A Qualitative Research Report on:
FAILED RETURN TO WORK, DELAYS IN
CLAIMING AND LONG DURATION CLAIMS
CONDENSED REPORT
Ref No. 22706/22707 • June 2013 • V5
Authors:
Jen Hodges, Jo Kirkhope, Lisa Naphtali and Monique
Slevison
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Table of Contents
Background ......................................................................................................................... 3
Overview ............................................................................................................................. 4
The Individual Return to Work Journey .................................................................................... 6
The Individual .................................................................................................................... 11
The Organisation ................................................................................................................ 18
The Healthcare Professionals ................................................................................................ 22
Role of Comcare ................................................................................................................. 24
Appendix 1: Objectives and Methodology ......................................................................... 27
Sweeney Research is accredited under the International Standard, ISO 20252.
All aspects of this study have been completed in accordance with the requirements of that scheme.
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Background
An agency of the Australian Government, Comcare is responsible for implementing policies in federal
workplaces to drive social inclusion and productivity. In this aim, Comcare partners with workers,
employers and unions to support the health and safety of workers, and to minimise the incidence and cost
of workplace injury and disease.
As part of the Comcare scheme – which provides all scheme employers with an integrated safety,
rehabilitation and compensation system – Comcare is responsible for the management of workers’
compensation claims submitted by federal government employees in addition to 30 companies who have
been granted a self-insurance license for workers’ compensation by the Safety, Rehabilitation and
Compensation Commission (SRCC).
In 2012, three research needs were identified.
1. Failed Return to Work
Despite the best efforts of Comcare’s employers and the scheme, a formal and successful return to work
(RTW) does not happen in all cases of workplace injury. While RTW has known benefits for psychological
health and overall recovery, this process does not always occur successfully: research has shown that an
initial return to work after an injury is frequently followed by one or more recurrences of work absence.1
Data obtained from the Comcare Injured Worker Survey is reflective of this fact, with approximately 15
per cent of injured workers experiencing an unsuccessful attempt to return to work after injuring
themselves in their workplace. This figure is cause for concern due not only to the detrimental impact on
workers’ wellbeing but also to the burden placed on the Comcare scheme.
2. Long Duration Claims
In addition to this, long duration compensation claims – claims with between two and five years of
incapacity – represent a significant personal, social and financial burden on both individuals and
organisations, while also increasing the liability of the Comcare scheme. Comcare’s claims database shows
that around 50% of our active claims have received 5 or more years of incapacity payments. As the
number of long duration claims increases, so too does the pressure on the financial position and
sustainability of the scheme.
3. Delays in Claiming
A third project commissioned (conducted in 2013) looked at why employees delayed lodging a claim. To
consider this important component a small number of interviews were conducted. Considerable similarities
between this project and the other two were found.
For this reason, the three projects have been combined into one overall project, and reported in one
document. Any differences across the projects have been highlighted throughout the report.
Objectives and Methodology are appended to the end of this document.
1 Butler, Johnson, & Baldwin (1995). Managing work disability: Why first return to work is not a measure of success
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Overview
When reading this report, it is important to remember that the ability of an individual to successfully
return to work is neither straight-forward nor one-dimensional. Rather, it is multi-faceted and continuously
evolving.
The report has been structured in a way that focuses on the journey experienced by individuals who are
injured or become ill at work. We go on to explore the dynamics and nuances of all parties involved in
workplace injury/illness and return to work experiences.
The report follows distinct sections, which encompass the following key sections:
1. The Individual Return to Work Journey

Outlines the journey individuals go on and the key stages throughout the journey, from the
pre-injury context, the period of persuasion (i.e. the point between the injury and the point of
claim), the inevitable slump, the pivotal phase and how this moves towards either on-going
success or failure to return to work.

