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Home » Employers » Injury Management- What is Happening and When? » Months 1 to 3 - What is happening / should be happening?

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:
  1. 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
  2. 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.
  3. 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.
  4. 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.

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