Workers' compensation systems
Evaluating The Impact Of Workers' Compensation Policy In Australia Using A Population Based Administrative Dataset.
Monash University, Australia
Australia has state and territory-based workers’ compensation systems that provide income support, healthcare and rehabilitation for injured and ill workers. The eleven major Australian WC systems provide coverage for over 90% of the labor force and accept approximately one quarter of a million new claims per annum. Governments commonly use changes in scheme design (most often enacted through legislative amendment) to influence WC system performance including rates of claiming, costs and return to work outcomes.
Using a national, longitudinal, case level dataset of workers’ compensation insurance claims data, we evaluated the impact of multiple, state level legislative amendments. The impact of legislative amendments in the states of South Australia (year of 2009), Tasmania (2010), Victoria (2010) and New South Wales (2012) were evaluated using interrupted time series analysis. Outcomes included volume and incidence of accepted workers’ compensation claims, employer and insurer claim processing timeframes, and duration of work disability.
Major findings include (1) the Tasmanian amendments designed to improve RTW outcomes failed; (2) the South Australian amendments designed to encourage early employer claim lodgment were partially effective; (3) the New South Wales amendments designed to ensure the financial viability of the workers’ compensation scheme reduced access to benefits and disproportionately affected workers with occupational disease and mental health conditions; (4) the Victorian amendments designed to increase benefit generosity led to an increase in claims and longer duration of disability.
Changing workers' compensation policy settings can have significant and population wide impacts including on access to benefits, claims handling and duration of disability. Study findings demonstrate both intended and unintended consequences of workers’ compensation system reform, and provide an evidence base for future reform.
International Work Disability Policy Challenges and Directions
1University of Waterloo, Canada; 2Linkoping University, Sweden
Introduction: There has been a move across international jurisdictions since the 1990s to policies and programs that focus on work ability, not disability, and on strategies that encourage employment integration of people with temporary and permanent impairments. Almost 30 years later, we can reflect on those programs: their ideals, what worked, what did not work and why. This presentation describes a synthesis of key challenges and directions in work disability policy derived from a recent edited volume, The Science and Politics of Work Disability Prevention.
Method: Key work disability scholars from 13 countries assembled in Toronto in 2017 to share knowledge about work disability conditions, policies and practical social, economic and political realities of work integration. Each addressed work disability policies in their jurisdiction, current issues and practices, and avenues for change. This resulted in a book edited by MacEachen published by Routledge in late 2018. The final chapter of this book compared, contrasted and synthesized issues raised about the 13 countries.
Results: Across countries, rising levels of disability claimants were a concern, together with increasing work absence due to mental illness, work disability in ageing populations, and limited social protection for self-employed workers. Many systems were redesigned in recent years to address these and other issues using strategies including program coordination, tightened timelines, eligibility restrictions, and reduced income and health care support for sick listed workers. Employer activation, management of non-severe impairment, and the timing of work activation processes were locations of developing and disparate policies.
Conclusion: More tracking is needed of employment outcomes for people who receive or are declined support. Strategies for successfully engaging employers and health care providers in work integration are still developing. Areas of emergent concern are effects of quality of the claimant encounter with providers and approaches to support the growing “self-employment economy”.
Disability Assessments in Two Australian Injury Compensation Systems: Key Informant Perspectives
Faculty of Law, Monash University, Australia
Disability and medical assessments play an important role in supporting decision-making in injury compensation systems. Despite this, they have long been the subject of controversy. Costs, delays and negative client experiences are chief subjects of criticism, and these issues are magnified in disputed claims. Adversarialism can contribute to an evidence ‘arms race’ between claimants and insurers or authorities, often spurring repeat examinations and increasing claim duration and costs.
There is surprisingly little published research on practices surrounding the generation and use of disability assessments in Australian compensation settings. The most prominent strand of research on assessment practice has documented the challenges from the claimant perspective. There is far less understanding of the perspectives of the evidence producers (assessors) and users (eg claims decision-makers, lawyers and healthcare providers). There is a pressing need to improve the evidence base in this area to improve assessment practice and scheme decision-making and, in turn, outcomes for claimants.
This presentation draws on focus groups and interviews with key informants in two Australian injury compensation systems. Established assessment practices are examined, highlightng issues of quality, reliability and independence of assessments, and the relationship between repetitive assessments, claim duration and claimant recovery and return to work. Preferred methods of assessment and the development of novel assessment practices are also presented. The roles and responsibilities of key medical, legal and claims management actors are explored, and the chief barriers to improved practice in disability assessment in Australia are identified.