This section looks at what happens at each stage, the main players and influencers and
considerations for driving a successful outcome
2. The Individual

The individuals perspective and experience of sustaining an illness/injury at work, submitting a
workers compensation claim and the impact it can have on their lives and sense of identity

Drivers to claiming and barriers to submitting a claim

Factors influencing an individual’s ability to return to work (including personal situation,
expectations and relationship with the organisation), and four key claimant typologies are
identified and outlined in this section
3. The Organisation

The organisational perspective of the return to work journey and the challenges that
organisations face

Factors that influence the organisation’s approach to return to work and defining successful
and unsuccessful return to work

An overview of the organisations’ process of return to work
4. The Healthcare Professionals

The role and perceptions of the rehabilitation provider (from an individual perspective and an
organisational perspective)

The role and perceptions of the GP and other healthcare specialists including “Approved”
healthcare providers (from both the individual and organisational perspective)
5. Comcare

Perceptions of Comcare from an Employers and Employee perspective and understanding of
the scheme

Outline of the Comcare experience and the various challenges that employees and employers
face, including administrative, timing, case management and communication issues

Explores some of the potential opportunities for Comcare moving forward and the important
role that Comcare has the potential to play in the future
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Other key contributors to an individuals’ ability to return to work (or not), that should be considered whilst
reading this report include:

The stigma associated with workplace injury or illness

The tension between return to work and return to health

The prevalence of mental health
The current document provides an overview of the findings of the recent Failed Return to Work, Long
Duration Claims and Delays in Claiming research studies. A more detailed report is also available, which
can be obtained from the Comcare Research Team. For further information, please enquire at
[email protected]
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The Individual Return to Work Journey
The RTW experience is a ‘journey’ undertaken by the individual, encompassing a range of experiences.
Irrespective of outcome, it is often emotionally charged, intense, exhausting, demanding and always
challenging to some degree.
There are five stages along the journey:
Figure 1: Return to Work Journey
Pre-incident
Period of
Persuasion
Inevitable
Slump
Pivotal
Phase
Ongoing Success
Positive Maintenance
Entrenched
This cycle
can become
a continual
loop
RTW Cycle
Culture and
Prevention
Constructive
Collaboration
Reassure
Educate
Support
Continued
Support or
Damage
Control
Rebuild and Re-educate
The following looks at each key stage of the journey in more detail:
Stage 1: Pre-Incident Context

This stage includes all contextual aspects in which the journey commences, from the unique
circumstances of the individual through to the approach by the organisation
−
Individual... personal situation, expectations of the organisation, relationship with the
organisation and personality typology
−

Organisation... commitment to RTW, corporate culture, middle management skills and flexibility
The dynamics between the individual and organisation are critical. The relationships fostered between
the two prior to any injury or illness can have a strong impact on an individual’s ability to return to
work

These circumstances will determine the ‘base’ expectations of the individual entering the journey as
they start to ask the question... ‘Will I be supported or will I have to fight?’
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Key to driving toward a successful outcome...

Prevention... organisations encouraged to take a pro-active approach to workplace
health and safety. Ensure all avenues of health and safety are adhered to (i.e.
workstations are correctly set up, individuals have access to the correct equipment)

Culture… organisations encouraged to take all concerns seriously, act on issues quickly
before they escalate, working collaboratively with the employee to find workable solutions
Stage 2: Period of Persuasion
Between Injury / Illness and Claim

At this stage there is scope to affect a positive outcome and even, in some cases, prevent the claim

Those who delay their claim rely heavily on the advice of others and are at their most positive about
their recovery at this stage – a claim delay at this stage isn’t necessarily a negative thing
Once a Claim is Made

This phase is pivotal to setting the ‘tone’ for the rest of the journey

Individuals can be quite positive at this stage (with some exceptions) both about their recovery and
how the situation may unfold

Employees tend to have little understanding of what will happen in terms of the formal processes, the
potential for assistance and about their own injury which many believe will be a temporary ’glitch’ in
their life

Individuals are particularly vulnerable at this point and will be acutely sensitive to the responses of the
organisation to their circumstances

Individuals can ‘lean’ heavily on any and all cues from the organisation and, in fact, anyone who is
offering advice. It can appear to the employee that the organisation has the initial power in the
journey to influence the chances of a successful outcome

Any cynicism or doubt displayed by the organisation can result in a profound and personal sense of
betrayal by the individual, which once established, is very difficult to shift
Key to driving toward a successful outcome...

