When insurers treat injured workers with suspicion, GPs respond by protecting their patients more fiercely — they certify more conservatively, provide less detail, advocate more aggressively or leave the system entirely. Every response extends the duration of the claim. This is predictable, preventable and currently happening at scale.

The cost

Workers who are concerned about making a claim are 3 times less likely to return to work. One in 5 workers' compensation claimants meets the criteria for probable serious mental illness. The same injury produces worse outcomes inside your system than outside it.

These are not accidents. They are consequences.

A systematic review found that interactions between insurers and injured workers resulted in the development of secondary injury instead of fostering recovery. The system designed to help people recover is making them sicker. And keeping them out of work longer.

The It Pays to Care policy documents what clinicians observe daily: when injury occurs in a compensable setting, health outcomes are significantly worse than for identical conditions in non-compensable settings. The same injury. The same person. Worse outcomes, Just because they entered your system.

This is system-induced harm. And it is extending your claims.

The mechanism

Research shows that when workers feel their pain isn't taken seriously, they experience a sense of injustice that impedes recovery. Perceived injustice leads to a 2- to 7-fold increase in the risk of failing to return to work.

SIRA NSW research demonstrates that workers who did not trust the compensation scheme reported poorer customer experience, reduced perceptions of justice and worse health outcomes. Workers who are in the system longer report worse outcomes across every measure.

Your processes, your delays, your culture of suspicion — these are psychosocial risk factors as real as workplace hazards. You are not neutral administrators. Your actions directly influence whether people recover or deteriorate.

And when you invalidate patients, their GPs validate them harder. They spend longer appointments rebuilding their patients' sense of self-worth. They write more detailed letters explaining why the suffering is real. They refer patients to psychologists to address the secondary injury the system has caused.

All of this extends the claim.

The GP response

General practitioners manage 80 to 90% of workers' compensation cases in Australia. They are the gatekeepers, care coordinators and certifiers of work capacity. They are also, when necessary, the shield between injured workers and a system that too often treats them as problems to be managed rather than people to be healed.

Here is what happens when trust breaks down:

GPs certify more conservatively

Victorian data showed 74% of initial certificates recommended complete unfitness for work, with 94% of mental health conditions certified as totally unfit. These numbers reflect GPs who have learned that nuanced certification invites challenge. 

When GPs feel their clinical judgment will be dismissed or overridden, they certify conservatively to protect their patients from premature pressure to return to work. Your suspicion produces their caution, and your claims last longer.

GPs provide less detail

When detailed certificates are used as ammunition against patients rather than as tools for collaborative recovery, GPs learn to write less. This creates the very information gaps that justify IME requests. It becomes a doom loop of mutual distrust, with patients caught in the middle.

GPs advocate more aggressively

Every time a case manager questions a worker’s symptoms without clinical justification, every time an approval sits unanswered for weeks, every time a worker is made to feel like a suspect rather than a patient, GPs become more determined advocates. They document more thoroughly. They push back harder. They anticipate conflict and prepare for it. This takes time. Your claims take longer.

Some GPs walk away entirely 

Melbourne research (1) found many GPs refuse to see workers' compensation patients or only see them if they pay privately. Workers' compensation care has become so administratively toxic that doctors are leaving the system. And who suffers? Injured workers who can’t find a GP willing to navigate these processes. Workers whose claims then go on indefinitely.

From their consulting rooms, GPs see what the data can’t capture: the defeated posture of a tradesman whose legitimacy has been questioned for the fifth time. The tears of a teacher who feels branded a liar because an IME doctor spent 20 minutes with her after 20 consultations with her GP. These patients are then not merely injured, but demoralised. Their physical recovery becomes hostage to their psychological survival of the system.

Consultations that should focus on rehabilitation become damage control for the psychological harm inflicted by insurer processes.

The evidence

Kilgour et al.'s (2) systematic review of qualitative research found that insurer-worker interactions produced psychosocial harm rather than fostering recovery. 

Giummarra et al. (3) demonstrated that perceived injustice mediates the relationship between compensation and poor RTW outcomes. 

The RACGP has identified compensation paperwork as contributing to GPs retiring early, with delayed payments stretching into months.

Independent Medical Examinations (IMEs) have become tools of administrative convenience rather than clinical clarity. When an IME doctor — who has never treated the patient, reviewed their history or witnessed their functional decline — produces a report that contradicts months of the treating doctor’s observations, something is broken.

