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Information of interest to our Clients and for the industry


Case Study: When altering your reactions can affect RTW outcomes

At Work Options we see many situations where a worker submits a claim for an injury at work, and doesn’t always have the experience they expect. In this case study, we look at a landscape labourer who was suffering from unknown mental health issues, and an employer who could have acted differently to avoid a negative and costly experience for both the employer and worker.

Case Study:

Ron* was a 38 year old labourer working for a landscaping business in New South Wales when he tripped on-site and fractured his right elbow, resulting in a worker’s compensation claim. Due to the nature of his work and the injury sustained, Ron was deemed ‘unfit’ for work and took temporary leave whilst he recovered. Whilst on leave, the employer made no attempts to communicate with Ron, until 6 weeks post-injury and post-surgery, when Ron was given the capacity to return to work in alternate duties. At that time the employer did not engage in discussion with Ron, but rather sent him a pre-drafted return to work plan outlining office-based duties.

Ron became frustrated with the lack of communication and spoke aggressively to colleagues who were contacting him via phone, the insurance agency and the Workplace Rehabilitation Consultant. The employer responded to Ron’s frustration by telling him to ‘pull himself together and understand that they were trying to support him’.

After a number of weeks of non-communication between Ron and the employer, Ron made a suicide attempt. Following this, Ron spent extended periods of time at home, not engaging in normal self-care or hygiene practices, which further isolated him from any support outside of his family. It was then discovered through Ron’s wife that there was an extensive history of mental health in his family.

Over the next several months, Ron rejected any communication attempts from the employer and insurance company, made three additional suicide attempts and was admitted to two impatient units for a combined total of 15 weeks. The employer became frustrated with Ron’s aggressive behaviour, considering it inappropriate, and elected to no longer attempt to engage with him.

After two years Ron had still not returned to work and his mental health did not improve during this time.

Recommendations:

  1. Communication is key! As soon as an employee is injured at work, it is important that the employer or a colleague checks on them regularly to ensure that they feel supported and are open to the recovery process. In this case, if communication lines were open, it would have been easier for the employer to determine that Ron was suffering from a mental health condition, which could have been managed and potentially prevented from escalating to suicide attempts.

Open communication may seem like a simple step however is often not done, particularly when mental health is concerned, for fear of making it worse for the individual.

 

  1. It is important to understand that, even when introducing positive changes, people experiencing low mental health will often react emotionally and can feel increased stress with change. This is likely how Ron felt when he received a return to work plan outlining alternate duties, without first being notified. By consulting Ron initially, he would have felt as though he had some input on the plan itself, and felt compassion from his employer.

This logic also applied when a person is still working within the workplace – businesses have a legal obligation to make reasonable adjustments to the workplace environment when a worker has disclosed low mental health, and that person needs to be a part of that discussion.

 

  1. Using language such as “we will work through it together” or “we are here to support you” shows empathy for the injured workers situation and allows them to feel valued. In this case, using language like “pull yourself together”, gave the opposite effect and caused Ron to stop communication altogether. This behaviour known as ‘avolition’ or ‘demotivation’ is typical for people experiencing low mental health, and is a sign that they often need more support to help them during these periods. It is important that if things have escalated to this point, professional advice should be sought. Suicide is fundamentally a coping strategy, a sign that a person doesn’t have a better way of coping or needs more communication around their mental health experience, and should be done professionally.

 

  1. Often people with low mental health such as Ron don’t understand why things happen unless it is explained to them; again, communication is key. Despite non-communication from Ron over the next several months as well as additional suicide attempts, although his aggressive behaviour was in fact unacceptable, reasonable attempts need to be made to explain why the employer’s communication will cease.

Although Ron’s reactions to his alternate duties were considered aggressive and unreasonable, his actions are realistic for someone suffering with a mental health condition. If your seeing signs similar to this case in your workplace, ensure that you initiate engagement, provide communication and support, and show compassion. Follow these steps, suggest and seek professional support if required, and preserve employee performance at work.

 

 

Understanding How Psychosocial Barriers to Pain Affect RTW Outcomes

Have you ever been for a routine chiropractic appointment and met with, ‘Oh wow, you’re back is really out of alignment’ before a click and a crack has you sorted? But then in another week or two your back starts to ache and you automatically think ‘my Chiropractor said my back is out and it’s hurting again so I obviously have a bad back.’ Think about it… have you actually always had a bad back and since your Chiropractor has pointed it out, you’re more sensitive to back pain? Or have you just been sitting for a long time and need to stretch out, or lifted a heavy box from an awkward position? Perhaps there are a range of other factors that are impacting your perception of pain…

The psychosocial approach to pain looks at the combined influences of factors – or barriers – within a social environment, and determines the effects they have on physical and mental wellness. Beliefs, values and behaviours are examples of these barriers which can impact on an individual’s pain threshold and perceived pain tolerance.

