Building a Better Recovering Worker – The Advocate, The Adversary and The Addled

Bob Wilson

I am in Washington State this morning for the second time in just over 2 weeks. Earlier this month I spoke to the Washington Self-Insurance Association. Today I am speaking at a Vocational Conference produced by the Washington Department of Labor & Industry. My topic for this presentation is called “The Cost of Anti-Engagement.” I will be talking about the negative outcomes that can often be the result of our failure to properly communicate and understand the viewpoint of the injured worker.

One of the key points I intend to discuss are certain categories of injured workers we see in the industry. I emphasize that no concept is an absolute, and not everyone fits under these particular umbrellas. They can, however, represent a significant number of the workers we see. The categories of injured worker I will mention are the Advocate, the Adversary and the Addled.(“Addled” has several meanings. The use of it in this context in no way implies lack of intelligence)

The “Advocate” is first and foremost a self-advocate. They are an injured worker who has come to terms with the realities of their situation. They understand that life may have changed; they own their injury and impairment. Ownership has nothing to do with accepting or assigning blame over the injury event, but rather acknowledging that they must work from “what is” rather than “what was.” They are focused on restoring normalcy and function to whatever level possible, and are actively engaged in their own care. They are advocates for their own recovery, and actively partner with the industry to recover for both themselves and their family.

The “Adversary,” thinks everything you say is a lie. They don’t trust you or the system. They question your motives, and doubt much of what they are told. They blame others for their situation. As the injury itself goes that blame may be completely accurate, yet their inability to accept their new reality and move on prevents them from participating in meaningful restoration. They resist, both passively and overtly, attempts to return to work or to restore function.

The “Addled,” are, in a word, befuddled. They are scared and confused. They are broken and depressed; helpless victims entrapped in a system that can devour their very essence. On the surface they are more cooperative than the Adversary, but their faith is absent. The phrase, “I’ll try, but I doubt it will work”, encapsulates the mental position of the Addled injured worker.

Here is the tricky part. We don’t just see these types of injured workers; we often help create them. Again, no concept is an absolute, but the workers’ compensation system as it exists today plays a major role in coaxing injured workers into these categories. We create the Addled. We certainly can create the Adversary. And when we do things right, we can help create the Advocate. The question is, which injured worker do we want to work with?

I would take an Advocate any day of the week.

The core to creating an Advocate out of an injured worker lies in 3 words. Communication, Care and Compassion. It involves empathy, and at times brutally honest information. It lies in the understanding that newly injured workers entering the workers’ comp system have no idea who we are, what we do or how we do it. To complicate matters, they have no idea what their rights and responsibilities are in this process.

And yes, injured workers have responsibilities in this process. They must understand from the outset that the they will not heal or return to work until they make the individual commitment to do so themselves. The system can and should provide proper care and therapy, but, if we’ve done our job correctly, the ultimate onus for real recovery is still in their purview. No one will watch out for their interests better than they will when they are engaged and partnered in their care. Everyone knows that an injured worker will not return to work until they make the decision to do so.

It should be part of our job to educate them to that fact, and that they will be better off when they do.

The process of dealing with injured workers from an empathetic view point could be the subject of a complete dissertation – far more space required than what I can cover here. Instead I will suggest some key points that should be part of a broader discussion within the industry.

  • We should position ourselves to view life from the perspective of a newly injured worker – They are home from the emergency room, medicated, in pain and out of work. They do not know what will happen next. They have bills to pay. Their employer often does not call them. Instead, they get a call from someone they do not know who works for a company they have never heard of. They speak of “Your claim” and “timely benefits.” Perhaps a follow up doctor visit is mentioned. They may mention an investigation. And then they’re gone. Heavy caseloads often makes it difficult to contact them.
  • Injured workers have questions. Many, many questions. It is unfortunate, as few people in our industry are currently geared to providing patient answers. Remember, in the absence of good and transparent information, cancerous thoughts will grow. This is the fertile ground from where litigation often springs.
  • That injury may be one of 150 or more files on your desk, but to them it represents their entire life at this moment; a life that often is thrown into tumult and stress. We would be wise to remember that, Always.
  • Someday it might be you. I’ve spoken with several comp professionals over the years who told me they had no idea how difficult the system could be until they had a spouse or loved one enter the system. It gives them a new perspective on the importance of what we should be doing.

Communication, Care and Compassion will help you create Advocates out of the injured workers in your charge. I think you’ll find that they heal faster and better than Adversary’s or Addled’s. In fact, i think you’ll find that building Advocates is a critical step towards building a better recovering worker.