Breaking down the Barriers of RTW

Identifying long term, complex and difficult claimants early

Presented by Robert MiglioreDirector, Actevate Pty Ltd

What is the most dangerous job in the disability service industry?

“…long term worklessness is one of the greatest risks to health in our society. It is more dangerous than the most dangerous

jobs in the construction industry, or the North Sea, and too often we not only fail to protect

our patients from worklessness, we sometimes actually push them into it,

inadvertently…”

Professor Gordon Waddell, commenting on the health effects of being off work

Worklessness

The role stakeholders play in creating worklessness

The elephant in the room is often there from the

very beginning….

RTW is a human drama in which the psychological and social

characteristics of the players influence the unfolding of events

Figure 1: Likelihood of RTW after various lengths of time off work

The number of days spent away from work impacts on a persons chance of RTW work

Psychosocial risk Factors• RTW rates have declined from 80%-72% in the last 4 years.

• Non-medical barriers to RTW play a major role in determining outcomes.

• These common barriers are:• Conflict in the workplace

• Personality traits of the characteristic players

• Fear of pain and injury

• Conflicting advice and diagnosis shopping promoted by health professionals

• Lack of self awareness and insight

Assessing Psychological Stress markers to reduce claims

Vocational discontent expressed by the individual prior to making a claim

Pre-existing personality styles makes certain types vulnerable to ordinary workplace stressors. Highly personalised and sensitive reaction high level of emotionality), perfectionist traits, paranoid and distrustful thinking styles, high level of self focus (viewing oneself in a highly positive manner)

Not necessarily problematic at work but a poor match between personality type and culture of the organisation

In a recent study of 400 claims, 70 percent were deemed legitimately caused by work related factors.

In- Psych Journal June 2006. Avg cost of Psych claim was $27,798 (21 wks)Avg cost of physical claim was $18.913 (8 wks)

Average age of claimants in study was 41-45, followed by 50 yrs and older.

Vulnerability in age group over 40 due to: vocational discontent, distress as a result of burnout associated with organisational change.

Difficulty with upsurge of younger managers and older workers

Extract from “Non-durable RTW: Learnings from the Campbell National RTW Monitor

Research on workers perception of blame has shown that people who fault their employer have a poorer response to treatment.

Traditional RTW Approaches• Employing the traditional medical model

• RTW Coordinator collecting information and not actively involved in the treatment and rehabilitation planning

• Multitude of service and treatment providers issuing conflicting advice

Traditional Claims Management Approaches

• Third party involvement such as:• Broker• Claims agent• Rehab provider• Company Doctor• Lawyer• HR advisers

Application of a biopsychosocial approach that considers the physical, social, psychosocial and emotional needs of the worker

Considering a new pathway

•Doctors treatment providers, and workplace rehabilitation providers reinforce incapacity, pain and the diagnosis shopping.

• The role of RTW coordinator is under threat from a multitude of stakeholders who know less than you do about the workplace, the individual and the return to work process.

• Motivation to return to work is influenced by a range of factors, most of which are not medical.

Nicessness

NicessnessWorkers receive prompt attention and intervention appropriate to their needs•Barriers, risks and strengths are identified and managed as part of the rehabilitation planning process•Immediate supervisor’s skills in managing workplace difficulties are enhanced by coaching, professional backup and development of principles of open communication and systems•Taking charge of the stakeholders and focussing them on the needs of the injured worker

•Improved RTW rates are seen in organisations with:

• Proactive disability management

• A people-oriented culture

• Active safety leadership

• Maintaining contact with absent workers, even when it is unlikely that they will return to work early

• Involving workers and their work mates in a co-operative approach to planning workplace adjustments

• The RTW coordinator has direct involvement in the RTW planning process

When an injury happens•Listen: Engage the worker with curiosity, not defensiveness and suspicion• Identify: the relationship that really matters • Investigate: What do we know about the psychosocial background of this staff member?• Encourage: Immediate supervisors to play a more active role in the support and engagement of the staff member? • Educate: RTW Plan belongs to the immediate supervisor and injured worker• Trust: The employee as the best judge of capacity