Constructive Collaboration… encouraging constructive and collaborative exchange between the
individual and the organisation that demonstrates professional care. Individuals need to work with the
organisation (rather than have the organisation make decisions for them) to decide how to progress.
Conversations should be two way.
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Stage 3: Inevitable Slump

Occurs in the initial days or weeks of returning to work when claimants are re-engaging with their ‘new
reality’ and the certainty of full recovery is being challenged

This slump has three key triggers:
‒
Unrealistic personal ability expectations… they over-estimate their physical and mental ability
to cope once back at work
‒
Exaggerated expectations... on how returning to work would positively influence recovery
‒
Challenging RTW conditions... their new roles, responsibilities or team environment and sense
of professional value diluting.

In a few cases returning to work is seen as a positive. Those who had positive RTW experiences were
almost solely from the Delays in Claiming interviews where, despite having been a delay in the claim,
the return to their role or their workplace was viewed favourably because of the strong level of
employer support. Essentially, these employers had taken on a very proactive approach to
injury/illness management; by working with the employee to rectify any issues, and cooperating and
accepting the needs of the individuals
Key to driving toward success...
Individuals need reassurance in their own ability to return to work, and that others (i.e. colleagues, team
leaders, the organisation as a whole) are there to help and support

Reassurance... it’s important for recovery that the individual has a sense of being valued even under
the new conditions. Either the solutions should be discussed as temporary so they don’t define their
future and/or the value of the RTW activity should be expressed

Educating… ensuring individuals are aware of the emotional challenges they may encounter in
returning to work and being prepared for these – even when the injury is solely physical in nature

Practical support... providing follow up discussions/check-ins from management to address growing
doubts early before they build momentum
Stage 4: Pivotal Phase

A decisive point in the journey - this stage reaffirms or challenges the injured worker’s decision to
continue or to cease their RTW attempt

Moving toward success... individuals will have found ways to manage their circumstances, are
adjusting to their new conditions and moving forward

Moving toward failure... these individuals have essentially failed their first attempt at RTW

The Return to Work cycle… RTW can take numerous attempts, but each attempt can negatively
impact attitude and motivation to continue. The challenge is to ensure that the injured worker sees
each attempt as a small victory, or success and to learn from the problems they experienced to move
on and have a more positive experience next time
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Keys to drive toward success...
A period of ‘damage control’ for the employer and Comcare if the individual has ‘failed’

Understanding... recognising the disillusionment and frustration that the individual may be
experiencing, to keep the emotional dialogue constructive and progressing forward

Practical solutions... looking at alternate options as RTW solutions to demonstrate potential
for return

Plan... reasserting optimism is important. Providing clear steps on how the individual can
move forward toward recovery after a setback is essential to help avoid a feeling of
hopelessness, helplessness or worthlessness.
If the individual has continued at work…

Continued support… is essential to reinforce their positive choice
Stage 5a: Ongoing Success

The individual is on track toward a successful RTW outcome. They are committed, more settled and
looking forward to their future

They have largely accepted their new circumstances and transformed their views on their identity (if
necessary)

Fundamental to the success of this stage is recognising that the individual’s capability is only as good
as the continued respect and accommodation for their physical/mental health limitations allow

Important also is the employers’ demonstration that they have learned from the incident
Key to driving toward success...

