We all have targets in our jobs. Finish a certain number of reports, close a certain number of files, don’t drink more than a certain number of coffees (a particularly difficult one to stick to).

Insurance agents are no exception. Increasingly claims agents and insurers are rewarded on performance, so targets are set for their own staff. Their ‘KPIs’ – Key Performance Indicators – determine a level they should be striving towards, and some have been known to include claim rejection and claim termination targets.

A little like the now abolished university Bell Curve marking system – in which, no matter how students fare, some must ace and some must scrape through – insurers’ KPIs can dictate that, even if every claim that comes their way in a period of time is legitimate and worthy of compensation, a reason to reject at least some must be found.

Frieda believes this is exactly the reason her claim was rejected.

She is young – tick. Motivated – tick. Likes her job – tick. Relies on the income – tick. Wants to return to work – tick. Her employer is cooperative and willing to accept claim – double tick.

Her situation ticks every box for a successful return to work; yet her story ends in unemployment, followed by financial stress, anxiety and uncertainty about the future.

The human case inside Frieda’s story was lost to an acrimonious system.

Frieda developed a common shoulder condition, after 8 years working in small but busy factory warehouse with colleagues who’d become friends. It was a role she felt good in and positive about.

After developing intense pain in her shoulder and neck, her eight-hour shifts became impossible. Concerned, she sought treatment.

She trialled a restricted work duties plan. The pain returned. Her work implemented ergonomic improvements. It was too late. She tried another, longer, period of restricted duties. Her symptoms remained.

Her anxiety was building. As a single mother, Frieda’s income was the only financial source for her and her young son; she could not afford to lose it.

Her workplace backed her. They helped her lodge a compensation claim and expected that, in doing such, both they and Frieda would be assisted to move forward and clarify the best way to get Frieda back into a sustainable work arrangement.

Instead, lodging the claim introduced them to an insurance agent with little time and little compassion to appropriately accommodate Frieda and her employers’ uncertainties and aims to settle the claim.

In a meeting with the insurance agent, both Frieda and her employers found him to be rushed and hostile, and he asked no questions. When people who find themselves tangled in a process they don’t understand very well, it can be very difficult to find the courage to say, ‘Slow down please and explain to me what’s going on. What should we expect from all of this?’

That’s all Frieda and her employers wanted to gain from the meeting.

Her claim was rejected, to the disappointment of her and her employers. The basis of rejection was an early medical examination which indicated the injury was not work-related.

Frieda felt she had been treated somewhat like a criminal, as though she were trying to defraud the workers’ compensation system, and her needs for secure payment for lost wages and coverage of medical care were left unmet. The warehouse employed two staff, and there was little in the way of productive modified duties. She felt furious for the lack of support and advice she and her workplace were given from the source she believed had a role to play in helping. She also felt disempowered.

Those available to assist the employee through the dispute resolution process recognised the claims person involved, and told the employee she wouldn’t be successful in the matter being resolved. They understood how the claims person and their organisation operated. It didn’t matter that three other doctors indicated Frieda’s condition was work-related, and that the employer accepted her problem.

Frieda is now looking for another job and has done some part-time work, but found it difficult with the ongoing shoulder pain. She is in low spirits, struggling financially, and doesn’t see how the situation is going to change. Her employer is disappointed, and despite going through the dispute process to help get the matter resolved, feels let down; the system did not help their employee.

The process-driven system won. Encouraging effective claims management saves money, and claims staff should be rewarded for effective claims management. But when the process supersedes caring for employees, it’s time to question the system. Loudly.

Process over people may work in the short-term. But the longer term impact is lack of respect for the system.

For better individual and community outcomes, we need people in all roles in the workers’ compensation system to ask questions, not argue; to be sympathetic and supportive, not cynical; and to drive a successful and speedy return to work – not to impede it.

The notion that most people are scammers out to rort the workers’ compensation system is a false one; approaching cases with that attitude is one step in the right direction. Another is transparency in performance incentives paid to claims management organisations and claims staff.

Cases that finish up as Frieda’s has could – and should – be avoided.