An injured worker refuses to attend an appointment. The claims agent loses important paperwork. The surgeon never answers your emails.

If this unhelpful behaviour would sour your mood, you’re not alone.

Research into reciprocity suggests that people respond to others’ actions with grander acts of a similar kind.

Buying someone a glass of wine may prompt them to bring a whole bottle of Merlot on the next date. But people who are treated badly often treat the perceived culprit even worse.

Robert Eisenberger from the University of Delaware did a study where college students’ answers on a test were criticised by his assistant.

When it was their turn to criticiser, the students showed no mercy. They used harsher language towards the assistant, objected to more points and showed visible anger, like crossed arms or scowling.

This was true even for students who were not identified as “angry” or “dominant” in every day life.

This phenomenon, known as negative reciprocity, plagues return to work schemes across Australia.

Negative reciprocity in the return to work system

A study by MacEachen from the Institute for Work and Health suggests that mundane system-level issues can damage a worker’s chances of returning to employment.

Let’s say the return to work manager rejects the doctor’s suggestion for modified duties. The doctor feels sidelined and becomes un-cooperative. The patient’s claim is put on hold because the doctor did not complete the paperwork. The patient calls the claims agent but gets no response.

The patient is already feeling vulnerable and scared. He now suspects that the system is geared against him. He remembers that his supervisor sighed and rolled her eyes when told about the injury.

When enough injustices pile up, it leads to what MacEachen calls “the toxic dose”. The worker begins to deteriorate mentally and physically as they lose faith in the system.

As time goes on, the worker becomes less focused on returning to work. They put less effort into self-help strategies and rehabilitation plans. They might consult with a lawyer and raise a legal dispute. Why, they ask themselves, should they care about their rehabilitation when no one else seems to?

In particular, people who already feel marginalised are more likely to react negatively to being wronged. Their trust in the system is already so low that a single bad experience can make them to reject the process as a whole.

Negative clients need to be treated with extra care. But their negativity tends to result in less assistance. This only escalates the client’s feelings of isolation, kicking off a negative cycle.

Some managers faced with a work injury freeze up. They express no sympathy for fear of admitting liability. They do not understand the scheme well enough to give advice. Rather than risk doing something wrong, they do nothing at all.

To a recently injured person, this inaction can be interpreted as disrespect or suspicion. The worker is put on their guard and any chance for open communication has passed.

According to William Shaw from the Liberty Mutual Research Group, many workers expect return to work managers to offer communication, support and practical assistance. The managers, however, see their role as representing the company and assessing injury.

When the worker’s expectations are not met, they feel let down by their supposed supporter.

Meanwhile, some employers avoid reporting an injury in order to keep their premiums low. They ask workers to come back early or withhold approval for time off. 

Workers who believe their managers are hostile to injury claims will be wary before the first conversation is had.

Damaging effects

These conflicts can cause moderate cases to drag out for years and eat millions in compensation costs.

In the US, it was estimated that five to ten percent of injured workers with musculoskeletal problems incurred up to 85% of total workers’ compensation costs. In Canada, eighty percent of costs are tied up in twenty percent of claims.

These costs are not determined by the severity of the injury, but the length of the claim. And the length of the claim is impacted heavily by the level of co-operation in the system.

Suggestions to improve return to work often focus on changing policy or system structure. Different groups point fingers at one another. Doctors think employers should do more; employers think doctors should be more involved.

What gets overlooked is that day-to-day interactions between people have the biggest impact on a claim’s progress.

Trust is built on a foundation of small gestures, like a warm smile or a returned phone call. These minor factors can be more powerful in improving return to work rates than all the doctors’ reports, policy frameworks and rehabilitation providers combined.