An analysis of injured worker and healthcare provider experiences in workers’ compensation systems

It is becoming widely accepted that recovery is slowed for injured persons who are involved in compensation systems, yet the reasons for this are unclear. Interactions between injured workers and healthcare providers and insurers can affect the injured workers’ engagement in rehabilitation and thus their recovery and return to work. Injured worker perspectives have only recently been considered in the research literature, and less attention has been paid to healthcare provider experiences within workers’ compensation systems. This thesis examines the experiences and perceptions of injured workers internationally, and healthcare provider experiences and perceptions both internationally and within the state of Victoria, Australia, regarding their involvement in workers’ compensation systems. This thesis focuses on the experiences of psychologists as a subgroup of healthcare providers that provide services to injured workers who have sustained both work-related physical and mental health injuries. This thesis utilises three distinct qualitative methodologies to investigate injured worker and healthcare provider experiences: a systematic review of qualitative literature; exploratory research through “idea building” with groups of psychologists; and in-depth interviews with individual psychologists. Critical realism is the paradigm that serves as the theoretical framework which guides this research. Critical realism fits neatly with other methodologies such as thematic analysis and meta-ethnographic synthesis methods that were used to analyse the findings and to uncover the deeper meaning of participants’ experiences and the corresponding broader implications for workers’ compensation system administrators. A number of key messages were repeated across the systematic review, the group research and individual interviews. It was identified that interactions between injured workers and insurers are interwoven in cyclical and pathogenic relationships that create secondary psychological consequences for injured workers. A number of claims management processes, namely independent medical evaluations and surveillance, were identified as being harmful to injured workers and complicated treatment. The research highlights independent medical evaluations as a central procedure in the workers’ compensation system that creates stress and promulgates stigma for injured workers. Insurers’ evaluation of psychologists’ treatment and disputation of professional opinions via independent medical evaluations also impacted the efficacy of treatment. Injured workers can be caught between the adversarial interactions that exist between healthcare providers and insurers. Healthcare providers found that system-related administrative demands, together with delays in treatment approvals and payments, reduced their level of job satisfaction and willingness to work in the workers’ compensation arena. The findings from the research outlined in this thesis support existing literature that concludes injured workers’ recovery is slower when involved in compensation systems. The thesis also extends current knowledge in the occupational health field by identifying the lack of procedural justice that should be accorded to injured workers and healthcare providers alike. A number of changes to policy and clinical practice are suggested to effectively address the identified problems.