Our WorkCover system is in need of an overhaul, at least in its handling of psychological injuries. Rather than helping injured workers have an optimal recovery, it often exacerbates their psychological difficulties. Problems include the invalidation of injured workers suffering from conditions such as post-traumatic stress disorder, unhelpful delays in treatment, and an unnecessarily long time before compensation claims are finalised. This results in part from the conflict-of-interest that health insurance companies have in providing rehabilitation services as well as in containing costs of rehabilitation.
A recent Four Corners program (August 1st), Insult to Injury, raised these issues. Whereas that program focused on the processing of workers compensation claims by police suffering from post-traumatic stress disorder, similar problems apply to others claiming mental health problems, physical injuries and pain occasioned by work incidents.
A key issue in the optimal treatment of mental health problems is that sufferers receive assistance early. Delayed treatment leads to a compounding of problems. Because of continuing stigma around mental health problems, many people do not immediately seek help when suffering from debilitating psychological distress. This might especially apply when people are working in professions with stoic cultures, such as police, soldiers and firefighters.
I know of many incidents where insurance companies have denied people’s claims out of hand, initially or after a handful of sessions. It often seems that their goal is to contain costs by creating an extra hurdle for those applying for compensation. Such initial delays and frustration of people’s efforts to seek help will often interfere with the person’s hopefulness for an early recovery.
Sufferers’ recovery is also often affected by the degree of suspicion with which their claims are viewed. This compounds their sense of invalidation and helplessness. This suspicion is partly reflected in the active surveillance of claimants. Few things cause injured workers more distress. It seems to imply that if someone is pursuing any normal activities, then they are likely exaggerating their mental health problems. This detracts from a sufferer’s motivation to increase daily activities, an important aspect of recovery.
However, in my view the greatest problem in our workers’ compensation system relates to unhelpful delays in determining the outcome of compensation claims for workers with psychological injuries, often taking many years. This stems from how our legal system deals with such claims.
The legal argument is that a final determination of compensation should not be made until the person’s work-related psychological difficulties and pain have stabilised. In the meantime the client goes through repeated assessments, including psychiatric assessments, over a period of years. Unfortunately, the stress around ongoing assessments and the uncertainty of the final outcome greatly interferes with the client’s stabilisation.
I would estimate that approximately 50% of WorkCover clients experience suicidal thoughts in the lead up to court hearings. By contrast, their conditions have often settled within 12 months of resolution of their claim to the point where they no longer need to attend for psychological treatment. They might have some ongoing difficulties, which might be substantial, but have usually then been able to shift their focus to living in the present and planning their future rather than having to repeatedly demonstrate how much they have been harmed by the past.
I believe it would greatly help if the vast majority of compensation claims were resolved within two years of the original injury. This would likely often lead to a cost saving of several further years of legal and psychological and psychiatric fees. More importantly, sufferers would be relieved of the uncertainty about the outcome of their claims at an earlier point, and would be freed from the role of having to highlight the extent to which they had been psychologically harmed. That role does no one’s mental health any good.
Hopefully the cost savings from predictably reducing the extended years of expensive treatment and legal services could be partly used to facilitate early treatment with lesser invalidation of those who were making claims in the first place.