Motor accident and workers' compensation insurance design for high-quality health outcomes and cost containment

Abstract

This paper studies scheme structure and information concerning rehabilitation outcome for claimants under the NSW Motor Accidents Scheme and the NSW Workers' Compensation Scheme. It argues that to ensure effective rehabilitation there is a need for consistent, national accident schemes which provide services regardless of fault. In general, health outcomes will be improved if dispute resolution and estimation of level of disability occur in a context which avoids adversarialism. On the other hand, negligence could best be punished and compensation provided to victims as a result of prosecution for breach of duty of care under the relevant protective legislation. Other vital elements in injury prevention and rehabilitation are more effective risk management, worker representation and information provision at the workplace level. Comparable performance measures for rehabilitation and other service providers are also necessary for the attainment of quality management and evidence-based medicine.

Employers' perceptions of claims/injury management and rehabilitation in South Australia

“…There is no doubt that action taken at the time of injury in the workplace has a major impact on the longevity of a worker's compensation claim and cost escalation (see Kenny 1996;RACP 2001;Shrey and Lacerte 1995;Bloch and Prins 2001). Likewise the workplace culture and the attitudes of employers, supervisors and co-workers will be critical to the management of a successful return to work and overall cost containment (see Amick et al 2000;Borthwick and Lichter 1986;Bruyere and Shrey 1991;BSRM 2000;Lesher 1987;Lohan, 2001;O'Donnell 2000;Purse 1998;Purse 2000;Stone 2000;Veerman and Palmer 2001;Webster 2001).…”

“…1 Even so, the majority of the employers agreed that the probability of an injured worker returning to work decreases with each day the worker is absent following the lodgement of a claim. However, early intervention reflects a management response that focuses on increasing the likelihood for an early return to work wherever possible (see O'Donnell 2000;Sinclair, Hogg-Johnson and Cassidy 1997;Reissner and Shrey 1997). In support of this premise, employers commented that:…”

Promoting Excellence: A Learning Partnership Approach to Workplace Claims/Injury Management and Rehabilitation in South Australia

“…A sequence of events is often set in motion that has as great an impact as the actual injury, if not a greater consequence. Such outcomes are influenced by the actions and reactions of employers, co-workers, families, friends and supporting professionals from the onset of injury (RACP, 2000;Barth, 1996;Bloch & Prins, 2001;Burmain ck Margolin, 1992;Hochstenbach, 2000;Kenny, 1996;Lu, 1997;Medini, Bendsten & Ekberg, 2003;O'Donnell, 2000;Presser, 2000;Roberts-Yates, 2003a;Stone, 2000). Key events ot features of the process which could escalate tension and a breakdown of alliances might include pay disputes, process frustration, stigmatisation, problematic relationships and communications at home and work, procedural language confusion, and indifferent case management.…”

Beyond Blame: An Exposition of Systemic Barriers in the Return-to-Work Process

“…Similarly, there is a dearth of research examining barriers to vocational outcomes for people injured in MYAs who are covered under motor accident schemes. The current Australian literature is limited primarily to governmental reports and surveys (O'Donnell, 2000). Consequently, our understanding of the factors that impede a successful return to work (RTW) following injury in MVAs remains scarce.…”