Leading the pack or dragging it down?

Dr Mary Wyatt

When one part of the system underperforms, the others follow suit.

We have three university-aged children at home. While getting them involved with housework has always been a challenge, there is usually the possibility of the after-dinner dishes getting done.

Sometimes this mission is on track and running smoothly. Other times, one of the kids finds other priorities and doesn’t play their part. After that, it doesn’t take long for the other two to follow suit. Pretty quickly, standards fall to the lowest common denominator.

And such it is with life. When one part of a team is underperforming in a difficult area, it gives others permission to follow suit.

Today I saw a complex case that looks like being a long term and expensive workers’ comp claim. The patient is a 30-year-old chap who hurt his back doing heavy lifting in a small manufacturing plant.

His case is complicated by a strong element of blame – directed at his employer for not providing lifting equipment. The patient is also frustrated at treatments that are not helping. He is demonstrating very limited movements, without evidence of a back problem that should be causing such a significant disability.

Rather than simply answer the process-driven set of questions attached to the insurer’s letter, I thought it was worth a discussion with the client’s case manager about their thoughts, and the type of management they wanted to see carried out in this type of situation.

I got onto the case manager, who had in fact only taken on his case only three days before. She was not at all familiar with what had occurred. After looking at the case file notes, she said that no one had been attending to the portfolio for some months, and other than the background provided in the letter, there were no other notes or actions planned.

As far as I can see, the most likely scenario here is that this chap will remain on WorkCover payments for another year and a half, and his case will likely go to common law. He may or may not return to work in the future; he may go through his superannuation fund, end up on disability benefits, or perhaps return to the workforce.

Either way, the whole situation is probably going to cost between $500,000 and $800,000, if one takes into account his weekly payments, any claim settlement and future expenses if he does not return to the workforce over the next five to eight years. It is truly a mess, with little medical foundation.

Even the best case manager may not make a difference in cases like this. But then again, perhaps they could; not only to the cost of the claim, but also to the client’s health.

Just as importantly, one part of the system sets the tone for the rest. If claims management can be absent in a major case such as this, doesn’t that tell the rest of the system that it doesn’t matter too much if you don’t do a good job? Ultimately, how does this message affect the mindset and RTW outcomes of an injured or ill worker?

The effective communication of values and goals between the workers’ comp and RTW stakeholders may be a work in progress, but there are things that ordinary RTW professionals can do to improve accountability and engagement across the system.

Our article “8 tips for a great relationship” outlines how to get the claims manager on the same page, to improve communication and return to work outcomes. It’s fair to say that many claims managers really do want to help; it’s just a matter of building rapport with them and communicating intentions.

Think about things from their perspective. How much do you know about the working life of a claims officer? Have you acknowledged that they will also have their own set of pressures, requirements and limitations?

Get to know each other personally. When relationships are stronger, you get a better read on the individual’s approach and it helps for ongoing communication.

Let the claims staff know how you want to approach cases. They will usually respond favourably to whatever you can provide them. Talk through the issues and you will be far more likely to work together constructively.

Set up a regular type of communication. A face-to-face meeting is more effective, although a telephone hook-up may be more efficient if you have time constraints. Ask the claims manager or claims team to meet with you at the workplace once a year - make them part of your team.

Put things in writing. You might make a request by phone, but fire off a quick e-mail afterwards to confirm the agreement as well.

Be positive in your dealings with the claims manager. Being grumpy won’t get you a better service. If you need something done, follow-up, and be polite and helpful.

Address persistent problems. If you have a persistent procedural problem and things aren’t improving, arrange to meet with the claims manager and the team leader. Bring documentation of your concerns so the issues are clearly evident.

Solve challenges together. If you have a ‘stuck’ case, arrange a meeting with the claimant and the claims manager. Work together as a group to find a positive way forward.

Published 19 June, 2011 | Updated 04 August, 2015