Assessment processes in workers' compensation aren't neutral. Across jurisdictional surveys and scheme data, repeated assessments can create delays, foster mistrust and shift attention from function to verification. 

By the numbers (selected studies)

Here's what the evidence shows (n is the number of people in the study):

2019 national Australian cross sectional study (n=10,946)

• 23% reported a negative or neutral claims experience (vs 77% positive). 
• Workers with a positive experience had 2.5 time higher odds of RTW (AOR 2.50, 95% CI 2.27–2.78) — meaning a negative experience = 60% lower odds (AOR 0.40, 95% CI 0.35–0.44) [1].

2020 national Australian cross sectional survey ( n=3,755)

At the start of the claim, 41.5% recorded moderate or severe psychological distress (K 6). [2] Compensation cohorts are more distressed at baseline, so delays and adversarial tone have outsized impacts. 

Post 2008 review of administrative data (UK Work Capability Assessment)

After adverse ‘fit for work’ decisions, about 40% appealed and roughly 40% of appeals succeeded — the high levels of disputes were associated with high levels of perceived injustice. [3]

How and why the harm occurs

Verification over care

Assessments answer the question: ‘Is this justified?’ rather than ‘what restores capacity?’. When assessments are requested repeatedly, they pause treatment and turn clinical encounters into audits. Time in the queue can replace time in active rehabilitation and fear of movement grows while decisions are pending.

Fragmentation and contradiction

Different assessors, methods and report templates can produce conflicting opinions. Disagreement often triggers further assessments rather than resolution. In practice, this can become a cycle of ‘duelling experts: each report references the last, narrows its brief or reframes the question. The worker becomes the courier between views, while function is on hold and the file grows.

Scheduling delays as treatment

Even when assessments are appropriate, booking and reporting cycles introduce predictable delays — days to weeks for appointments, and more time to transmit, interpret and act. Each round pushes back graded activity, work trials and problem-solving with the treating team.

Baseline vulnerability

Compensation cohorts include a higher proportion of workers with moderate to severe psychological distress at the start of the claim. This may increase susceptibility to nocebo, fear avoidance and disengagement when processes feel adversarial or slow [2].

Provider disengagement shrinks trust and access

Repeated verification, high administrative burden and perceived adversarial tone erode GP trust and willingness to take compensable patients. This reduces timely access to experienced primary care and pushes more decisions into assessment pathways — a self reinforcing cycle [4].

Nocebo reinforcement

When assessments repeatedly question the legitimacy of symptoms, expectations can turn negative. This shapes attention and pain perception (the nocebo effect), reduces confidence in active care and increases the likelihood of avoidance and disability. Over time, these effects can outweigh the impact of the original injury.

Performing pain

Workers learn, often implicitly, how to present symptoms in ways that are perceived as ‘credible’. This performance pressure can create hypervigilance to bodily sensations and rehearsal of injury narratives. Clinical encounters become tests to be passed rather than opportunities to build function. The effort to perform can itself increase pain focus and fatigue.

What we've known — and what we overlook

Assessments are essential when they change management — clarifying red flags, planning surgery, resolving genuine conflicts of opinion or guiding safe duties. The issue is the default use of repeat assessments where there is little chance of altering the care plan. In those circumstances, the cumulative delay and the messages embedded in reports can contribute to poorer outcomes. 

Why this matters for schemes

Time and attention are finite. Each additional assessment consumes clinician hours, worker energy and organisational focus without necessarily improving function. The opportunity cost is real: delayed graded activity, postponed work trials, rising medication exposure and an increased risk of chronicity. 
Scheme spend shifts from help that restores capacity to reports that rarely change the plan. Where assessments are necessary, they should be few, well-timed and tightly linked to decisions that matter.

Questions for discussion

• What percentage of assessments change the plan — and how many days do they add?
• What criteria best predict when an assessment will change management — and how can we pre authorise those while minimising pause time?
• What metrics should schemes publish on request to decision times for treatment decisions and IME assessments?

References

1.    Collie A, Sheehan L, Lane TJ, Gray S, Grant G. Injured worker experiences of insurance claim processes and return to work: a national, cross-sectional study. BMC Public Health. 2019;19:927. doi:10.1186/s12889-019-7251-x.  
2.    Collie A, Sheehan L, Lane TJ, Iles R. Psychological distress in workers' compensation claimants: prevalence, predictors and mental health service use. J Occup Rehabil. 2020;30:194–202. doi:10.1007/s10926-019-09862-1. 
3a. Wyatt M. Decision-making justice — Part 1. RTW Matters. 
3b. Wyatt M. Decision-making justice — Part 2. RTW Matters.
3c. Wyatt M. 'This is so unfair': preventing perceptions of injustice after a work injury. RTW Matters Research. 
4.    Kaye S. The silent struggle: GPs and the workers' compensation system. newsGP. Royal Australian College of General Practitioners (RACGP); year unknown. 

Part 2 examines the relational and procedural dimensions and explores how workers experience assessments, what scheme data reveals about assessment burden and the opportunity costs of duplication.