Use Change Negotiation Techniques for Delayed Recoveries

Nancy Grover

Sarasota, FL ( – What’s the best way to deal with an injured worker who just doesn’t appear to be recovering? The worker with the so-called ‘creeping catastrophic’ or ‘runaway’ claim, with a seemingly minor injury whose time off work continues on endlessly represents a small fraction of claims, but can cost a bundle.

Often claims adjusters and case managers believe the worker is just trying to game the system, even though the truth could be something very different. There are several successful ways to negotiate with these workers to get them engaged in their recoveries and returned to function — and work.

Delayed Recoveries

Most people with a broken ankle will heal relatively quickly and miss little, if any time off work. But occasionally such a worker will be prescribed medications, physical therapy, surgery and other treatments, and still complain of pain.

The first step can be to look at all the appropriate information and do a full workup to determine what is happening. For example, is it a willful effort to defraud the system or something else.

“It happens due to misdiagnosis, so they are not recovering; or they’ve got other things going on,” said Michael Coupland, network medical Director for Integrated Medical Case Solutions. “They might be catastrophizing, or have fear of moving [their bodies,] There could be return-to-work issues, they are aging out of work or there is no RTW. Things like that.”

If it’s determined that a proper diagnosis was made and appropriate medications and/or treatment prescribed, it could be a psychosocial issue. The person may just be stuck. A biopsychosocial intervention, such as cognitive behavioral therapy, or merely helping the worker get unstuck may resolve the issue.

Negotiate for Change

As an example, say an injured worker refuses to go to physical therapy and when asked why, has no logical reason. Getting to an underlying psychosocial reason for an injured worker’s delayed recovery can be done by helping him go through a change process

“We try to lead people through it,” Coupland said. “When negotiating with somebody in delayed recovery, [we want to] negotiate for them to change and be more active in their work.”

Coupland suggests three steps to help the person go through the states of change.

  1. Active listening. This involves repeating back to the person the gist of what he is saying, in a non-confrontational way. “If you are going to ask a question that can make [the injured worker] defensive, turn it into a statement, such as ‘I’m really concerned you didn’t show up for physical therapy,’” he said. “The worker says, ‘well, I just don’t think it will help.’” The therapist then paraphrases back what the worker said. “’So what I hear you saying is you feel stuck and nothing is going to help,’” Coupland said. “It may sound childless … but it leads them to say something else and become more disclosing.” The injured worker, for example, might admit he doesn’t like his job. Coupland’s response would then be, “so really the issue is you don’t want to go to this job.’”
  2. Overcoming ‘I don’t know.’ When asked why she did not show up for a physical therapy appointment, the injured worker will often say, ‘I don’t know.’ “‘I don’t know,’ means ‘I don’t want to take responsibility,’” Coupland said. The best response to shake the person out of that mindset is to ask, “What would you say if you did know,’” he said. “They will comfortable saying [whatever] it is.”
  3. The broken record technique. This entails coming up with a brief statement of what you want the person to do and making the request over and over. “In negotiating for change, you say, ‘I really need you to go to physical this Friday,’” Coupland said. “Like a broken record, you say, ‘what I really need you to do is go to physical therapy Friday. The injured worker may respond, ‘I told you, I don’t want to go to that job.’ Coupland’s suggested response: “‘I appreciate that, but I really need you to go to physical therapy Friday.’”

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