Positive Maintenance… the primary challenge at this stage is to ensure on-going diligence to
avoid relapse.
Stage 5b: Entrenched (Long Duration)

This stage is largely defined as the ‘end point’ for many. The journey has proven unsuccessful and
they are generally ‘stuck’ or ‘entrenched’ in a workers compensation solution for the foreseeable future

Amongst individuals in this study, the majority of cases were within the Long Duration stage either
because their injury / illness is still too severe and they are still recovering (or they have developed
depression or another mental illness that has caused ongoing debilitation) or the organisation does not
have a suitable position to accommodate their circumstances

High risk of system entrapment. Many can’t move into work nor can they develop their skills or
volunteer. They question whether another employer will take them on with some suggesting that if
they were an employer they wouldn’t hire themselves
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
Some resort to a ‘secret activity’ (i.e. volunteer work), others transition to a much more reclusive
lifestyle (making ever returning to work seem much more difficult)
Key to driving toward success...

Rebuild and Educate… confidence and skills to enable re-entry to the workforce

Opportunities… realistic and achievable opportunities to return to work and keep engaged
Case Study 5
The individual fractured her wrist at work, and has been undergoing surgeries and has been in
severe pain ever since. There had been some conflict with her supervisor prior to the injury,
and she has not had any contact with her supervisor the whole time she’s been off work, which
has been very upsetting for her.
The individual struggles to adapt to life with her injury and feels hopeless about her chances of
getting better. She feels extremely apprehensive about the thought of RTW, and has been
informed by medical professionals that she won’t return to her job. The priority for this
individual is on getting well before she can think about going back to some form of work.
Gender: Female
Claim: Fracture
Status: Unsuccessful RTW (Long
term claim)
Time off work: 22 months
RTW attempts: 0
“I don’t hear from work at all. That’s been huge. I didn’t even get a card for my last operation.”
“I’m really apprehensive [about RTW]. I barely get through a day without crying. It would depend on what the job was. I would prefer to feel better,
not to be going to work in this much pain.”
“It’s not a case of saying ‘I can’t return to work until I’m fully better’. I need to be coping better with life, really.”
“I don’t think I’ll be able to return to the department. I haven’t given it a lot of thought. I would have to be so much better.”
Case Study 6
This individual does not believe she will ever attempt to RTW again, as she is too afraid of her
depression worsening and undoing the progress she has made – it is simply not worth the risk.
The individual attempted RTW once and was eager to get back to work, however when she
returned she found that her position had been changed without her input, she was moved to
another floor of the building, and no one spoke to her. She perceived this as ostracism, and felt
insulted by alternative duties offered to her.
Gender: Female
Claim: Bullying and harassment
Status: Unsuccessful RTW (Long
term claim)
Time off work: 21 months
RTW attempts: 1
“I’ve lost faith in people. They didn’t care at all about me or what I went through. You just don’t expect it to happen at work.”
“I couldn’t afford to go backwards. I was too vulnerable. I’d be a fool to go back if nothing’s changed.”
“I have accepted the way things are – this is me now, I don’t have a lot of hope that I will get better.”
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The Individual
The Impact of the Experience
The experience of ‘going through’ a workplace injury / illness, a workers’ compensation claim, being off
work for a long period of time and failing to return work, all have a profound impact on individuals’ lives.
The process affects the individual, the people around them, their finances, emotions, their jobs and
careers and can alter their whole sense of identity.
A Shift in Identity
Experiencing the pain and challenge of the injury / illness, the loss of life and work structure, and the
impact on their relationships (personal and professional) all contribute to challenging their world and sense
of self.

Loss of confidence in themselves… the injury / illness highlights their own fallibility which in itself
makes it difficult for employees to feel confident about any stage of the process from decision to claim
through to RTW

Loss of structure… regular, employment gives employees a purpose, as well as a social outlet. No
longer being part of that ‘hustle and bustle’ makes many feel disconnected and isolated

The experience… all talked of the experience as a whole as having a significant and permanent
impact on their life - changing their physical and/or mental state, as well as their outlook on life. They
face…
‒
A lack of control – leaning more heavily on others to help out (due to incapacity of their
injury/illness)

