At first glance, it can seem as though employers and insurers have good reason to thoroughly investigate stress claims. After all, work is work, not a walk in the park. We all get stressed sometimes, but we don’t necessarily take time off to deal with it, or blame our employers for the problem. Workers’ comp for stress can seem like having your cake and eating it too: why should some people get away with it?

Before we can begin answering this question, we need to think for a minute about what stress is, in the context of a workers’ compensation system. Or we could, as Dr Rod Gutierrez from Injury Management Solutions suggests, forget about “occupational stress” altogether. Sound tempting? 

Dr Gutierrez has done some very interesting research into claim patterns in NSW and he believes that “occupational stress” is a misleading term.

“It’s too broad,” he told us, “And it’s become clouded by its use in everyday language and by its relationship with general biological explanations of stress. Stress, occupational stress, it’s all become one and the same. Not a very useful or descriptive concept if you’re trying to investigate why people submit claims for workers’ compensation.”

Instead of talking about “occupational stress,” Dr Gutierrez prefers to talk about “psychological injury.” In this context, “injury” is used as a legal, not a clinical term: a psychological injury has occurred when someone makes a claim because they hold their employer responsible for their distress.

Unlike, say, a broken leg, psychological injury is usually invisible; but to believe therefore that it doesn’t exist is a bit like a child covering their eyes and believing that, because they can’t see you, you can’t see them. In fact, Dr Gutierrez’s study found that, despite all the resources spent on investigations, the majority of psychological injury claims were valid. 

However, not all psychological injuries– no matter how genuine – are compensable, and what is compensable seems to be determined more by political than medical factors.

“The workers’ compensation system is a legal-political construct, so it keeps changing,” Dr Gutierrez told us. “The definition of what is a psychological injury today may be different tomorrow. It almost becomes a political football at times, what will be compensated and what will not.”

Talk about muddy waters! It’s no wonder that employers and insurers view psychological injury claims with suspicion.

Of course, psychological injury claims also have a reputation for being expensive. Fear of getting involved in a costly and drawn-out claim is another reason why employers and insurers are keen to investigate these claims thoroughly. Ironically, the very process of investigation makes a long term, adversarial claim far more likely.

In NSW, where Dr Gutierrez is based, claims are supposed to be validated within 21 days, but in practice insurer liability determinations can drag on for months. During this period, the claimant and the employer are both in limbo. Employers don’t want to spend money on an intervention until the claim is validated, which leaves claimants sitting at home, with ample time to stew over the causes of their distress and no encouragement to return to work. Sounds like a recipe for trouble, doesn’t it?

Dr Gutierrez certainly thinks so.

“Initially, when a claim for workers’ compensation is submitted, we’re still spending a lot of time purely investigating the claim rather than getting in there and managing it from the beginning. We know that the longer these people are out of the workplace, the less opportunity we have to get them back to work. That’s where I think we’re getting it wrong. We’re spending way too much time, valuable time, critical time, investigating claims instead of spending it encouraging return to work.”

And there is a nasty cherry to top it all off: for employees (and employers) being investigated is stressful.

“You’re asking the claimant to prove that what they’re saying is true. An investigator will go out and interview the claimant, interview the workplace. Then, information from the worker will go to the employer and information from the employer will go to the worker and you can imagine if that’s not done very well and skilfully, it can be potentially a very damaging process, for both the employer and the worker.”

If it wasn’t so harmful and costly, you’d have to laugh. Investigations of the validity of psychological injury claims discourage employers from giving employees the early help they need, and encourage distressed employees to become even more upset. The “process steamroller” powers over people again!

Organisations should think hard about who is investigating their psychological injury claims – and how competent they are at handling these delicate matters. The very nature of “stress” means that claims need to be dealt with as soon as possible. Within two or three days, a psychological injury claim can easily spiral out of control. It is these out of control claims – not timely, effective intervention – that are costly in the long run.

Investigation should never happen instead of intervention. When it comes to psychological injury, people should always be more important than process.

We first heard Dr Gutierrez at the 2009 Workers’ National Compensation Summit.
You can contact him via Injury Management Solutions or email rod.gutierrez@imsolutions.net.au