Australian Study Suggests Health, Injury Type & Timing of Claim Filed Contribute To Claims Satisfaction and RTW

F.J. Thomas

Sarasota, FL (WorkersCompensation.com) – “There is a strong positive association between worker experiences of the insurance claims process and self-reported return to work status,” states a new study. “Revision and reform of workers’ compensation claims management practices to enhance worker experience and the fairness of procedures may contribute to improved return to work outcomes.”

The study, published on BMC Health and authored by Alex Collie, suggests that health and injury type can have an impact on injured worker satisfaction.

The study interviewed 10,946 Australian workers 6 to 24 months after filing a workers comp claim. Workers were covered under several different scenarios including centrally funded and privately underwritten. Case management included single and multiple private insurers. Return to work included employer and payer responsibility. Independent contractors, sole proprietors, and self-employed are exempt from workers compensation.

The most common conditions of the workers surveyed included occupational related respiratory and circulatory diseases, musculoskeletal injuries, and mental health conditions.

Workers were asked five questions in response to the statement, “thinking about the entire experience of being on workers compensation, I’d like you to tell me whether you agree or disagree with the following statements:”

  1. Was the process open and honest?
  2. Was there good communication?
  3. Did they feel the system was working on behalf of their best interest?
  4. Did they feel they were treated fairly?
  5. Did they feel like the system contributed to their recovery?

Overall, 77 percent reported a positive claims experience, with the remaining 23 percent reporting a negative experience.

“Workers with fractures and other traumatic injuries had higher odds of reporting a positive claims experience than those with musculoskeletal conditions, in contrast to those with mental health conditions and other diseases which had significantly lower odds,” the study says.

The timing for reporting a claim also had an effect. Delays of more than 28 days were “associated with significantly lower odds of a positive claims experience. Workers employed by self-insured organisations, and those who were interviewed more than 18 months after claim lodgement, also had statistically lower odds of reporting a positive claims experience.”

Workers who perceived the workers’ compensation process as being fair also had better RTW rates. “Features of just procedures include that they are unbiased, accurate, consistent, and that the affected person is involved or has ‘voice’ in decision making,” the study says. “Review and reform of workers’ compensation claims processes to promote these features may improve workers’ claims experience and have a positive impact on RTW outcomes.”

Differences in satisfaction was noted by age and sex as well. Workers 56 years and older had a 33 percent higher positive response than younger workers. Men indicated a 22 percent higher satisfaction rate in comparison to women.

You can read the full study on the BMC Health website.

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