Increased Benefit Generosity And The Impact On Claiming Behaviour: An Interrupted Time Series Study In Victoria, Australia
Monash University, Australia
To measure the effect of legislated increases to workers’ compensation benefits on claiming behaviour.
Controlled interrupted time series of workers’ compensation claims in Victoria, Australia (2008-2012), assessing 1) the overall effect of the legislation and 2) raising the wage replacement cap on higher earners, in total and by condition type.
Overall claiming increased 12.9% (p = .006) and disability duration increased 5.5% (p = .005), driven largely by musculoskeletal condition claims. Mental health claims’ disability durations decreased 9.7% (p = .008). Among higher earners, claiming increased 7.8% (p = .015) and disability durations 8.7% (p < .001). Claiming for mental health conditions decreased 15.8% (p = .017) and disability duration among fracture claims increased 49.6% (p < .001).
Findings mainly align with existing evidence: more generous benefits increase claiming and disability durations. Among higher earners, unexpected findings among specific conditions suggest complex interactions between injury type, earnings, and benefit generosity.
Does Region of Residence Matter for Return-to-Work After Work-Related Injury? A Multilevel Analysis of Six Canadian Workers' Compensation Jurisdictions
1University of British Columbia; 2Institute for Work & Health; 3Monash University
Background & Objectives: To investigate whether there are regional differences in return-to-work following work-related injury and whether these differences persist after adjusting for individual characteristics.
Cohorts of injured workers from six Canadian provinces were analysed using claim-level data for work-related injuries occurring between 2011 and 2015. Work disability duration was measured using cumulative days that claims received work disability benefits during one-year post-injury. Multilevel log-linear random intercept models were used to separate out the variance of individual and regional-level variation in work disability duration, adjusting for confounders. Geographical Information Systems software was then used to map the unadjusted and adjusted average work disability days paid.
The cohort included 746,029 work disability claims nested within 46 economic regions across six provinces in Canada. The average work disability days ranged from a high of 45.3 days in Edmundston-Woodstock (New Brunswick) to a low of 21.6 days in Ottawa (Ontario). Regional variation was greatest in the transportation sector and smallest in the health care sector. Adjusting for various demographic, employment, and injury characteristics, 6.6% of the total variability could be explained by economic-region variability. When adjusting for workers’ compensation jurisdiction, total variability explained by economic region decreased to 0.4%.
Regional variations in work disability duration remain after accounting for individual differences at the regional level, such as demographics and industry. Variation at the level of the economic region was not as great as variation at the level of the provincial workers’ compensation jurisdiction. These findings suggest that provincial differences in the provision of workers’ compensation may be more important than smaller regional differences.
Identifying Industry Intelligence Related to Providing Targeted Care
1Monash University, Australia; 2RMIT University, Australia; 3Institute for Safety, Compensation and Recovery Research, Australia
Background: Targeted care is the use of individual-level information to identify an approach of care that would not have occurred had the initial information not been collected or analysed. Targeting care involves collecting, interpreting and acting on information specific to those in need of care. This project aimed to identify current industry thinking and practice related to implementation of targeted care following accident or injury.
Methods: Structured interviews were conducted with 21 key informants from 14 Australian organisations including compensation authorities, compensation insurers and life insurers. Interviews focused on factors related to the implementation of targeted care approaches.
Results: Targeted care is a topic of great interest to the industry in general, and significant industry intelligence exists related to this area. However, there are few examples where organisations feel they have found the best solution. While access to data had generally increased, data driven approaches to achieving targeted care appeared to incorporate a large number of variables that in practice are hard to collect, or require long and complex collection methods. There was focused activity within the industry to identify clients who need little or no intervention. This has the potential to provide savings to allow more resources to be focussed on complex cases. There was agreement about the importance of staff engagement. Changes to case manager practice were reported to be genuinely difficult. Even when pilot programs demonstrated success in an approach to service delivery, challenges remained in expanding this to wider business practices.
Discussion: The success or failure in improving client outcomes does not seem to be related to a particular model or a specific approach. Some of the factors which may act as barriers or facilitators identified in this report are: complexity, time pressures, communication approaches, organisational capacity, information, and changing healthcare and industry context.