the bio-psychosocial model. What this
means is that it is not only the physical aspects of person’s health that needs
to be assessed and planned for in treatment. The person’s psychological, and social situation also needs
to be considered. For example,
psychological responses to injury are inevitable if the injury is significant
(or trauma is involved). When an
injury doesn’t resolve or considerable discomfort occurs it is likely to affect
sleeping, energy levels and ability to carry out activities at home at work.
Financial difficulties also occur when income is reduced as a result of injury
and there is an incapacity to meet commitments. All of these changes and
potential challenges are likely to result in increased stress for the injured
worker , and have the potential to become associated with clinical anxiety and
depression if the underlying issues aren’t addressed. The environment the injured worker is exposed to
at work also affects stress levels.
An unsupportive employer or limited support networks at home can and
usually does compound coping difficulties and treatment responsiveness.
The NTD is supposed to have the
skills and experiences to assess and identify possible problem areas. Unless the NTD is able to identify
barriers and is proficient in making relevant referrals, treatment access is
likely to be delayed and treatment responsiveness reduced.
Problems
with Treatment
There are a number of potential issues concerning treatment
and responsiveness of your employee. These include:
- The
treatment being inappropriate for the
injury - the correct diagnosis may not have been made or more
information needs to available before the most appropriate interventions
applied. This may involve referral
for a more sophisticated test, such as
MRI, because rest and interventions such as physiotherapy are exacerbating symptoms or having no
positive results
- Treatment
inappropriate at this stage - There are situations where a treatment, although
appropriate in the medium to long term may be inappropriate if used to
early. For example an exercise and
strengthening program being ordered in the first 2 months after injury may be
premature if uncertainty remains about diagnosis and a range of red or yellow
flags are present.
- Quality
of treatment - The skill levels and expertise of treating practisonsers and
doctors varies. Some are better
than others, some have better “bedside manner” and can engage and motivate
their patients. These factors
influence treatment responsiveness and outcomes.
- Treatment
access issues - The ability to access treatment is a factor that has a huge
impact on than injured workers recovery, ability to return to work and the
overall cost of a claim. Typical
problems experienced by injured workers include treatment access declined by insurer( deemed as unreasonable and unnecessary), extended delays in treatment being approved, conflicting opinions between the workers team and NTD and the insurer about ways to treat and manage an injury, extensive delays in getting appointments to see specialists, and long times between appointment to see specialists or treatment providers due to supply and demand issues.
Worker Issues
Return to work out comes are affected by the nature and type
injury, the proficiency of the doctor and treatment provider in getting the
injured worker better and the support the employer and agent provides. Of at least equal if not greater
significant however are factors are related to the injured worker
themselves. Some of these
factors include:
- Fundamental
drive and need to get back to work, as work means different thing to different people. Some people
are compelled to work and feel useless or frustrated if they are not at work
- Financial motivators play a role as does
- Job satisfaction particulalry with the worker’s pre-injury work
role
- The need for support and enjoyment of working with the team
vs. lack of support when that worker needs it also influences motivation
- The feedback and support by family member also effects motivation levels, psychological
outlook and treatment responsiveness
- A worker’s continuing motivation and resilience to setbacks and difficulties
- Stress
levels and mental health having had a work place injury and being integrated
into the worker compensation systems.
Assuming all
has gone well and none of the barriers outlined above are present the internal
drivers that will influence a successful return to work outcome include:
- General
health and fitness prior to injury
- Previous
injuries or illness
- The
personality of the worker
- Internal
resilience
- What
the job meant for the worker before injury and their general satisfaction with
the job
- Adaptability, to make changes in life style and attitude to accommodate an injury
In the current NSW
workers compensation system even the most resilient, motivated worker is likely
to find the situation stress full, particularly if their injury has not
recovered or nearly recovered after a month. The potential obstacles cited above can lead to:
-
Financial difficulties
- Treatment delay
- Conflicts between stakeholders
- Bullying by stakeholders
- Communication breakdown
- Stress on the injured worker and other stakeholders
- Reduction in motivation levels
- Secondary physical and mental health problems - anxiety depression, poor life style habits, loss of physical activity, diet, and lifestyle change, social avoidance, relationship conflicts.
