Case management critical to psychosocial workers' compensation claims

A New South Wales state law review has highlighted the need for a specialised approach to workers' compensation claims when they involve psychosocial illness. There has been close to double the volume of these types of cases with around 11% of all current NSW workers' compensation claims relating to a psychological injury, compared with 6% a decade ago.

Compensation claims for psychosocial issues differ from those for physical injuries, with much longer absences from the workplace: 20 weeks compared to six weeks, and when cases involve both psychosocial and physical problems the average time off work increases to 31 weeks.

This may be partly due to underlying factors. A recent Australian Council of Social Services report showed that one in 10 wage earners in Australia report high or very high levels of psychological distress. The State Insurance Regulatory Authority's (SIRA) own customer research shows one in five people who made workers' compensation claims have a probable mental illness.

Compounding the extended recovery times for psychosocial issues, making a workers' compensation claim may expose the employee to exacerbating conditions including:

• high case manager turnover
• low workforce capability
• investigations
• delays in decision making and accessing treatment.

These statistics support the need for updating workers' compensation services to improve the quality of case management, particularly in the area of psychosocial illnesses. Such measures adopted by insurers could include screening for the risk of delayed return to work and psychological distress, developing tailored pathways and hyper care arrangements where those risks exist, and minimising friction points.

Recruiting, training and retaining highly capable case managers is also key to improving case management. SIRA is now actively considering case manager credentials to lift standards across the industry and is piloting an outbound assistance service for workers' compensation cases.

Businesses' case managers can access guidelines for managing claims for workers with psychosocial issues and the return to work process.

Why Gallagher Workplace Risk offers competitive advantages in handling psychosocial claim cases

Our psychological claim management framework delivers best practice management throughout the 12-week provisional liability period to assist all the stakeholders involved, relevant to the type of psychosocial injury concerned.

The framework includes premium forecasting of the potential impact on insurance costs in future years. As part of this offering Gallagher also connects clients with preferred service providers such as legal or rehabilitation specialists familiar with the legislation, who can steer processes and provide guidance.

Gallagher has a network of qualified workers' compensation, injury management and risk management specialists across Australia, with broad experience in managing scheme, risk and self-insurance workplace related claims programs. This means that we can support businesses across Australia with relevant technical advice on claims and injury management levers that can assist to sustain workers in stay at work programs and reducing compensable costs.

Gallagher employs occupational therapists to manage mentally ill and injured workers. Occupational therapy is a regulated, degree-based health profession with a focus on the 'whole person' perspective to working and participating in meaningful activities. Gallagher occupational therapists work with injured workers by aligning their goals and motivations and with return to work objectives that assist in injury rehabilitation and prevention of recurrence.

Given the sometimes adversarial and complex nature of workers' compensation programs, our experts can provide valuable input by reviewing submitted claims and providing guidance on evidence or the approaches required concerning eligibility, managing minor claims or addressing complex claims. This includes recommending strategies for engaging with insurers or scheme agents.

Our Workplace Risk and Advisory Team can assist employers with reviewing their claims trends and confirm if the business's safety management system adequately identifies, assesses, controls and monitors mental health hazards.

Gallagher Workplace Risk services that meet recognised psychosocial claims case needs

Engagement with GP and treating mental health providers as a multi-disciplinary approach to managing recovery: our occupational therapists can coordinate medical case conferences or provide advocacy to medical providers on safe return to work and stay at work plans.

Providing training and guidance to line managers and supervisors on recommended approaches to managing mentally ill and injured workers to prevent further complexity or improve return to work rates.

Risk review of mental health hazards to help inform risk control plans for injured workers and to protect others in the workplace.

Completion of inherent requirements of the job (IROJ) reviews to build job dictionaries that provide role guidance on physical and cognitive demands. These are used to help build worker support plans for professional development, respond to worker injuries and assist in planning for workplace change to structure or job demands.

To access our expertise in reducing workplace injuries and impacts in the workplace connect with our Workplace Risk specialism now.

Disclaimer

Gallagher provides insurance, risk management and benefits consulting services for clients in response to both known and unknown risk exposures. When providing analysis and recommendations regarding potential insurance coverage, potential claims and/or operational strategy in response to national emergencies (including health crises), we do so from an insurance and/or risk management perspective, and offer broad information about risk mitigation, loss control strategy and potential claim exposures. We have prepared this commentary and other news alerts for general information purposes only and the material is not intended to be, nor should it be interpreted as, legal or client-specific risk management advice. General insurance descriptions contained herein do not include complete insurance policy definitions, terms and/or conditions, and should not be relied on for coverage interpretation. The information may not include current governmental or insurance developments, is provided without knowledge of the individual recipient's industry or specific business or coverage circumstances, and in no way reflects or promises to provide insurance coverage outcomes that only insurance carriers' control.

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