The Heads of Workers' Compensation Authorities (HWCA) is the organisation that brings together all comp authorities in Australia and New Zealand.  Each year it publishes a report called the Monitor which evaluates performance and sets benchmarks. In 07/08, the Monitor was based on a survey of 3,017 injured workers.  It states:

"In 2007/08, just under nine in ten injured workers returned to work.  This rate is comparable with all previous years of the Monitor." 

Sounds good.

Actually, the return to work rate for 07/08 stated was 85% (eight-and-a-half people out of ten).

But durable RTW rates - that is, claimants who went back to work for 21 weeks - was only achieved in 75% of cases.  Turn that stat around and it says that 25 out of every 100 people who have a workers' compensation claim don't make it back to work.  No doubt some of them return to compo, go the common law route, or in time are shuffled off onto a welfare benefit scheme.

We know from the recent Australian Safety and Compensation Council report on the cost of work-related injury and illness for Australians, that in 05/06 this totalled $57.5 billion or 5.9% of GDP. Scary. This tells us clearly what the price is in $ terms, but what is the human cost and how many people suffer it?

Because there is no single report that addresses this question for Australia we have to extrapolate from various documents to get some sort of picture. It is difficult to work out exactly how many workers' compensation claims are accepted nationally each year, but the WorkSafe Victoria annual report gives a claim rate of 11.1 for every 1,000 workers. 

If that claim rate holds true across the country, then of the 10.8 million employed people in Australia, 118,767 will make a claim each year.  And if the durable RTW is only 75% then approximately 29,691 people end up out of work every year as a result of workplace illness or injury.

What does that mean for those 29,691 people?  We know from numerous evidence-based research projects on worklessness, that the consequences are dire.  Incomes go down, families break up, social isolation results, health suffers and mortality rates increase.

According to Owen and Watson writing in the Journal of Psychiatric and Mental Health the risk of suicide is 10 times higher among workless people.  The European Commission report on Employment and public Health (2002) states there is a positive link between mortality and unemployment for all age groups with cardiovascular mortality accelerating after two to three years of unemployment and continuing for the next 10 to 15 years.

Addressing the question "Is work good for your health?" Prof Gordon Waddell writes:

"There is strong evidence that unemployment is generally harmful to health, including:

• higher mortality;
• poorer general health, long-standing illness, limiting long-standing illness;
• poorer mental health, psychological distress, minor psychological/psychiatric morbidity;
• higher medical consultation, medication consumption and hospital admission rates."

Suddenly the apparently cheery news in the Workers' Comp Authorities' Monitor report that nearly 9 out of 10 go back to work after a workplace illness or injury doesn't sound so good.

There is no reliable statistic available to show what the annual death rate is as a result of worklessness that stems from work injury or illness. However, even if it is as low as 1%, then 297 people in each new annual claims crop will die as a result of failed return to work.  Compound that with only the last decade worth of compensation claims and suddenly the national mortality rate for failed return to work jumps to around to 3,000 deaths a year. And that, if our estimates are even vaguely accurate, is a national tragedy - far worse than the road toll.

It is natural for the organisations responsible for administering workers' compensation to want to reflect positively on their efforts.  They are staffed by highly trained professional managers who give their best effort to systematically resolving problems that they know exist. In that context they deserve applause that compensation officers rarely hear above the chorus of criticism from claimants. It is also true that the existing benchmarks and reporting processes reveal negatives that are then actively addressed e.g. the current focus on overcoming the poor results in the South Australian system.

However, the difficulty with the kind of benchmarking used by workers' compensation authorities and reported on in the Monitor is that it relies on figures rather than people.  There is a danger that the focus slips to improving the numbers rather than the product.  

If we look at Australia's state workers' compensation authorities only one of them, Queensland's, manages claims directly.  Instead of doing the job the authorities are established to do by their governments, they actually outsource the work to agents.

One wonders how many of the senior managers in the state authorities have ever managed a workers' compensation claim. How many of them have actual personal experience, real knowledge, of the people and circumstances against which they establish benchmarks to evaluate the performance of their systems?

From this perspective it is easy to understand why the most common criticism RTWMatters hears about the claims management of workers' compensation authorities is that they are system driven; that it is a process; that it is about numbers, not people.

There are problems in workers' compensation that current analysis does not reveal.  In our view it is of vital importance (a matter of life and death) to examine and report in detail on where the systems fail. Return to work is clearly one of these contexts.  The absence of RTW as a publicly declared national problem is alarming.

Without an open evidence based approach it is not possible to align the many conflicts of interest that exist in the return to work field.  Until the "one big problem" that is return to work is examined in detail it cannot be addressed.  And so long as RTW continues to be assessed and reported on as a positive, its practice will remain an insufficient scrap of nourishment that all the chooks fight over.

Good people within the system who are trying to improve it will give up and leave. Young claims officers will continue to burn out within a year or two and move on, treaters will remain frustrated, RTW Coordinators will struggle on without the true partnerships that should support them, and claimants will continue to fail in their attempts to return to work.

The people who are on the wrong end of this thing, who suffer in very real generational ways as a consequence, need it to change.  They do not need systems and benchmarks.  They need relationships, the creation of partnerships that work from top to bottom, engagement in which there is a willingness to acknowledge, examine, understand and solve the problem. 

The one big problem in return to work is in fact thousands and thousands of small problems.  At present the majority of these fall through the fingers of systems that don't comprehend that what it is really all about is not a better system, it is not benchmarking.  It is not a process. 

It is about relationships, partnerships, people.