Pain threshold refers to the point at which a stimulus causes pain that can no longer be tolerated, whereas pain tolerance refers to putting up with pain day to day. In order to recover, an individual must tolerate pain in order to increase physical capabilities, which ultimately then increases pain threshold.

So how does this all relate to return to work outcomes? Often an injured person will tell themselves that they can’t do something, or they can’t function at full capacity, because of their injury. As a result, they start to move less in fear of making their injury worse, which is the opposite of what they need to do to make it better, slowing down their recovery time. Their thought process goes something like this:

Injury Management Specialists will tell you that a fast and efficient recovery and return to work is about increasing physical capabilities which will therefore increase pain threshold, and reduce reliance on passive treatment and medications, in order to gain a sense of empowerment and return to their pre-injury state.

Here’s how an Injury Management Specialist will assist an injured worker reduce the impact of psychosocial barriers, and get back to work sooner:

  • Provide rehabilitation services, recovery strategies and mediation between doctors and specialists to manage pain, with sustainable upgrades in capacity to increase function
  • Set personal goals for increases in self-efficacy, improved relationships, mood and reduction in pain through personal, domestic, work and community
  • Provide pain education and encourage shifting beliefs about pain:
    • Provide valuable and educational resources beyond Google
    • Listen to what the worker hears, rather than what they are told
    • Checks in to identify what they’ve learnt and put ideas into practice
  • Focus on reducing pain by encouraging the worker to reduce reliance on passive treatment, reduce pain medication and home help, and take control of their pain

Pain is a subjective experience; everyone has personal barriers when it comes to pain, which is often reflected in our actions. But what is important to understand is that psychosocial barriers to pain, and the fear of making an injury worse, can sometimes mean that pain gets worse anyway, or an individual develops chronic pain as a result. Defusion – changing the relationships with thoughts – and acceptance – turning off the struggle switch – are key factors in the psychosocial approach to pain and recovery. An Injury Management Specialist will use these tools, and others, to create a placebo affect, and shift pain beliefs by allowing increased confidence to function, the resolution of the cause of pain, and ultimately allow improvement in life and return to work as quickly as possible.

Consult an Injury Management Specialist or Return to Work Provider.

 

Common Injury Management Mistakes Guaranteed to Rise Insurance Premiums

As an employer, you have a lot on your mind when a worker gets injured… I’m not going to meet the deadline; how will I get the job done now; what will this cost me; should I hire a temporary replacement?

The last thing you need to add to the stress is the cost of your insurance premiums rising because you haven’t followed the correct procedure or not acted quickly enough.

At Work Options, we see a lot of situations where an employer’s insurance premiums rise because of common injury management mistakes. Here are the top 6:

Not offering suitable duties
Offering suitable work duties is critical to the return to work process and keeping your insurance premiums down. How? Returning to work in some capacity is proven to significantly increase the chance of the worker returning to a pre-injury capacity, assisting their physical and mental recovery, in a much faster timeframe than doing nothing at all. In turn, there are less costs for medical, legal and wages.

Not acting soon enough
It’s pretty simple really… failure to report the injury will result in delays in the claim, treatment approvals and actions taken by the insurer to start the process; all costing valuable time and money, lost wages, and ultimately a slower return to work. You should notify the insurer within 48 hours of a workplace accident or injury.

Not being active in the process
We hear it from workers all the time… “My manager acts differently towards me since my injury”. Unfortunately some employers don’t take an active part in a worker’s recovery and return to work until they notice a jump in their premiums. Not only does this often lead to conflict between the two parties, but workers will feel undervalued and employers forfeit any control they have over the direction of the claim, ultimately resulting in rising premiums.

Not having a rehab provider involved in the early stages

It seems pretty obvious that complex injuries require specialist advice, support and treatment… and without it, the return to work process will take longer. Simple to do – just ask your insurer to refer. Did you know that the cost of a rehab provider does NOT go onto your claim cost?

Not making WHS a priority

Prevention is ALWAYS better than a cure! Again, it seems like a simple task but unfortunately many Australian businesses don’t implement WHS initiatives because they either lack the know-how or resources. Education, appropriate PPE and tailored WHS policies and procedures are the best way to reduce the amount of injuries which occur in your workplace, keeping insurance premiums down and reducing costs in the long run. Ever wondered why workers are repeating injuries in the workplace, or how they are aggravating existing injuries? This is all avoidable when you make WHS a priority!

Termination of injured workers
Here is the biggest mistake you can make! Firstly it is illegal to terminate an injured worker within six months of a work-related injury, due to their injury; secondly by terminating an employee within three years of a claim, your premiums are likely to escalate..

It’s easy to be frustrated when an employee is injured at work, but it’s important to act quickly, offer support and provide suitable work duties, to get the worker back to work, with minimal disruption to the business. And you should know… if suitable work duties are not provided, your insurer is required to calculate an estimate for wages to be added onto the claim, and history tells us this can be somewhere between one and up to eight years of wages!

The best option? Protect your business by engaging an experienced Return to Work Provider to help you navigate through the minefield of regulations and technical information and avoid costly mistakes.