This article is based on my introduction to the presentation by Professor Alex Collie at the Pre-Symposium Seminar held in Hobart on 15 June 2017.
I have previously tried to explain the reasons for my interest in reform of compensation systems. I made an amateurish video to explain, but my wife was aghast that I was wearing what appeared to be a flannelette shirt in the video. That probably represents the Sharman background as farmers on Tasmania’s NW Coast!
As I tried to explain in the video, what I see in my current practice, on an almost daily basis, are workers whose recovery is unnecessarily impeded by ‘the system’. While some have argued that Tasmania performs better than inter-state jurisdictions, I don’t think it matters too much about how we compare, rather any worker’s recovery unnecessarily affected by the system is a waste. That’s my concern.
I started my medical career in Tasmania in 1981, working at Tullah on Tasmania’s West Coast as the doctor for the Construction Workforce for the Pieman River Hydro-Electric Scheme. I vividly recall 3 fatalities during that period – a construction worker on a power station roof feel to his death, a loader operator in a sand quarry was buried alive when the wall of the quarry collapsed and a diver who died trying to retrieve valuable stainless metal gates used to close off the diversion tunnel from very deep within the cold and dark waters of the Murchison Dam. During my later period of employment with the Hydro, I recall an incident causing multiple confined space deaths at the Tungatinah Power Station in the Central Highlands. There were serious accidents that didn’t result in death and even some positive stories. I remember a seriously injured construction worker who went on the a prominent career in Human Resources in the Mining Industry as a result of his incapacity for ongoing physical employment.
What I have seen over the years is a reduction in these types of incidents with improvement in workplace safety generally, as reflected by falling incidence of workplace injury and associated compensation claims. I have however witnessed an increasing problem with chronic pain and secondary psychological consequences resulting in long-term disability following work injuries. Most of these cases end up receiving income support from Centrelink.
The overall trend in claims management has been a tougher approach. I recall the days when the Tasmanian Government Insurnace Office (TGIO) operated in Tasmania and acted as the insurer for the Hydro Workforce. There was sense from the claims personnel of doing what was right for the greater good, not just the financial benefit of the insurer they worked for. That ethos has all but disappeared. In the late 1980’s there was enthusiasm for the new concept of ‘workplace rehabilitation’ and I have a certain nostalgia for a generally positive and co-operative approach to help injured workers back to work at that time.
In recent years, I have become ‘politically’ involved because of my observations about escalating adversarialism and worsening claims outcomes from a medical and rehabilitation perspective. My observation might reflect the change in the work I undertake. I have changed from a role as company doctor involved in strategies for both prevention and rehabilitation through to my current role where I see the worst end of the compensation system – the litigated, controversial and long-term cases of incapacity.
An alternative explanation is that the apparent deterioration in our systems is due to increasing numbers of people with age-related and degenerative disorders being managed through our compensation systems where they don’t really belong. Or perhaps the change results from increased focus on financial outcomes and scheme viability. I can’t answer that, only guess. The evidence might provide some clues.
When I started talking to other practitioners about these issues, I became aware there were similar concerns amongst a variety of medical, allied health and rehabilitation practitioners, both in general medical and rehabilitation practice and the specialities that become involved in long-term compensation cases – pain physicians, clinical psychologists, rehabilitation physicians, orthopaedic & spinal surgeons, and psychiatrists.
Many doctors tell me they only get involved in workers compensation reluctantly and in some fields it is difficult to get a doctor prepared do see a workers compensation case at all.
The other significant development in recent years has been the apparent exponential growth in research in the field of Compensation Health.
The RACP/AFOM document “Compensable Injuries and Health Outcomes” released in 2001 stated:
“There is good evidence to suggest that people who are injured and claim compensation for that injury have poorer health outcomes than people who suffer similar injuries but are not involved in the compensation process”
“However, research into causes of poor health outcomes for these people is fragmentary and inconclusive. Not enough is known of the effects of different types of compensation schemes or different methods of management of cases (by all practitioners involved) to allow the development of a ‘best practice’ model.
Any attempt to ‘reform’ the compensation system(s) must be informed by further rigorous research”
Since that time there have been organisations set up dedicated to research in this field e.g. ISCRR (Victorian-based) and the Recover Injury Research Centre (Qld Based).
When I was involved in putting forward ideas about how to improve the system, there was fierce resistance, initially from the insurers. I encountered this personally when I made a presentation a few years ago to the Private Insurers Group on behalf of the AMA. Luckily that initially hostile reception has led to processes being put in place that have allowed constructive ongoing communication to occur between doctors and insurers.
When the same ideas were put to WorkCover as the regulator, it was questioned whether there was indeed any problem at all. WorkCover drew attention to Tasmania’s performance relative to mainland jurisdictions with the conclusion that Tasmania sits at the top of the “League Table” as follows:
- the lowest proportion of compensated time loss payments (31% off work at 3 months in a 2010 ISCRR study)
- According to the SafeWork Australia RTW survey, Tasmania achieves a 92% “Return to Work Rate” and 86% “Current RTW Rate”
This data has been questioned as to whether it accurately reflects health outcomes within compensation systems. Whether inter-jurisdictional compaisons can be made using this data has also been questioned, as follows:
- Much of the data comes from insurers. Time loss data reflects time off where compensation was paid and doesn’t reflect actual recovery times (one researcher has suggested this approach underestimates time off by between a factor of 1 and 7 at one year post claim)
- The SafeWork Australia RTW survey captures data about whether a worker has participated in any type of RTW programme at a defined point during the course of their injury, not their capacity to return to pre-injury or even full-time alternative employment
- It is not valid to compare performance between jurisdictions because of the very significant difference between the way in which each system operates
There does seem to be agreement though that, if there was a problem, it is only 5-10% of cases managed through the workers compensation system. The majority of straightforward cases do well. Like in most systems though, it is the complex 5-10% of cases that incur the majority of the costs, both financial and health-wise.
WorkCover have publicised the results of the RTW survey and highlighted that Tasmania is performing well:
For a meaningful debate about the performance of our workers compensation system we need facts and evidence, not just speculation and opinion.
I asked Alex Collie, as former CEO of ISCRR and now Director of the Insurance Work and Health Group at Monash University about evidence about the following matters:
- How do you measure the performance of compensation systems?
- Can you compare different jurisdictions in relation to performance?
- Are doctors withdrawing?
- What does the existing evidence base tell us about
- The Policy Environment and how our policy settings affect worker outcomes
- How interactions between doctors, insurers & employers in injury schemes affect worker outcomes
My personal interpretation of the evidence I had seen was that there is a need for major reform of how Governments should manage “work disability”, including workers compensation. There is enormous waste and “collateral damage” to workers health from liability assessment processes. Resources expended on determining which system injuries affecting work capacity belong within, is a waste within our financially strapped health care system. Tasmania at present is unfortunately at the forefront with extreme pressure on its Public Hospital System. My presentation at the main TAVRP Symposium “The Dark Side of Rehab” on 16 June 2017, focused on that waste.
A link to my summary of Professor’s Collie’s responses to my queries and some of the other key presentations at the TAVRP Symposium is provided below:
TAVRP Symposium Evidence Summary