By Simon Booth
The Victorian government’s Independent Review into the Victorian Workers’ Compensation System is due to be published in April. Aegis RMS made a submission addressing its concerns about the scheme. This article is part of that submission.
More often than not, when a claim for Mental Injury is lodged the claimant lists not just the issue that led to them ceasing work, but a myriad of other perceived slights and injustices dating back the length of their employment. Additionally, quite often the precipitator of the claim relates to non-compensable reasonable management action.
Two major issues develop from this:
Firstly, the Agent may identify that the action taken by the employer was reasonable, but the claim may still be accepted because the claimant experienced conflict with a co-worker. However, the reason for the claim acceptance is not relayed to any of the stakeholders.
At present the response is simply that the claim has been accepted, providing no clarity for any of the stakeholders on the appropriate way to proceed.
This lack of clarity impacts on the expectations of key stakeholders. With the claimant often believing that the claim was accepted for the components that fall under reasonable management action and, in line with this, the doctor provides restrictions, not relating to the conflict with the colleague but to inhibit the employer from continuing their performance management. All of this leads to conflict between the stakeholders, creating unnecessary barriers to return to work.
Failing to unpack the complaints made by the claimant and clearly identifying which have resulted in an entitlement to compensation is a significant indicator of a complex claim.
Secondly, the Independent Medical Examiner (IME) will list the complaints made by the claimant but they are never asked and rarely provide a clinical assessment as to which of the factors is wholly or predominantly the cause of the claimant’s injury and more importantly the claimant’s current incapacity.
As an example, we had a situation where a claimant lodged a claim following the commencement of performance management. It was agreed that the performance management met the criteria for reasonable management action. However, the claim was accepted due to an incident that had occurred with team members nine months earlier.
Clinically it is unlikely that:
- a) If the incident nine months prior had caused an injury it had not resolved, as the claimant had worked without incident or time off throughout this period until performance management commenced.
- b) The incident from nine months prior had anything to do with the claimant’s current incapacity, as the incapacity immediately followed the performance management.
Where historic issues are the basis for an accepted Mental Injury that has been lodged following the commencement of disciplinary action, it is an indicator that the claim will become complex.
The management of mental injury claims requires a complete review and revamp as the current approach does little more than reinforce symptoms and drive long term injury.
With mental injury claims growing in both frequency and duration, a failure to identify an effective approach to the management of these claims will add additional pressure on the financial viability of the scheme.
With over twenty years’ experience in Workers’ Compensation, Simon Booth is a vocal advocate for employers in a scheme that often leaves them feeling powerless and frustrated. Simon and his team work with employers across Australia, helping them take back control of their Workers’ Compensation programs.
Disclaimer: This article provides general advice and should not be considered legal advice or an insurance consultation. You should seek appropriate counsel for your own situation. In addition, this post is directed at people in Australia. If you are outside Australia, please be aware that the circumstances in your own country may be different.
