Managing Claims for Psychological Injury

Presented by:

Greg Larkin

Melanie Pickering

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Gallagher Bassett

A third party administrator Agent for the NSW WorkCover Scheme Provide customised claim and risk mitigation solutions

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Overview

- OHS & Workers Compensation Legislation- Psychological hazards in a risk management framework- Non-work related factors- Types of psychological claims- Dealing with your insurer- Return to Work- Financial impact- Psychology framework

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OHS Regulation 2001 – an employer must:

Identify

Eliminate or Control

Review & Monitor

Assess

Work Practices

Objects

Work Environment

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OHS Regulation 2001

An employer must take reasonable care to identify any foreseeable hazard that may arise from the conduct of the employer’s undertaking and that has the potential to harm the health or safety of:

(2)  In particular identify hazards arising from:

(b)  work practices, work systems and shift working arrangements (including hazardous processes, psychological hazards and fatigue related hazards), and

(j)  the potential for workplace violence.

OHS Regulation 2001 - Chapter 2 (9)

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Prevention – is it possible?

The alternate to risk management is risky management!

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Identify psychological hazards

Can be difficult to do as:- People make assumptions about something that is ‘psychological’- Attitudes towards who is responsible for psychological issues- Psychological hazards are not always tangible- Lack of suitable strategies to confront psychological issues

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Factors to consider

Identify:Organisational factorsInterpersonal relationships at workIndividual’s role within the organisationCareer development, status and payHome/ work demandsPhysical work environment and equipmentWork demands (including load, pace and hours)SupervisionInformation, instruction and training

Work Safe VIC – StressWise

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Risk Assessment

- What are the circumstances when/ where the hazard occurs?- Frequency and duration of exposure?- What feedback to employees give?

RISK = frequency x likelihood x consequence

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Risk Controls

Prevention Strategies and Early Intervention are key!

Train managers and supervisors; to identify stressors/ hazards and performance manage employees An implemented Anti-bullying policy EAP services Critical Incident Planning to include counselling Independent mediation services where required Flexible workplace solutions

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Individuals at Risk

People may be exposed to psychological injury risks

outside of the workplace. It is important to recognise this!

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Risk Controls

Controls can be short or long term:

Identify psychological hazards

Assess risk & establish action plan

Make necessary changes

Educate & inform staff – check understanding regularly

Manage, monitor & review

communicate& consult

with your

Employees

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Claims Process – Workers Comp Act 1987

1. Assessment

Section 9: Has the worker

sustained an injury?

Section 9a:Was work a “substantial”

contributing factor?

Section 11a:Exclusionary factors; “reasonable action”

of employer

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Sec 9a: Was work a “substantial” contributing factor ?

-“a” not “the”

-Time, place, nature of work etc

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Sec 11a : Reasonable action by an employer

- Compensation not payable if the injury “was or predominantly caused by the reasonable action taken or proposed to be taken by or on behalf of the employer with respect to transfer, demotion, promotion, performance appraisal, discipline, retrenchment or dismissal of workers or provision of employment benefits to workers: - section 11A(1)

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Decision making

1. Does the worker suffer from a recognised psychological or psychiatric disorder ?

2. Was employment a substantial contributing factor to the psychological injury ?

3. Does section 11A (1) apply ?

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React

Respond

versus

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How do you respond as an employer to a potential psychological injury claim ?

1. Blunt psychological trauma e.g. assault, armed hold ups,

What is your response ?

2. Workplace incidents e.g. harassment, bullying,

What is your response ?

3. Normal workplace behaviours e.g. performance appraisal

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Return to Work

1. Get involved from the outset

2. Establish contact with treatment providers

3. Develop a return to work plan

4. Document . . . . . Document

5. Workplace rehabilitation has a start and an end

6. Utilise external resources

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Dealing with your agent / insurer

General guidelines-Establish communication with your Case Manager-Employers must actively coordinate and manage return to work-Understand the cost (“business of health”)-Document conversations, letters, meetings etc-Realise that decisions are made within the context of legislation

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Dealing with your agent / insurer

Specifically regarding psychological injury claims:-Meet with your Case Manager-Submit any supporting documents you may have-Understand that factual investigations may be initiated-Continue to manage the return to work-Stay involved and hold Case Managers to account

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Statistics – 2006/07

Psychological Injury

Average cost: $28 952

Average lost time: 18 weeks

All InjuriesAverage cost: $17 914 (with half costing $6 705 or less)

Average lost time: 9.7 weeks

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Financial Impact

- Claims have a cost (actual, anticipated)

- Understand the effect on your premium-Ask for cost projections based on a number of scenarios e.g. return to pre – injury duties, providing suitable duties or not.- Disputes and legal costs- Termination of injured workers

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NSW WorkCover Psychology Framework for Treatment

Draft framework with proposed gazettal by NSW Parliament by early 2010.

Fees regulated

Requirement for treatment plans to be developed and submitted for approval.

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Questions and Discussion