Abstract
BackgroundInsurance claims management practices may have a significant impact on the health and experiences of injured workers claiming in workers’ compensation systems. There are few multi-jurisdictional studies of the way workers experience compensation processes, and limited data on the association between claims experience and return to work outcomes. This study sought to identify worker, claim and injury related factors associated with injured worker experiences of workers’ compensation claims management processes, and to examine associations between claims experience and return to work.MethodsA national, cross-sectional survey of injured workers involved in ten Australian workers’ compensation schemes. A total of 10,946 workers completed a telephone survey at 6 to 24 months post claim acceptance. Predictors of positive or negative/neutral claims experience were examined using logistic regression. Associations between claims experience, return to work status and duration of time loss were examined using logistic regression.ResultsNearly one-quarter (23.0%, n = 2515) of workers reported a negative or neutral claims experience. Injury type, jurisdiction of claim, and time to lodge claim were most strongly associated with claims experience. Having a positive claims experience was strongly associated with having returned to work after accounting for injury, worker, claim and employer factors.ConclusionsThere is a strong positive association between worker experiences of the insurance claims process and self-reported return to work status. 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.
Highlights
Insurance claims management practices may have a significant impact on the health and experiences of injured workers claiming in workers’ compensation systems
Fifty five percent of claims were lodged within 14 days of injury onset, with nearly three-quarters being lodged within 28 days
Insurance claims management practices can have a significant impact on the health of injured and ill workers involved in workers’ compensation systems [5, 6, 25]
Summary
Insurance claims management practices may have a significant impact on the health and experiences of injured workers claiming in workers’ compensation systems. This study sought to identify worker, claim and injury related factors associated with injured worker experiences of workers’ compensation claims management processes, and to examine associations between claims experience and return to work. While approaches vary dramatically between and within nations [1, 2], these systems share common features, including applying eligibility criteria for claims and making payments for income support, healthcare and other benefits A systematic review of quantitative literature identified that aspects of the work injury claims administration process can impede return to work in some people [4] These included delays in decision making, strict or rigid processes and poor communication. Conceptual models of work disability suggest that administrative policy and procedure can impact RTW, through the settings and actions of insurance and compensation systems [7]
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