Positively managing workplace injury

Work injuries are a pain for all concerned and a drain on resources. Workers suffer physically and employers suffer financially after a work-related accident. But despite all precautions, work injuries are a fact of life and their cost can be great.

Increased claims lead to increased workers compensation premiums, yet these are eclipsed by losses incurred from time taken off work - especially time exceeding that which is really necessary for the injury.

So what can be done about it? The answer lies in dealing with insurance claims proactively rather than reactively, and in seeking professional claims management assistance when you need it.

Coordination is the key

The NSW workers compensation legislation allows shared or 'engaged' return-to-work coordinators, permitting employers to contract out all or some aspects of claims management to experienced professionals.

Director of Rehab Options, Steve Stephens believes that both employers and employees need someone who understands how the system works.

"For instance, it is important to have a good rapport with insurance companies. They get to know you, and develop a relationship of trust so that when you supply accurate information and talk about actual, real injury management and claim status you are more likely to be believed."

It also speeds things up if you have a network of approved medical professionals at your disposal. "I draw from a pool of WorkCover accredited doctors, injury management consultants (IMC) who are prepared to address all the relevant barriers to return to work. They can usually fit the injured worker in immediately, rather than requiring him or her to spend hours in pain waiting at a hospital," Stephens says.

Early intervention

It is important to take action as soon as possible after the accident. Prompt medical attention by a qualified specialist in the field of the injury will provide an accurate diagnosis and prognosis. This is essential to prompt and effective recovery.

It must be considered when a new injury occurs whether an inspection or investigation is required. Often crucial evidence can be lost or destroyed, making eyewitness accounts less reliable. A return-to-work coordinator can attend the scene of the accident within the hour. The site is examined, photographs and measurements taken, and witnesses identified and their accounts recorded.

"Early intervention helps you understand how and why the injury occurred. Sometimes it can lead to surprising results. Just one example is when I discovered that the scaffolding erected by one company on a construction site was incomplete and the injury was not the actual employer's fault".

"The workers compensation claim did not impact on my client's policy at all, as a result of that we were able to recover the sum from the insurer of the company that erected the scaffolding," says Stephens.

Early intervention also helps prevent the recurrence of similar accidents. Without knowing the precise cause of an accident, it can be difficult to guard against it happening again.

Saving money

By developing a complete understanding of the particular claim as well as a sound knowledge of the system, inappropriate costs can be excluded from being calculated into the matter. Further, make sure that all relevant treatment and prompt action is undertaken to prevent matters from exceeding acceptable recovery times.

"Myself or my staff keep in close contact with everyone during the entire process. The process is clearly documented. This means that when it's time for the claims review there is a great degree of certainty and everyone is on the same wavelength".

"Therefore, if a certain test or treatment is required, I am able to get immediate approval as opposed to someone who descends on the insurer out of the blue. You could say that my role is to keep everything on track," Stephens says.

"Employers and their financial representatives cannot effectively argue with the insurance companies' trained claims experts," says Stephens. "However, if correctly briefed, action can and will be taken to legitimately improve the status of the individual claims. This eventuates in an agreement of improved status by the insurer, with the cost savings immediately applied".

"Something often not realised is that insurance companies, when given no usable information to the contrary, are required by the workers compensation legislation to base their figures on worst-case scenarios. This, of course, results in a higher premium."

Changing the culture

Legislative changes and the use of a return-to-work coordinator can lead to a change in the culture of work relations. The incentive to malinger after an injury occurs can be eroded, and the use of a go-between can reduce resentments between workers and employers.

"Workers don't like feeling that they are being hassled by their boss. I am in regular contact with injured workers but they don't resent it. As a matter of fact, they feel that by employing a specialist to care for them through their injury the company is compassionate and caring. They realise I am independent and have to work under strict WorkCover guidelines, so there is the perception that I am fair."

Equally, employers don't have the time, expertise or resources to effectively address all the issues and complications that are not unusual in an injury claim.