What’s happening at the Frontline?

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The Tasmanian Minister for Primary Industries, Building & Construction and Veteran’s Affairs, Guy Barnett recently announced in a Media Release about PTSD Reform

“that Tasmania will become the first jurisdiction in Australia to legislate a presumptive provision for workers compensation claims arising from diagnosed Post-Traumatic Stress Disorder.”

He confirmed the government’s commitment in the following terms:

“….. Hodgman Liberal Government is committed to seeing first responders provided with a fair and reasonable access to workers compensation for work-related PTSD.”

Mr Barnett has also expressed his support for Veterans in the following Media Release:

New Proposals to Assist Veterans

These announcements have been generally well-received, although I have heard some concerns expressed that opening up presumptive provisions across the entire State Service might encourage claims from undeserving workers and create additional unanticipated problems. We are yet to see the detail about how the legislative amendments will work. Hopefully there will be consultation with the consumers and practitioners who work within the system regarding implementation.

There are however issues about how our Front-line “First Responder” workers are being treated where they have been accepted by the compensation system. A recent Channel 9 News Article highlighted the issue of a Fire Service employee denied  important treatment recommended by his treating doctors despite having suffered a serious injury.

While I have no knowledge of the case highlighted above, I have observed in a number of recent cases the adverse effects of an adversarial claims management approach towards Police, Ambulance, Hospital and Fire Service employees who have sustained serious physical and psychological injuries in the course of their front-line work.

The most common scenario is that funding for important treatment is denied, usually based on the opinion of an “independent” doctor who spends a relatively brief time assessing the worker. Many of these independent doctors have not practiced in the relevant field of medicine for many years and are reliant for repeat business from insurers according to the value to the insurer of the opinions they express.

The insurer (in the case of the State Service – a Self-Insurer) chooses the opinion of that doctor in preference to the opinion of the treatment team who know the worker’s condition best through multiple contacts over a period of time. Lengthy destructive legal processes are necessary to re-instate treatment.

If barriers to claims for PTSD by front-line workers are lifted, it will become increasingly important that the systems to support and assist workers managed within the compensation system are reviewed to avoid an increasing number of front-line workers being adversely affected by the system meant to support them.

Recently two important National reports have been released relevant to Workers Compensation in Tasmania.

The ABS Report – Work-related Injuries Australia July 2017 to June 2018 provides  interesting reading about the number of injuries, but highlights the relatively low number of people who actually make claims and have their conditions managed through our workers compensation schemes. While there is no breakdown by state, nationally only 55% of workers who experienced a work-related injury applied for workers compensation.

The 2018 National Return to Work Survey provides increasingly useful data about some of the outcomes for injured workers in compensation systems around Australia, including comparison between the states. While the official Return to Work rates around Australia of just over 80% (Tasmania is on a par with other states at 79.3%) are relatively stable,  some new information in the current survey is interesting. While Tasmania fares reasonably well on a number of measures, the rates of reported persistent pain and psychological distress are somewhat higher than most other jurisdictions.

The report states:

“While there is no statistically significant differences between jurisdictions, it appears that a higher proportion of workers from Tasmania and Comcare have experienced persistent pain than those from other jurisdictions”

“A significantly higher proportion of workers from Victoria (15.6%) had a Kessler 6 score indicating probable serious mental illness. Workers from Queensland and Tasmania also had a relatively high incidence of workers with ‘probable serious mental illness’ (11.5% and 11.8% respectively), although these results were not significantly higher than other jurisdictions”

Some of the Workplace Domain measures for Tasmania were also of concern, perhaps reflecting the relatively greater proportion of smaller employers in Tasmania.

I hope to provide a more detailed analysis of these reports from a Tasmanian perspective soon but, irrespective of inter-jurisdictional comparisons, the rates of persistent pain and psychological distress are a cause for concern.

Measures to improve the mechanisms to support injured front-line workers are important. This should not only include improved access to compensation system support, but also ensure that compensation schemes do actually support injured workers as intended.

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About Tasworkdoc

As an occupational physician in private medical practice in Hobart, Tasmania - the southernmost state of Australia, I see workers referred by their general practitioners with various types of work-related injuries and diseases. These are mostly musculoskeletal injuries, both of traumatic and gradual onset as well as various associated psychological disorders. With interaction with patients for treatment and providing advice about rehabilitation, I have the opportunity, first-hand, to observe interactions between individual patients and compensation systems. I also conduct independent medical assessments, including impairment assessments for musculoskeletal injuries and asbestos-related disease compensation. This provides another perspective of workers within compensation systems.
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2 Responses to What’s happening at the Frontline?

  1. jqu33431quintner says:

    ‘The most common scenario is that funding for important treatment is denied, usually based on the opinion of an “independent” doctor who spends a relatively brief time assessing the worker. Many of these independent doctors have not practiced in the relevant field of medicine for many years and are reliant for repeat business from insurers according to the value to the insurer of the opinions they express.’

    Peter, it has taken me a long time to understand what may be going on here.

    The best explanation that I can come up with is that doctors such as those you mention have been approved by our Western society to carry out an important function – that of stigmatizing people with psychological problems, or medically unexplained persistent pain, who are sent to them by third party payers for “independent” assessment.

    Why these people are selected for stigmatisation is a question that I hope we will be able to answer in a book chapter we are preparing for volume 2 in the series “Meanings of Pain”.

  2. Tasworkdoc says:

    Thanks John
    While I think there is some acceptance of roles by doctors as “protectors” of the financial systems (such as the various WorkCover schemes), I think the important issue is how adverse effects can be minimised within our existing systems.
    One aspect is to improve the independence of IME assessments, through measures to reduce bias and ensure IME assessors have up to date knowledge in the areas where they are providing opinions.
    A better approach i.e. without a full-on legal process to settle disputes about medical management, is the use of Medical Panels of recognised experts. The thorny issue though is the make-up of the Panel – who chooses the experts? Currently in Tasmania that is decided by a lawyer, who might not be aware of the nuances and biases of various medical specialities. Another challenge is a speedy resolution – and our legal systems are not renowned for speed!

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