Contents

1. Examples of long-term or difficult cases

2. Events and factors of influence

3. What you can do

4. What workers want

5. Extra resources

6. Determining when assistance or referral to others may be required

Articles from RTWMatters on difficult cases

7. Think scary RTW cases come out of the blue? Think again.

8. Stalled RTW?

9. Flagging the obstacle course of bad outcome

10. Frustrated by "victims"?

11. Quick guide: Avoiding litigation

12. Life in the slow lane

13. What's more painful than chronic pain? Chronic pain in 'The System'

14. When the doctor says "no" to return to work

15. Top ten tips for preventing long term claims

 “Experienced disability claims handlers often report that more than three-quarters of their most problematic cases started out as seemingly minor problems." (2006) Preventing Needless Work Disability – SAW/RTW Paper

Difficult or long-term cases can be among the hardest to deal with.

What kind of cases can be classified into this category? Generally these tend to be claims that last in duration from one to three years. The employee may have made a number of attempts to return to work during this period, but has not been able to complete a sustained return to their pre-injury employment.

The following quotes have arisen from a number of academic papers and surveys that were created to assist in the reduction of these types of claims. The quotes identify what factors occur to turn what may be a minor injury into a long absence from the workforce.

"There is a surprisingly large number of employees who end up with prolonged or permanent withdrawal from work due to medical conditions that would normally cause only a few days absence. Many of those who end up receiving long-term disability benefits of one sort or another have conditions that began as common, everyday problems like sprains and strains of the low back, neck, shoulder, knee and wrist, or depression or anxiety.” (2006) Preventing Needless Work Disability – SAW/RTW Paper

“Perhaps most importantly, the injured or ill worker is engaged in a personal adjustment process, dealing with the disrupted life situation around the illness or injury. Getting sick or hurt suddenly disturbs the equilibrium that life was before the change occurred. Often workers are dealing simultaneously with a mixture of things in different dimensions: physical, logistical, financial, emotional, social and psychological. Virtually everyone has to cope with at least some transient disruption even though some medical conditions are so minor there is little objective impact to cope with: however, not everyone has the same resilience and level of coping skill, so some people find it hard to adjust to things that others barely notice.”(2006) Preventing Needless Work Disability – SAW/RTW Paper

“However, if an injured worker does not resume work within 4-12 weeks after sustaining an injury, and no significant physical pathology has been identified for treatment, then he/she will be at increasing risk of never returning to work.” (1999) Waddell and Burton

“Those injured in small companies (with fewer than 50 employees) are less likely to return to work at the place where they were employed at the time of their injury. Smaller organisations generally do not have as much experience dealing with workplace injuries as do larger ones, do not have specialised staff to co-ordinate return to work programs, and may be unfamiliar with their legal obligations. They may have difficulty providing appropriate modified work for an injured employee, or keeping the person’s job for them until return to work is feasible.” (2004) Return to work: Factors that influence return to work Institute for Work and Health

“The factors associated with protracted disability included low workplace support, personal stress, shorter job tenure, prior episodes, heavier occupations with no modified duty, delayed reporting, greater severity of pain, more significant functional impact and extreme symptom reports.” (2004)  Disability Management, Return to Work and Treatment, Goldner, Bilsker, Gilbert, Myette, Corbiere, Dewa

1. Examples of long term or difficult cases

Jill’s story                           

Jill had been employed as a nurse for 19 years before she was injured at work.

In May 2005 Jill was adjusting a trolley carrying a 97-kilogram patient when the trolley collapsed. Although Jill managed to keep the patient safe, she noticed an immediate and severe pain in her back.

Jill notified her supervisor of the incident, left the workplace and remained off work for a period of three weeks.

Jill made an attempt to return to work in June 2005; however, she continued to experience severe strain when undertaking any of her required duties. A range of treatments was tried but none seemed to bring much relief to Jill.

She struggled on and off for the next 15 months by trying a number of coping strategies. She alternated job tasks, the hours that she worked and the frequency of her shifts, but nothing seemed to help. Jill would often break down in tears at the workplace.

In September 2006 she could no longer work and has remained away from her workplace since.

In November 2006 at the suggestion of Jill’s supervisor, she tried a new specialist who subsequently ordered a new MRI scan. It was then discovered that Jill had a tear in a disc.

Further treatment consisting of nerve blocks, physiotherapy etc, was undertaken by Jill who was now managing to gain some relief from the pain.

Jill has now been absent from the workplace for a full total of 14 months (inclusive of all time lost).

Rob’s story        

Rob has been a serving member of the Victorian Police for a period of 12 years.

In this time he has worked in a number of roles; however, the three years prior to his injury Rob was mainly involved as an undercover operative.

