What has been achieved by twenty years of conversation and reviews about harmonising the rules of workers compensation in Australia?

From my perspective as an Occupational Physician and a participant in some of the reviews, discussions and well-meaning efforts, the situation has not changed to any significant degree in two decades.

And in the current push to make harmonisation happen, one question seems to have been forgotten. Will harmonising the rules of workers' comp going to improve return to work rates and health outcomes?

Given the intricacies of Australia's eleven workers' comp jurisdictions, this is not an easy question to answer. 

For a long time, Australian workers' compensation jurisdictions used lump-sum payments to compensate employees for injuries at work.  In the 1980s, in an effort to shorten the time to claim settlement and make the process less adversarial, most systems changed to paying wages and medical costs. 

Since then there have been multiple amendments within every jurisdiction.  Each system is now a unique combination of rules for the level of wage replacement, claim acceptance, lump sum payments, and involvement of private insurers. Tinkering with the rules of systems that have evolved over time will have consequences, as was noted in a previous RTWMatters article about the pros and cons of harmonisation.

But is changing with the rules the only way for harmonisation to achieve better outcomes across all ten workers comp jurisdictions?

At the recent forum on harmonisation organised by SafeWork Australia, I was given the opportunity to speak as a designated 'expert' in the field. The audience consisted of about 90 people - CEO's of the state and federal compensation systems, their 2IC's, and lead people from unions, employers, insurers, health practitioners and researchers.

Below is an abridged version of my presentation. The full text is here.

The message I endeavoured to get across is that rearranging the lounge suite is not a fix when mildew is growing on the walls.  Rather than tinkering with the rules, I argued that:

1. Return To Work is important, but is not going well;
2. Harmonisation as it has been discussed won't improve return to work; and
3. We have an opportunity to create harmonised tools and techniques and this opportunity should not to be missed.

1. Return To Work is important, but is not going well

The data we have tells us that our compensation system are not producing good results.  Employees with a compensable condition have poorer outcomes than those who have the same condition in a non compensation situation.  For example, those who have surgery have four times the odds of a poor outcome when the condition is compensable.   

The RTW Monitor surveys employees across Australia and NZ at six months post claim lodgement.  According to the RTWMonitor reports, return to work have been steadily declining in Australia (National) rates over the last three years.    

An individual not back at work after six months has a relatively poor chance of ever returning to work. People who remain out of the workforce in the longer term have significantly increased risk of health problems. They are more likely to get cancer, heart disease and to die earlier. Odds are they will suffer from isolation, depression, marital separation, and the health of their children will be poor.

SafeWork Australia’s report “Cost of Work-related Injury and Illness” indicates that the total cost of work injuries is 57.5 billion dollars, representing 5.9 per cent of GDP for the 2005-06 financial year. 

These are troubling statistics. 

2. Harmonisation as it has been discussed won't improve return to work

Harmonisation of workers compensation rules is a sensible thing to do, and would likely benefit many multi-state employers. However it would be a massive exercise that consumes vast amounts of time, energy, and resources from all jurisdictions.

At this point, our focus should be on the improving return to work performance and health outcomes for employees within the system.  This is the best way to help workplaces reduce costs and improve productivity.  It is the best way to reduce the cost burden on the community. 

3. The creation of harmonised tools and techniques is an opportunity not to be missed

The training, resources and tools available to employees, employers and people who work in the field are limited. Complex cases are hard to manage, and being the return to work coordinator for a difficult case is harder than being a medical practitioner. The coordinator may need to simultaneously manage a disbelieving production manager, a busy supervisor who does not understand that their input is crucial, and an organisation that is not effectively dealing with a negative workplace culture, return to work systems, and individual employees.

I proposed that the harmonisation initiative focus on a project to develop a standard national set of tools and techniques to support and enable return to work. A national project that focuses on what is our core challenge in the 21st century – returning people to health and activity as quickly as possible. 

Developing a standard set of tools and techniques that can be used across the country offers the opportunity to create a world leading set of tools and resources. 

By shifting the focus from rules and regulations - and arguments over differences - to tools and resources harmonisation will address a set of unresolved problems that are common to all authorities and every stakeholder in the field.

Individual systems have strengths in certain areas.  Those strengths, such as information for employees, partnership approaches, web content, could be used in the development of a national tools and resources set.

I suggested the following starting point for discussion:

• Supervisor training;
• Basic ergonomic training for coordinators;
• Information on telephone communication techniques;
• Practical tools to address motivation;
• Ways of influencing senior management to improve workplace culture;
• A tool to clarity the costs to the business;
• Ways of talking to the Finance manager;
• A bank of videos of employees who have done well with return to work, and how they’ve achieved that;
• Information for employees about how to get the best out of their situation; and
• A national curriculum for doctors and allied health professionals about return to work.

A list of the necessary tools and techniques should come from those who work at the coalface, from employees and RTW coordinators , from health practitioners who deal with the core issues on a daily basis.

As the forum on harmonisation progressed, I felt that return to work, the stigma of compensation and the need for better outcomes, became the dominant discussion themes.  There seemed to be little appetite for tackling changes to the rules. This was encouraging.

There is a chance  that improving return to work resources and outcomes will become a major focus of harmonisation, rather than only tinkering with the rules. 

If that occurs, your input into what tools and resources are needed will be vital.