Is there a consensus about the vision and purpose of worker’s compensation schemes?
According to the Merriam-Webster Dictionary Obfuscate means – ” to make it so that it isn’t clear or transparent, much like dirty water makes it hard to see to the bottom of a pond”.
I am not suggesting that vision and purpose are being maliciously or purposely hidden, but often the over-riding objectives (and the assumptions and values that underly them) are not explicit, leading to uncertainty and confusion.
Read on for my views about this important subject.
Management Principles – an historical take
In the 1980’s and 90’s, as Senior Medical Officer and later Health & Safety Manager with Tasmania’s Hydro-Electric Commission, I was exposed to various “flavour of the month” management systems aimed at improving productivity and assisting workers and managers alike focus on core business functions and service delivery .
Don Williams as an incoming General Manager in 1988 (a newcomer from outside the organisation), brought with him “Objective Management” to stamp his own style on the Hydro-Electric Commission’s 5000+ workforce. His successor, Graham Longbottom, introduced TQM – Total Quality Management as his preferred system. I am sure there are plenty of other approaches that have come and gone since that time, but I wanted to reflect on how such management approaches might relate to workers compensation schemes.
I recall it was “Objective Management” that required the development of “Vision” and “Mission” statements supported by a series of relevant objectives discussed and agreed by each work team. While labelled a wasteful “talkfest” by some, there was value in bringing out what we were actually trying to achieve, the values that underpin objectives and how agreed objectives are best achieved.
Workers Compensation Schemes
Workers Compensation schemes were borne out of the recognition of an obligation by an employer to indemnify the workers for adverse health effects arising from employment. Schemes were developed, initially in Germany but the UK and the USA soon followed. It is beyond the scope of this article to go into historical detail.
While the principles and processes of providing workers compensation coverage have been the subject of continuing tension between workers and employers, I suspect there was never much shared and agreed understanding between those parties about what was hoped to be achieved. Some employers still consider they have no real obligation in this area, while some workers expect unrealistic benefits if they are injured at work. Lack of clarity about the purpose of workers compensation schemes is a significant barrier to delivery of effective service provision.
To this day unions and organisations that represent workers see workers compensation as a basic right, pursued through industrial action and the courts when not delivered, while some employers still only seem to accept that workers compensation benefits are to provide income and medical treatment support and financial compensation for clear cut “blood on the floor” injuries (and then only those employees who are deserving of such help).
On the other hand, other parties (such as my own – the medical and allied health professionals) see workers compensation as a health care system. Some perhaps merely as a source of funding for the treatment that they provide i.e. an alternative to Private Health Insurance or Medicare. The latter perspective ignores the important rehabilitation and income support aspects integral to compensation schemes.
I suspect insurers see such systems as another line of insurance business, a highly regulated one at that, that doesn’t take adequately into account the risks they take when they offer such products in the marketplace.
While such perspectives might not come to the surface in cases of straight-forward short term injuries, these differing expectations often come to the fore in longer term complex cases where the parties become frustrated and start to question why progress is not being made, who is to blame and who should pay.
Some worker’s expect that their employer’s Workers Compensation insurance will cover everything they consider they have lost (income support and ongoing medical treatment, even domestic help – ongoing until a full recovery is achieved), while an insurer will sometimes retreat behind what they are legally obliged to do in such circumstances and justify that withdrawal of support with rationale about the negatives of “over-medicalisation” or the need to promote self-efficacy.
The employer’s response is more variable, between “hand-balling to the insurer” – having paid their premium, though to active participation in supporting, or not supporting, their employee – depending on their perception of the merits of the worker and their claim. Sometimes employer behaviour is strongly driven by the financial aspects, particularly any impact on future insurance premiums.
My observations about doctor’s attitudes is that mostly they consider providing care for workers in compensation systems difficult and often unrewarding, both professionally and financially. These perspectives can arise because of lack of understanding of how the system operates, the “hands-on”approach by insurers to vetting medical expenses, and the variable motivation of both workers and their employers. Sometimes frustration seeing workplace rehabilitation providers paid more than doctors to sit in doctor’s waiting rooms and “regurgitate” medical opinions in long-winded reports to insurers causes resentment. (I should point out that I don’t agree with that view about real rehabilitation professionals.)
Scheme Regulator Statements
How do the various Government Regulators, as the “umpire” in this complex “game” see the overall objectives? Do they set out their vision and purpose?
In the states that carry the liability and responsibility for workers compensation, including New South Wales and Victoria, there are some relevant statements.
While it seems the Victorian Ombudsman disagrees that WorkSafe Victoria’s objectives are delivered (at least in relation to the long-term injured), as regulator and service administrator WorkSafe does state its role https://www.worksafe.vic.gov.au/about:
WorkSafe Victoria plays a critical role in the lives of Victorian employers and workers – as the state’s health and safety regulator and as the manager of Victoria’s workers compensation scheme. In both capacities, employers and workers are at the heart of our service
Our aim is to keep all workplaces healthy and safe, and to deliver high quality care and treatment when workers are injured.
In the states where private insurers underwrite workers compensation (the “underwritten” states, including Western Australia and Tasmania) there seems to be a more variable approach.