In the course of his daily duties Rob was exposed to numerous incidents which have impacted on his psychological health, the most noticeable of these having occurred in February 2005 when he was required to negotiate a deal for a large quantity of illegal narcotics in an inner city warehouse. When he arrived, Rob realised that he had previously arrested one of the men before and was genuinely fearful that if he was recognised his life would be in danger. In accordance with normal procedure, there was no backup provided to Rob due to the sensitivity of the transaction.

In May 2006, Rob slipped while undercover and landed heavily on his wrist. He suffered severe bruising and a minor fracture of his scaphoid bone in his right hand. He has stated that this is his dominant hand and he cannot undertake normal undercover duties with the use of only one hand.

Rob ceased work in 5 May 2006 and has not yet returned. He has now been absent for a total of 16 months.

Various treatments have been attempted and Rob, while managing to gain some relief, states that he still feels pain, some numbness and tingling.

Rob also states that he is experiencing:

• Violent nightmares
• Agitation
• A feeling of discomfort and anxiety in environments he is not familiar with
• Depression at not being able to continue in his job assignments.

Rob has not received any treatment or medication for any condition other than his hurt wrist.

2. Events and factors of influence

Often there are a number of events and factors happening concurrently with the injury or illness that the employee has suffered. Outside influences such as the family, the community, depression or anxiety, prior experiences with health professionals etc, may all be present.

Some of these may include:

A fear of the workplace

1. Injured workers may feel that their injury is not seen as “real” by co-workers or management, especially in cases where there are little or no external signs, such as carpal tunnel syndrome
2. Co-workers may be resentful of the injured worker, due to additional work demands and time pressures placed upon them
3. Fear that the time taken off for recovery will negatively impact their current or future position within the company.

Motivation

1. The employee may undergo a changed self-perception, from healthy to “disabled”.
2. The longer the claim goes on, the more layers of complexity are added to it. More treaters are referred to, the cost and time involved increases and the situation may become more confusing and polarising for the injured employee.
3. If this claim is the first lodged by the employee, there may be a lack of understanding about the process, how the claims process works, what information needs to be supplied, and what actions the employer and employee are required to do.
4. Some treaters may focus solely on a return to work date, rather than identifying any work capabilities that the employee has that would enable a return to work in a modified capacity
5. Often the treating doctor will use a different term from that used by a physiotherapist for example, resulting in confusion to the employee on what the actual injury suffered is. It also appears to be a problem when treaters do not clarify information for the injured employee, or use medical terminology and jargon in their communications with the employee.
6. The employee may be unsure what the benefit of an earlier return will be to them.
7. The negative consequences of remaining off work can be ascertained by discussions with the employee, and may include factors such as self-esteem, isolation from relationships and increased rate of depression.
8. Consider the impact of legal involvement (the employee’s focus may shift to compensation rather than returning to work). Data consistently shows that where the option of litigation is taken up by the employee, the chance of a successful return to work is decreased substantially
9. Consider the psychological stress and emotional impacts in coping with the injury, disruption to routine and daily life.
10. Financial pressures reduced income may result in increased stress levels through trying to maintain a certain standard of living.

3. What you can do

Fear of returning to the workplace

What you can do

1. See if you can locate another employee with a similar injury who has had an effective return to work to assist you
2. Ensure that the return to work program provides the employee with suitable tasks that respect the limits of their incapacity, and meets their skill levels within their chosen work environment.
3. See if you can locate another treating provider who can provide more advice
4. Deal with any specific workplace concerns.
5. Establish regular meetings to communicate with the employee on a daily or weekly basis.
6. Identify and seek assistance from other support staff at your workplace who can assist you.

Lack of motivation

What you can do

1. Identify what the employee needs or wants (this will involve a level of trust in each other to achieve this)
2. Encourage the employee and remain positive in your own attitude
3. Ensure that the employee realises that the return to work program has been tailored to best fit him or her, and can be negotiated dependant upon how the employee is coping and feeling
4. Surveys have reflected a better chance of a return to work when employees are offered tasks at the same job and skill level as they had prior to the injury. Employees who perceived that they had been given a completely different role or position below the prior one held are more likely to experience an unsustained or disruptive return to work.
5. While you are monitoring the employee, keep an eye out for things done well by the employee and praise accordingly.

Other issues

What you can do:

1. Encourage the employee to make use of the Employee Assistance Program (if available in your workplace).
2. Clarify questions.
3. Resolve disputes with co workers.
4. Move employee to another area.
5. Discuss long term options, retraining and deployment where appropriate.
6. Involve other team members such as Human Resources
7. Establish regular meetings to involve the team in management of the case
8. Offer to talk with the employee outside of the workplace in a social environment, i.e. a coffee shop