Worker’s Compensation: Don’t Be ‘Psyched’ Out by Return-to-Work Obstacles

When a worker is injured or becomes ill on the job, it’s important to close out the claim quickly. This minimizes the employer’s costs and the impact on the employer’s experience modifier, and it is good for the worker, too, ensuring that his or her medical needs were dealt with and resolved quickly. One way of closing out the claim and resolving the worker’s issue is to successfully return the worker to his or her job as closely as possible to the original position and rate of pay.

According to a survey of claims administrators published by Rising Medical Solutions in 2016, the most commonly encountered obstacle to getting employees back on the job is a troublesome category of related issues collectively called “psychosocial factors.”

Psychosocial is not ‘Psycho’

The term “psychosocial” is somewhat misleading; it doesn’t mean that psychiatric issues are the big thing keeping workers off the job. Although being sick or injured and out of work can lead to anxiety, depression, and other mental health problems, psychosocial factors are a broad array of other related factors that affect a worker’s willingness and ability to return to work. These factors include:

• Trust. Without trust between the worker, the employer, the claims administrator, and the treating physician, a return-to-work may be difficult to effect. If the employer does not trust the physician’s work restrictions, it may not strictly abide by those restrictions. If the worker is inclined not trust the employer, the employer’s failure to honor the physician’s work restrictions becomes highly suspect.
• Economic factors. Sometimes, economic factors can affect a worker’s ability to return to work. If the worker cannot drive as a result of his or her injury, for example, it may be difficult for him or her to find or afford alternate transportation. If a worker’s nonworking spouse went to work to make up for lost income while the worker was on leave, the cost of childcare may become an issue if the worker returns to the job.
• Involuntary exaggeration of the impact of pain. Called “pain catastrophizing,” people who suffer chronic pain (pain lasting more than 3 months) may eventually begin to worry about it excessively, think about it constantly, and overestimate the possibility of unpleasant outcomes resulting from pain. Patients will avoid activities that may cause pain to the point of impacting their lives—including their motivation to return to work.
• Health illiteracy. Related to pain catastrophizing, this factor has to do with a worker’s inability to understand how best to perform self-care and prevent reinjury. For example, a worker who has suffered a back injury may be reluctant to return to work for fear of reinjuring his or her back, but if the employee is fully recovered, his or her risk may not be any higher than it was before the injury. Workers also may be reluctant to accept that movement—including returning to work—is better for their back (or other injury) than bed rest and extended time off work.
• Coping skills or resiliency. When a worker is injured, he or she may turn to damaging coping mechanisms like alcohol, illegal drugs, or prescription drug abuse. Or, workers may fall back on ineffective, passive coping mechanisms like avoidance, withdrawal, or wishful thinking.
• Workplace situations. Workers may be concerned about how their supervisors or coworkers will react when they return. Do their supervisors or coworkers blame them for their injury or for another coworker’s injury? Will their coworkers resent them during the time that they are on light or restricted duty for their inability to really do the job? Will their coworkers have difficulty treating them normally if they suffered a permanently disabling injury? Workers may be reluctant to return to work for fear of the reception they’ll get, but they may have trouble putting that fear into words, making it difficult to identify and address.

The One Question You Should Ask

So, which workers are the most likely to encounter psychosocial barriers to return to work? Experts say there is one question that can give you a good feel for whether the worker has the coping skills and resilience to overcome barriers and get back on the job: “When do you plan to return to work?” For any answer that exceeds 10 days, you may need to provide more intensive supportive services in order to get the employee back to work in a timely manner.