Return to work rates in Australia are poor. Fewer workers are resuming full-time hours and initiatives to improve rates have had little effect.

Guthrie and Monterosso suggest one explanation: compensation systems are harming injured workers by putting them under stress, delaying their treatment and decreasing the quality of their care.

A study by Robert-Yates found that many workers believe the compensation process adds to their level of distress and disability. Lippel, according to the International Journal of Law and Psychiatry, identified signs of psychiatric injury in some workers linked to their experience with the system.

How do compensation systems harm injured workers?

Emphasis on causation

Compensation is only available for injuries that are caused or exacerbated by a person’s employment.

The result is a fixation on causation. During the course of a claim, the worker’s version of events is continuously challenged. Invasive medical evaluations, in-depth questioning and private investigators are all deployed.

The need to prove their injury pushes workers to focus on their level of disability rather than their potential for recovery.

Over-emphasising causation may cause patients to exaggerate their symptoms. Some may resist self-help strategies to prevent being accused of “faking it all along”.

A parliamentary standing committee on Employment and Workplace Relations recommended that claims agents drop their persistent hunt for fakers and frauds. The Committee argued that the focus on causation distracted from the claims agents’ real goal, rehabilitating workers.

Helping an injured worker return to employment is cheaper in the long-run than drawn-out disputes over how the injury happened.

Mistrust of workers

Some claims agents have an institutionalised skepticism of workers’ claims, particularly where the injury is more subtle or complex. In particular, musculoskeletal injuries, stress claims and RSI can be viewed with suspicion.

Yet the Standing Committee found no evidence that worker fraud was common. In fact, the committee concluded that most reports of fraud actually reflected incompetence, misunderstanding or mismanagement by the employer or insurers.

Distrust of injured workers also surfaces in workplaces.

Other workers may be resentful of taking on additional duties. The employer views the worker as a whinger or trouble-maker. This treatment isolates the worker, leading to depression and anxiety.

Lower quality medical care

Injured workers often receive lower quality medical care than they would for a non-work injury.

To establish causation or function, workers are subjected to repeated medical examinations that add little to their care. They become increasingly frustrated with medical professionals and less likely to seek out treatment.

Ironically, fear of being labelled a liar may cause patients to be less honest with their doctors. Physicians cannot give the best possible medical advice without a full understanding of the patient’s condition.

Meanwhile, some physicians are reluctant to accept patients with compensation claims because of the paperwork involved.

How to fix it?

Current systems in Australia are causing harm to the exact people they were designed to help.

The systems suffer from a critical lack of social capital, meaning trust, reciprocity and co-operation.

Guthrie and Monterosso suggest:

• Embedding “above all, do no harm” into the legislation as an interpretation tool
• Implementing safeguards against unnecessary delays and non-therapeutic medical evaluations
• Encouraging early intervention and respect for the dignity of injured workers
• Limiting investigations to cases where fraud is clear or highly suspected
• Training claims agents to focus on return to work rather than strict compliance with legislation

On a cultural level, the system needs to cast aside its fixation on whether the worker is lying. The primary focus of all involved in the process should be returning the worker to employment.

Building social capital would cut down on the need for evaluations, investigations and disputes which create unnecessary stress for workers. Where disputes do occur, they would be taken more seriously and dealt with more efficiently.

The worker’s compensation system should improve a worker’s position, not damage it. Mistrust in the current system adds to the suffering of people who are already in pain.