Key differences found in return-to-work process for MSD and psychological claims

Research comparing MSD and mental health compensation claims in Australia offers a picture of return-to-work challenges for psychological conditions

Published: August 10, 2016

People who file workers’ compensation claims for psychological injuries are less likely to be offered modified work and less likely to go back to work than those who file claims for musculoskeletal disorders (MSDs).

This is according to an Australian-based research project that includes on its team Dr. Peter Smith and Dr. Sheilah Hogg-Johnson, both senior scientists at the Institute for Work & Health.

Findings from the study, based in the Australian state of Victoria, demonstrate important differences in the post-injury experiences of workers who make workers’ compensation claims for mental health injuries and those who make MSD-related claims. Namely, psychological claimants:

  • are less sure about returning to their previous jobs;
  • are less likely to be contacted by their workplace’s return-to-work (RTW) coordinator;
  • are less likely to be offered and to accept modified duties;
  • face more negative reactions in response to the injury from supervisors and co-workers; and
  • experience more stressful interactions with health-care providers, RTW coordinators and claims agents.

These findings came from an early analysis in the project, which is following a group of over 850 workers’ compensation claimants over a 12-month period. The study is looking for differences in RTW outcomes between MSD and mental health claimants, as well as differences among claimants of different age groups.

Almost all the cohort research that has been done about return to work has been based on groups of people with musculoskeletal conditions, says Smith, who shared the early findings in a plenary held at IWH, now available as a slidecast.

We know from jurisdictions in Australia that cover broad psychological injuries that psychological claims result in longer durations of wage replacement and larger direct costs than other types of claims, he adds.

Those differences can be substantial. Mental health claims in Victoria, Australia, have a median duration of wage replacement of six weeks, compared to a median of less than one week for all claims. They cost $12,000 compared to a median of less than $1,500 for all claims.

One key distinction of Victoria’s workers’ compensation system is that it allows for psychological injury claims that are sustained as a result of chronic stress in the course of claimants’ employment. While a few Canadian jurisdictions also cover psychological injuries, some—such as Ontario—currently cover only psychological injuries that result from acute reactions to unexpected traumatic events.

However, that is starting to change, notes Smith. British Columbia, for example, has broadened its definition of work-related stress disorders. In Ontario, an appeals tribunal has agreed with a claimant that the Workplace Safety and Insurance Board’s restrictions on coverage of mental health conditions infringe the claimant’s rights under the Canadian Charter of Rights and Freedoms.

There is a growing consensus that work conditions can play a role in the development and exacerbation of mental health issues. Regardless of the system they are compensated under, we need to start thinking about whether we need different return-to-work strategies for psychological injuries, says Smith.

The early findings we’re getting suggest people with mental health conditions are not being offered accommodations. And when they’re offered accommodations, they don’t find them meaningful or useful, he adds. What that tells us is that many workplaces really don’t know what to do when someone has a mental health injury.

This study builds on some earlier work by Smith, also in Victoria, Australia. It used administrative data from the state’s workers’ compensation agency to determine if the factors associated with days of absence after a work injury are similar for mental health and MSD conditions. This study sample included about 10,000 MSD cases and 3,000 mental health cases collected over three years (2005 through 2007). The study, published in the March 2014 issue of the Journal of Occupational Rehabilitation (doi: 10.1007/s10926-013-9455-8), found:

  • for MSD claims, a longer average duration of days on wage replacement in sectors such as agriculture, forestry, fishing and mining, as well as longer average durations of wage replacement among employees of small organizations;
  • for mental health claims, longer average durations of wage replacement among workers in sectors such as public administration and safety, and education and training, as well as longer durations of wage replacement among workers in jobs with greater time pressures.

The study also found that industry groups with the longest average disability duration following a mental health injury are those where the ratios of mental health claims to MSD claims are highest. These include public administration and safety, as well as education and training. These findings suggest that industries where the nature of work may lead to mental health injuries, as opposed to MSDs, may also be the industries where accommodations for mental injuries are harder to put in place, or are less effective, says Smith.

In addition, workplace size is not related to claims duration in the same way for mental health claims as for physical injury claims. We usually think that larger firms have better RTW programs in place, and have more options in terms of accommodation, says Smith. However, we don’t see this same advantage for mental health claims. And this may suggest that the current practices, or ways of thinking about accommodation, don’t work as well with mental health claims.