Injured and Silenced: Working with Workers' Compensation Claimants and Their Families

Abstract

It is not uncommon for rehabilitation and workers' compensation systems to treat the injured worker as either a passive victim or a mischievous malingerer.Much ofthe literatureregardingrehabilitation ofpeople with chronic pain and soft tissue injury speaks ofparalysis and powerlessness as if the injured person is a piece offlotsam buffeted about by the socialforces of WorkCare (and other compensation systems), the employer and the medical legal systems. This paper will review the pertinent literature and demonstrate the lack ofobjective supportfor a 'blame-thevictim' attitude. The importance of the injured person playing an active role in his/her rehabilitation will be emphasised through a systematic analysis ofthe impact ofthe WorkCare scheme on the injured worker and their treatment. In this light, a systems based approach to therapy with injured workers and their families will be outlined.

Victims Twice Over: Perceptions and Experiences of Injured Workers

“…Related to legitimacy was the interviewees' perception that their claims were regarded as fraudulent until proved otherwise. Frankcom (1992) also observed that injured workers are assumed to be passive or frauds, and Baril et al (2003) noted that workers experience the systems as unfair, which results in frustration, anger, and anxiety. Our findings suggest that this experience goes beyond unfairness, as our interviewees considered themselves maligned, and treated without respect by bureaucrats and health professionals.…”

“…602, 611). Other authors have argued that compensation systems assume that some workers are acting fraudulently, or they encourage passivity, and that this can have either antitherapeutic or therapeutic consequences (Frankcom, 1992;Lippel, 1999). Lippel suggested that the compensation process involves multiple medical examinations to prove the legitimacy of a condition, stigmatization, surveillance, suspicion, disputes regarding compensation, and consequent delays in decisions, all of which affect the health of claimants negatively.…”

“…Still others perceive themselves to be injured but encounter problems both in returning to work and in obtaining recognition from the compensation system that they have a legitimate workplace injury. This latter group of injured workers is similar to the "undeserving poor" of the 19th century, in that attitudes toward them are characterized by blame and marginalization (Frankcom, 1992;Jolly, 2000;Lippel, 1999). The difference in the case of injured workers is that this attitude is hidden beneath the rhetoric of return to work and rehabilitation.…”

Disparities in Occupational Low Back Injuries: Predicting Pain-Related Disability from Satisfaction with Case Management in African Americans and Caucasians

“…While explanations for this result are speculative, the often‐adversarial patient–physician relationship that can characterize Workers’ Compensation case management may contribute to high levels of claimant dissatisfaction with the quality of their care [26,46]. Alternatively, there may be other impediments to satisfaction, including delays in treatment [7] and a lack of input into treatment decisions [24,33,47]. As discussed below, physician decision making may also contribute to differences in outcome.…”

“…Many patients feel devalued as they participate in the system [19,20], noting that health care providers seem to discount their injuries, particularly self‐reported pain [8,21–23]. Other concerns center on lack of choice regarding treatments and treatment providers [20,24]. In general, Workers’ Compensation claimants seem to distrust the very health care providers who are charged with their symptom control and functional restoration [25].…”