Articles

Author - Dr Ian Low

I was honoured to present a Pathways Injury Management™ workshop to members of the Return to Work Coordinator Interest Group meeting on 14 October 2010. This article is a summary of the workshop.

The vast majority of workers’ compensation claimants will return to work with minimal rehabilitation. A relatively few claimants, however, will be responsible for most of an organisation’s claims experience due, in essence, to the length of time they remain off work. Some of these (potentially) long term claimants will have suffered a high severity physical or psychological injury but our research has shown that most of these claimants have suffered no more than a relatively minor physical or psychological injury, their (continuing) symptoms being due to a disturbance in their psychosocial functioning unrelated to the reported occurrence or activity. These findings are supported by experienced disability claims handlers who report that more than three-quarters of their most problematic cases started out as seemingly minor problems¹.

We have found that, with long term claimants reporting musculoskeletal symptoms: 

• about a third have not even suffered a physical injury, their symptoms being due to a disturbance in their psychological/psychiatric functioning; 
• a considerable number have suffered a relatively minor physical injury complicated by a psychological/psychiatric disturbance unrelated to the physical injury; and 
• less than 20% have suffered just a physical injury or a physical injury complicated by a psychological/psychiatric disturbance consequent upon the injury.

We have also found that the diagnoses of treating practitioners, with these (potentially) long term claimants reporting musculoskeletal symptoms, are usually of a physical nature whereas, through a more comprehensive physical and psychosocial assessment of these claimants, the diagnoses are, typically, more psychosocial in nature, consistent with evidence based medicine. The difference in diagnostic formulations will be related to the time constraints typically imposed on treating practitioners and the lack of information about psychosocial stressors which may be impacting on their patients.

This finding can be summarised as follows:

With long term claimants, there are typically marked differences between the diagnoses made by treating practitioners and those made through more comprehensive assessments which explore, in greater detail, the claimants’ psychosocial functioning.

If the diagnostic formulation is incorrect, the claimant would be expected to continue to report (disabling) symptoms and not (successfully) return to work.

Pathways Injury Management™ is a structured process of identifying these potentially long term claimants as early as possible through the use of a comprehensive assessment incorporating Poor Prognostic Indicators™;  adequate and appropriate information gathering about the claimant’s condition as well as from the workplace so that, with the use of a decision support tool, the diagnostic formulation is correct; and  a structured and systematic intervention with the claimant being “taken down” an appropriate injury management pathway to the resolution of the claim.

The Pathways Injury Management™ process, which integrally involves the treating practitioners, is summarised below:

1. Information Gathering
Accident/Incident Report Form (mechanism of injury)
Workplace Functioning Assessment
Structured medical assessment
Other information is collected as required

2. Assessment & Recommendations
Assessment Report & Recommended Rehabilitation Program

3. Consultation
Consultation with claimant
Consultation with treating practitioner

4. Rehabilitation Program
Implementation of recommended Rehabilitation Program

The Pathways Injury Management™ provides organisations with the structure, processes and resources so that they can effectively and efficiently manage their workers’ compensation claims, with resultant benefits to both the organisation and their employees.

With the introduction of Pathways Injury Management™, organisations would expect a reduction in case management costs by at least one third; a markedly improved workers’ compensation claims experience (with more fair and equitable outcomes in common law); and reduced rehabilitation costs.

Actevate is the accredited implementation partner for the Pathways Injury Management program. Please call 1300 669 552 for more information.

References:
1. Preventing Needless Work Disability by Helping People Stay Employed – American College of Occupational & Environmental Medicine