Workers interpret these outcomes as evidence that the system is 'against them.' When IME doctors are selected, briefed and paid by insurers, the perception of bias is inevitable, regardless of actual bias. This is not to suggest IMEs have no role. The point is that their current use often generates precisely the adversarial dynamics that trigger GP protective responses and prolong disability.

How many of the one in 5 claimants with probable serious mental illness developed their condition after entering the compensation system? This is a question that demands an answer.

How we can do better

Some insurers and case managers already operate collaboratively, and their outcomes prove the model works. 

GPs have seen what effective workers' compensation looks like: Case managers who phone them before requesting IMEs. Rehabilitation providers who consult rather than dictate. Insurers who approve treatment promptly and communicate respectfully. In these cases, patients recover faster, are certified for work capacity sooner and speak of the system with gratitude. In these cases, GPs don’t need to protect patients from the system.

This article is not directed at those who already get it right. It is directed at the system-wide practices that remain the norm. These are the things that would make a difference:

Clinical judgment should not be treated as an obstacle

When a GP certifies a patient unfit, that reflects their examination, history and professional assessment. It deserves to be a starting point for discussion, not a problem to be overcome with an IME.

Communication is key

When workers reported what would increase their trust, the most common answer was improving communication, contact and follow-up. 

Implement mandatory response windows for GP queries and treatment approvals

This is not expensive. It requires intention.

Measure the harm you cause

Track secondary psychological injuries. Audit how many claimants develop mental health conditions after entering the system. Publish this data by scheme and by insurer. Take ownership of outcomes, not just process compliance.

Pay GPs fairly and promptly

Commit to timely payment cycles for GP invoices. Payments that are delayed for months and an administrative burden that exceeds clinical time — these drive doctors from the system and injured workers into limbo. 

Acknowledge the evidence

Workers who are not concerned about making a claim are more than 3 times more likely to return to work. The date shows that trust works. Suspicion doesn't.

The choice we have

The It Pays to Care initiative calls for scheme operations to be based on collaboration, timeliness, trust and reciprocity, personalised and respectful communication and the empowerment of stakeholders. These are not aspirational platitudes. They are evidence-based requirements for effective outcomes.

GPs will continue to protect their patients. That is their clinical and ethical obligation. But when patients are treated with suspicion, GPs will respond with advocacy. When patients' suffering is dismissed, GPs will document it more thoroughly. When clinical judgment is overridden, GPs will certify more conservatively.

Every protective action extends your claims. This is a consequence of the adversarial dynamic that the current system has created.

The question is not whether GPs will change. They are responding rationally to the system as it exists. The question is whether you will change. Whether you will build a system where collaboration replaces suspicion, where trust enables recovery and where claims resolve because workers heal rather than because they give up.

We call on all Australian workers’ compensation regulators to:

• mandate the measurement of secondary psychological injury by insurer
• audit IME usage patterns and outcomes
• establish communication response standards, and 
• consult with treating practitioners before — not after — policy changes.

GPs are ready to be partners. The evidence says it works. The choice is yours.

References

1. Brijnath B, Mazza D, Kosny A, et al. Is clinician refusal to treat an emerging problem in injury compensation systems? BMJ Open. 2016.
2. Kilgour, E., Kosny, A., McKenzie, D. et al. Interactions Between Injured Workers and Insurers in Workers' Compensation Systems: A Systematic Review of Qualitative Research Literature. J Occup Rehabil 25, 160–181 (2015).
3. Giummarra MJ, et al. Return to Work After Traumatic Injury: Increased Work-Related Disability in Injured Persons Receiving Financial Compensation is Mediated by Perceived Injustice. J Occup Rehabil. 2017.

Resources

• NHMRC-approved Clinical Practice Guidelines for Diagnosing and Managing Work-Related Mental Health Conditions
• Safe Work Australia, National Return to Work Survey (2021)
• SIRA NSW, Customer Experience and Health Outcomes Study
• SIRA NSW, Factors Influencing Return to Work Outcomes
• Royal Australasian College of Physicians, It Pays to Care: Bringing evidence-informed practice to work injury schemes
• RACGP, Principles on the Role of General Practitioners in Supporting Work Participation
• RACGP - The silent struggle: GPs and the workers' compensation system
• RTWMatters - 'This is so unfair'. Preventing perceptions of injustice after a work injury
• Sickness certification of workers compensation claimants by general practitioners in Victoria, 2003–2010 | Medical Journal of Australia