(8 steps for tackling a long-term case – Part 1)
 

6. Does the case require forensic work?

As a medical practitioner, I see complex cases and it is amazing how often basic information is not gathered.

A typical question might be, “Is this condition is still related to the work injury?”

A research study from the US looked at the health problems of those involved in a car accident. When the medical records of those in the car accident were reviewed, the researchers found that 50% of those who had said there were no prior problems in fact have had had pre-existing problems in the part of their body they were complaining about.

Does this mean they're naughty or not telling the truth? No. Over time, people forget about problems that occurred many years ago. When there is a claim, there becomes an intense focus on the incident that precipitated the condition; what happened in the past tends to fade.

Alternatively, people may not be telling the truth. In these circumstances, by far and away the best information is from the treating general or health practitioner they were seeing prior to the claim being lodged. It takes time and energy to get that information, but this is crucial to a complex long-term case.

Do you need a copy of the treating doctor’s clinical notes, or a report from the previous treating doctor? If so, what questions are you going to ask to ensure you get the right information? Asking for a general report with standard questions may not be helpful. Design your questions so that you get the information you need. For example:

• "When was Mr X first seen at the clinic?”
• “Has Ms X had prior consultations for low back pain?”
• “Have there been any investigations or treatment for low back pain?”

If the medical condition is complex, who can assist you to understand the issues? Do you have access to a doctor or health practitioner who can spend the time going through the file and help you understand the issues? Do you need that practitioner to help you develop a list of questions?

Getting another independent medical review on a long term claim has limited benefits, particularly if the forensic information is scant. Investing time and energy to get the full picture is important. You may need to get buy in from your manager to allocate sufficient time.
 

7. What are the barriers standing in the way of you achieving your stated outcome?

Is there a medical issue that has not been adequately or appropriately treated? Is the person entrenched in a victim mentality?

Is the person distressed, and too anxious to be able to effectively deal with the situation?

Does the person have low levels of confidence in themselves, i.e. low self efficacy? Are they good at problem solving, or do they become overwhelmed easily?

Are they depressed? And is this a major factor in the motivation? Are they comfortable in the current situation, motivated to maintain the status quo? Or are they angry with how they have been treated, and therefore justified in being difficult? Are they entrenched in a battle?

Do they expect a large lump sum payment? Do they believe that payment will be higher if they are ‘sicker’? This unfortunate situation exists and whinging does work in some compensation schemes.

Identifying the barriers helps you start to identify ways of overcoming them. Here are some relevant links:

• Victim mentality:
  • “Dealing with the victim mentality”
     
• Problem solving
  • “Resolving long-term claims”
     
• Anxiety
  • "Down the rabbit hole"

8. If the worker may consider return to work, what resources are required to help them re-enter the workforce?

Motivation is the key. A de-motivated worker will find all sorts of excuses and reasons not to be retrained, job-seek, or generally work with you.

If the worker is not motivated, how can you explore what is getting in the way? Look at motivational interviewing as a technique to help you identify where the worker is at.

Is getting back into the workforce something they would consider, but they are not yet ready for change?

Have they been motivated in the past, but given up after failures? Are they simply set in their ways? Perhaps you're going to have to do a fair bit of work with them to identify reasons why return to work might be a positive step for them, in their world.

Are they fearful of not managing? Have they lost their confidence? What might help to build their confidence?

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Dealing with a new long term claim can be demoralising. Are you going to be processing a file with an unhappy person, with relationships strained and a battle of wills undermining your endeavours?

Understanding the deeper issues can allow you to develop a strategic approach – one that will be more satisfying and ultimately effective for all parties involved.