WorkCover WA provides a comprehensive statement about its role, purpose and values. It’s vision is stated in the following terms:“a workers’ compensation and injury management scheme that works for all.”
is measured by reference to the following:
– the lowest standardised average premium rate across the states and territories
– over three quarters of scheme costs expended on services and payments for claimants, on par with the national average
– nearly 90 per cent of claim disputes resolved within 6 months, well above the national average of 73.3 per cent
– a return to work rate of 93 per cent, on par with the national return to work rate
Further WorkCover WA’s purpose is stated in terms of leading a contemporary, sustainable and integrated workers’ compensation scheme that is fair, accessible and cost effective for all participants, through:
– providing advice and guidance on workers’ injury management and return to work practices
– active, responsive and transparent management of the scheme
– focused information, education and compliance activities
– fair and speedy dispute resolution
– a strong service focus.
While the Tasmanian WorkCover Board and WorkSafe Tasmania have a broad (and highly commendable) objective in relation workplace safety with a 90% return to work target for injured workers, I can find no explicit statement about the workers compensation scheme itself, i.e. it’s vision and purpose, whether it is the preferred system for the treatment and rehabilitation for workers with workplace injury and what the objectives in respect of health status of it’s users.
While understandably the emphasis in strategic documents is on prevention, there does not seem to be an aspirational statement about whether workers with work injuries actually belong in the workers’ compensation system or a statement about the overall purpose of the the workers compensation scheme and how its effectiveness is assessed.
At a National Level, Comcare defines its role in relation to regulation, managing claims and administering their scheme, but apart from referring to recovery and return to work, does not refer to health service provision directly, as outlined below:
We are a government regulator, workers’ compensation insurer, claims manager and scheme administrator.
Through our role, we work with employees and other workers, employers, service providers and other organisations to:
– minimise the impact of harm in the workplace
– improve recovery at work and return to work
– promote the health benefits of good work.
We collaborate and partner with other schemes and organisations on research and innovative projects that improve outcomes
Comcare’s purpose is to promote and enable safe and healthy work. This outcome drives our work.
To deliver on this outcome, our focus is on five strategic priorities:
– Excellence in service provision
– Engagement with our stakeholders
– Prevention and early intervention across our scheme
– Insight driven and risk and evidence-based practice
– Being adaptive and sustainable in the face of change”
As important service providers, some of the private insurers do set out their aspirational goals.
For example, Allianz Workers Compensation includes the following statement:
Making a difference, together
We are proud to partner with employers across multiple jurisdictions, including a range of federal and state departments.We want to make a difference to workers’ recovery, their workplace safety, and their health and wellbeing. We’ll work with employers to provide a smoother journey, from coverage to making claims, helping workers get back to work if their recovery allows, and everything in between. Supporting what we seek to do are our four pillars, the things that will continue to help us make a difference.
One of their “four pillars” is stated as follows:
“We focus on the wellbeing and recovery of injured workers to help them return to work if their recovery allows.”
My own experience from the consulting room “Coal-face”
In occupational medical practice, however, I regularly see confusion about the purpose of workers compensation schemes with frequent queries about the advisability of making a claims and engaging with a compensation system. This particularly applies workers with mental health disorders.
To some injured workers it seems natural to submit a claim, but many hesitate to use the system – arguably the specific system designed for use in such circumstances.
At other times workers submit a claim because they “were told to” by their supervisor or manager (and are then taken aback when the claim is queried or contested).
To me this raises questions about whether the system is indeed “Fit for Purpose”, at least from the perspective of workers with injuries.
Here are some familiar scenarios in my own practice:
“Doctor, is this workers compensation?
“Should I put in a claim” ?
“I know this happened at work, but I don’t want to claim because:
– It will affect my promotion prospects/access to overtime/roster inclusion
– I might lose my job
– My boss won’t like it
– I’ve had a bad experience previously
– I couldn’t handle the stress
– I don’t want to make a fuss”
In this era of mounting medical costs with concerns in an ageing population about escalating rates of mental ill-health and degenerative disease (already overloading our Public Health and Hospital Systems), should use of workers compensation systems be actually encouraged to reduce the load on our already stretched mainstream health care systems?
With an effective health care focused compensation system, injuries could potentially be better managed. If the system was truly “Fit for Purpose” i.e. a system designed to most effectively manage work injuries and illnesses, and engage with the workplace might we not expect better health outcomes and return to work rates than are currently experienced? I am not sure if that can be achieved, but it is worthy of discussion.
As a starting point, an informed discussion about values and purpose i.e. “Mission” could be invaluable, before strategies are developed and detailed strategic plans are developed and implemented.
A first step would be for regulators and system stakeholders to engage in a discussion to see if a consensus can be reached about the “Mission” of the relevant workers compensation schemes that provide an important health care and income support system paid for ultimately by employers and the broader community.
Alternative Statements of Purpose:
Whatever is agreed, the fundamental need is for an attempt at consensus about the role and purpose of workers compensation schemes.
As I see it, the alternatives are (there might be others):
“the workers compensation system is the system specifically designed to support recovery and return to work used by workers who suffer injury or illness caused by their work “ i.e. this is where injured workers belong.
Or perhaps, an alternative:
“the workers compensation system provides a “Safety Net” for severe injuries where there is no other cover” i.e. closer to current implicit expectations of some stakeholders
Or something in between!