Many of you know of our focus on the psychosocial influencers for return to work, and how we have invested in tools to collect this information to gain a greater understanding on the influencers on a claim.
Well for this month we would like to give our platform to Dr Claire Muselman, an industry leader in the world of Workers Compensation Insurance, as we reproduce a blog she recently produced for WorkersCompensation.com. To see the full article, click here.
Thank you, Claire, for permitting us to reproduce your article and for your help ‘banging-the-drum’ of psychosocial awareness in claims management!
What goes into an injury that creates differences in the healing process?
Let us look at a relatively common diagnosis in workers’ compensation, low back pain. Many injured workers will have a short treatment period. There will be moderate use of prescription drugs and physical therapy. Return-to-work will be prompt and there will be a smooth recovery with limited future problems for the injured person.
While many injuries workers will experience the above, there will be some injured workers who do not have the same outcome with a diagnosis such as low back pain. These injuries will seem to have an injured worker over treat, use a heavy amount of prescription drugs, and the injured worker will appear to magnify their pain. An appearance may manifest surrounding a lack of motivation or persistence to get better exhibited by the injured worker. As it relates to work and the injured worker’s behavior, a passive or resistance to recovery and return-to-work may also be present.
Why? …Why is there such a difference with the same diagnosis and relatively similar circumstances? This is where we need to dig deeper and shift our focus to psychosocial issues. Psychosocial issues matter.
Recovery is not simply that of an injured body part attempting to repair and heal. When working with an injured human, the entire person is involved. This includes the mental, emotional, and psychological components that make us human, not simply the physical aspect of having pain in the lower back from the example above. A multitude of elements play into the whole person who has been injured and this whole person needs a plan encompassing of these elements to get better on the road to recovery.
Psychosocial issues are sometimes identified in the workers’ compensation system as High Risk Factors. We all have them; however, when you have been injured, they can prevent or create challenges around the healing process. These psychosocial behaviors can be life style choices, life events, and other high risk characteristics. They are not comorbidities which relate directly to a medical health condition.
Fear is a common emotion attached with injury and when someone enters the workers’ compensation system because there is a lot of unknowns. From pay to medical treatment, to job security and family dynamics, there are a lot of unknowns with what happens throughout the process as well as what life will be like after recovery. This matters because fear is debilitating. People tend to freeze and fail to move forward with feeling the emotions associated with fear.
Marital issues play into the recovery process. Human injury can change the dynamics of a relationship, not only with a spouse but one with children. If issues existed previously, these can be amplified during this time of uncertainty. The nuclear family can be helpful during the recovery process; however, if they are too helpful, this can be just as damaging as if there is no support system, creating greater challenges.
Financial issues arise when there are unclear expectations and parameters set upfront when a claim occurs. Workers’ compensation is financially dependent upon statues set forth by each state jurisdiction. Many times, injured workers are ill informed about who is paying what and how much they will receive. This is amplified with commercials from attorneys who create the facade there is a big pay out in the workers’ compensation arena. Benefits are state mandated and set forth by specific statute language. This misconception put into our media makes it challenging to help an injured worker understand what they qualify for and that makes it imperative the adjuster as well as the employer, explain the process, timeline of benefits, and exactly how they are calculated for an increased awareness around expectations
Anger can be a reaction from injured workers throughout the process. It is important to dig at the source of these feelings and emotions because they can give you an insight in how to help during the recovery process. For example, if an injured worker has anger towards their direct leader or their company, explore why this exists. It can be helpful for the injured worker to feel heard as well as find a way for the employer to be involved. One of the most valuable and cost-effective things an employer can do post injury is have the direct leader of the injured worker call or shoot a text within the next 48-hours post injury to simply check-in. Anger tends to be felt towards employers for their lack of care and concern whereas anger tends to be felt towards adjusters when adjusters fail to be accountable and let items fall through the cracks such as returned telephone calls, payments being issued, and authorizations completed timely. All of these items previously mentioned are within the scope of control of the involved parties, cost nothing to complete, and make all of the difference with an injured worker.
Substance abuse and addictive behaviors can be a very large inhibiter of the healing process and if an injured worker has these types of characteristics present, assistance may be needed. This is where the team approach with the employer, adjuster, and a nurse case manager can be helpful to identify the behaviors to form a plan to navigate these challenges. While substance abuse is not related to the work injury, it has a drastic effect on the injured worker’s mental capacity to navigate the space and can inhibit healing of their body. Having a nurse case manager involved for these type of issues can allow for further communication with the injured worker and the medical provider to formulate a plan and adds another layer of accountability throughout the claims process.
Entitlement mentality is an interesting avenue to navigate. Verbiage is important, especially when looking at this issue. If someone is injured in a compensable manner, meaning their injury arose in the course and scope of their employment, they qualify for benefits outlined by the state of jurisdiction. Punitive damages are not involved in workers’ compensation as workers’ compensation benefits are inclusive of medical treatment and indemnity benefits. Many people fail to recognize this or explain it in a manner consumable for both the employer and the injured worker to understand which sets unrealistic expectations. The ideal of entitlement can then manifest itself into soft-fraud where the injured worker takes advantage of a system they feel failed by increasing claims cost and healing time as a result. Clear expectations of what an injured worker qualifies for must be outlined immediately for transparency in the process.
Stress, depression, and anxietyhave become a new state of living in our world during the pandemic. We are isolated and unsure when the world will return to a normal state leaving people feeling uneasy, high anxiety, and depressed for the future. Injured workers’ feel like this post injury. There is added stress not only around financials of learning where their pay will come from, how it is calculated, who is paying, and when, there is also a loss of commodore with peers, friends, community, and sometimes family. An injured worker can feel as though they are losing pieces of their identity during this time making it more challenging to focus on recovery during this process.
Why do psychosocial issues matter? They are driving forces behind delayed healing, increased claims cost, and poor outcomes. We can take a pro-active approach to an injured workers’ psychosocial issues by proper communication, expectation setting, and taking a sports mentality approach to getting someone back to work, back to life. Taking the time to outline roles and responsibilities with check points along the way holds all parties involved accountable for the recovery involved with the injured worker. Here is what your adjuster will do, here is what your employer will do, and here is what the injured worker will do. Set expectations and follow up to follow through so the accountability withholds through this relationship along the road to recovery.
Psychosocial issues matter. We should all come to the table to get the injured worker back to their life. Set realistic expectations, front-load communication, do what you say you are going to do, and improve employment practices. We can all do our part to improve the relationships in the workers’ compensation space to make each day and each counter better for one another. We can enhance the engagement of the injured worker or deplete it. We should all do our part to make the workers’ compensation industry a little more human by taking the time to identify the factors that could make the greatest difference.
By Claire Muselman
Claire Muselman is the Director of Workers’ Compensation for a regional insurance carrier, Professor at Drake University, and life-long cheerleader for making good things happen for people.
For more information on how we can help your claims operation understand “Psychosocial”, please email us at email@example.com.