Workers’ Compensation and the Cost of Mistrust

Your employee was just injured at work. The worker is in pain, cannot perform regular job duties, and is unsure how quickly he or she can return to work. The mortgage, medical care, and child’s tuition payments are due next month. It is a vulnerable time, with substantial uncertainty involved.

When a football player goes down on the field and is carried off, the crowd applauds in support of the player, and the player often returns a smile. When a worker is injured on the job, what happens at the workplace before and after the injury can affect the costs incurred by the employer and the outcome achieved by the injured worker.

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Twelve new state studies from the Workers Compensation Research Institute (WCRI) aim to help CFOs and other stakeholders identify ways they can improve the treatment and communication an injured worker receives after an injury, leading to better outcomes at lower costs.

The studies are based on interviews with 4,800 injured workers from across 12 states who suffered a workplace injury in 2010 and 2011 and received workers’ compensation income benefits. The 12 states were Arkansas, Connecticut, Indiana, Iowa, Massachusetts, Michigan, Minnesota, North Carolina, Pennsylvania, Tennessee, Virginia, and Wisconsin. The surveys were conducted during February through June in 2013 and 2014—on average, about three years after these workers sustained their injuries.

The research found that a worker’s fear of being fired after an injury had a large and pervasive effect on costs and worker outcomes, like when the worker returns to work. The fear of being fired may arise out of the relationship between the worker and the supervisor being one of high or low trust. If the relationship is low trust, the worker is more likely to fear firing when injured.

To describe the level of trust or mistrust in the work relationship, workers were asked to agree with the statement “I was concerned that I would be fired or laid off.” Workers were given four possible answers—strongly agree, somewhat agree, somewhat disagree, and strongly disagree. Depending on the state, 18% to 33% of workers strongly agreed that they feared being fired when injured.

Overall, workers who were strongly concerned about being fired after the injury experienced poorer return-to-work outcomes than workers without such concerns. Across all 12 states, 23% of those concerned about being fired reported that they were not working at the time of the interview—double the rate observed for workers without such concerns. The following are other findings from workers who were strongly concerned about being fired.

• Concerns about being fired were associated with a four-week increase in the average duration of disability.
• Workers who were strongly concerned about being fired had higher rates of dissatisfaction with care (21% were very dissatisfied with care) when compared with workers who were not concerned about being fired after the injury (9%).
• Workers concerned about being fired were much more likely to report problems with access to care. Among workers concerned about being fired, 23% reported big problems getting the services they or their provider wanted. The rate was double the 10% among workers not concerned about being fired.
• Sixteen percent of workers strongly concerned about being fired reported large earnings losses at the time of the interview predominantly due to injury, compared with 3% of workers not concerned about being fired.

What do these findings really signify? The following are some alternative possibilities:

• Workers reporting a strong fear of being fired might know they have a difficult relationship with their supervisor. That difficulty might translate into fewer opportunities to return to work, or more active management of the nature of medical care and the selection of medical care providers.
• The worker may be exaggerating the possibility of termination may be naturally pessimistic, and the tendency to overreact to a situation perceived worse than it is might characterize the workers’ general performance on the job—perhaps resulting in fewer return-to-work opportunities and more active management of the care by the payers.
• The worker may be more likely to retrospectively report a fear of being fired if the worker has had a poor outcome. Poor outcomes color the worker’s view of most events in the course of the claim. Conversely, workers who have experienced excellent outcomes tend to see events in the course of handling the claim in a much more positive fashion.

This isn’t the first time we looked at trust as it relates to workers’ compensation. A study we did several years ago on attorney involvement, which was covered by CFO, looked at why injured workers hired attorneys. The character of the employment relationship, for example, was a factor for the 23% who strongly agreed that they hired attorneys because they feared being fired or laid off. Fifteen percent also strongly agreed that they needed attorneys because their employer could perceive their claims as illegitimate.

Employers Can Make a Difference

WCRI reached out to Lisa Healy, who is a manager of claims at AGL Resources, a natural gas-only distribution company in the United States. She told us that AGL has been very successful in managing and reducing its workers’ compensation costs. In part, she accounts this success to practices in which employees in the organization feel engaged with and trusting of the company. The following are five things she told us the company is doing to facilitate trust within the organization:

1. Establishing a set of values and a code of conduct with the ability to report those who violate it without fear of retaliation. This gives an organization depth in terms of morals and standards, which appeal to workers of all ages.
2. Holding claim adjusters accountable for treating injured employees in an honest fashion and with dignity and respect.
3. Encouraging employees to identify possible safety hazards as well as recommend opportunities to improve safety. When workers are encouraged to point out safety issues or offer suggestions on how to improve things and these comments are taken seriously and addressed, trust is formed.
4. Providing a 24/7 nurse triage program to speed treatment for injured employees so they get the care they need as soon as possible. The employee can contact the nurse triage line immediately after feeling a twinge of pain or sustaining an injury that doesn’t require emergency treatment. This service not only ensures the employee gets the right care immediately, it also cuts down on unnecessary visits to the physician when the employee can use such self-care treatments as ice, rest, elevation, or an aspirin.
5. Promoting early return to work with transitional duty positions whenever possible. Research has shown that the longer a worker is out, the harder it is to for the worker to return―not to mention that the costs rise the longer that person is out. So getting him or her back quickly to work shows the worker you care – and that’s good for the worker and the employer.

Our research may be an important first step in realizing how important trust is between employee and employer in ensuring good outcomes when the employee is injured on the job. But employers can act now, in some of the ways AGL Resources has demonstrated, to improve trust while lowering their workers’ compensation costs. The keys are early intervention, putting safety first, effective return-to-work programs, and access to medical care.

Richard A. Victor is president and CEO of the Workers Compensation Research Institute (WCRI), an independent, not-for-profit research organization based in Cambridge.

Image source: Compliance and Safety