‒
The stigma – of mental illness or the stigma associated with being ‘on compo’
‒
Employers expectations – of returning the individual to work before returning them to health
‒
A lack of trust – with their workplace, colleagues and with the world in general
Relationships… changed capabilities (through the illness/injury) can mean changes to household
roles – resulting in a shift in power within the household, placing a strain on relationships particularly
with immediate family members and at the most extreme resulting in divorce
Not surprisingly, the impact of the experience on an individual can often result in feelings of depression
and/or anxiety. Discussions with employees revealed that all aspects of the journey can activate cognitions
and mood states that are core to depression, which are…

Worthlessness… the sense of having no worth or value in society

Helplessness… feeling unable to have control over one’s circumstances or any power to enact change

Hopelessness… the sense that one’s circumstances are never going to improve, and a negative
outlook towards the future.
Once the depression sets in, it impacts the individual in two key ways:
1. The symptoms of depression cause the individual to feel less motivated, more fatigued and low in
mood which impacts the likelihood of success in a return to work attempt
2. For some, the diagnosis of depression (and other mental illnesses) can become a label they attach
to themselves and come to identify with. This can be adopted as another barrier in their path
towards return to work – they begin to see depression as part of their life
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Factors Influencing the Decision to Claim
There were clear and consistent factors that impacted employees’ decision to submit a Comcare claim. The
factors cited were inherently similar.
Drivers to Claiming

Financial burden… for some the fear of financial hardship meant they claimed quite quickly. Others,
however, felt that after a period of time off work and having used all available leave that they were left
without an alternative

Advice from others… among some who were reluctant to submit a claim the advice from a GP or
loved one was the ‘push’ needed. Many were assisted / influenced by a HR contact in their
organisation.

Severity of illness / injury… many felt their situation would improve and so when it did not they
decided the best choice was to submit a claim…and resigned to the concept that it was necessary. This
can place them in a negative frame of mind from the outset
−
Interventions not successful… either their own actions (natural therapies, time on leave) or
that of the employer (change in hours, provision of a mentor, change to workstation) didn’t
rectify the situation satisfactorily
−
Fear of recurrence… concern that the injury / illness could have long-term impact on their
life both personally and professionally (once realised it was more severe than they first
thought)

Confidence in employer… believing they will be supported in their RTW endeavour by a supportive
and collaborative employer
Delays in Claiming
There were both positive and negative beliefs to claiming.
Positive beliefs included…

Belief they will get better (primary barrier)… no need to claim because the injury / illness will not
last long enough to warrant a claim

Confidence in the interventions… belief the action taken will be sufficient and effective

Trust in employer… their processes will work, and be sufficient
Negative beliefs included…

Stigma… not wanting to be someone who is ‘on compo’. The was of particular relevance and
heightened importance with mental health claims where there is also a stigma associated with the
illness

Feeling ‘unworthy’… perception that Comcare is only for ‘severe’ injuries

Fear of the unknown… uncertainty about the process, unsure what benefit there will be
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
Apprehension about employer… concern the employer would prefer no claim and so preference to
‘fall in line’ (no suggestion of coercion but rather desire to do what is wanted)

Lack of confidence in employer… when the issue is with the employer (mental health in particular)
there can be a concern of exacerbating an already negative situation. Some feel they have no one they
can trust in the organisation, others feel they will not be treated appropriately or fairly if they decide to
claim

Seen it before… ‘knowing’ that an employer will not react positively or be helpful based on prior
personal experience of what they have seen transpire with others

Advice from others… either those who have been in the situation or a GP. Being told that they would
be better off not claiming or that the repercussions of the claim (negative reaction by an employer)
could be prohibitive

Return to work too early… some returned to work (after having used sick leave or personal leave
rather) before they were ready or before their injury was fully healed resulting in some worsening and
delay in the decision to submit a claim
Factors Influencing Return to Work
Findings from this study suggest there are a number of key factors that influence why one individual has
the ability to return to work, whereas another, with a similar injury finds it impossible. These key factors
involve:
1. Personal situation… including, demographics, lifestage (i.e. dependents), where they are in their
career, role, experience, tenure
2. Establishing expectations … setting expectations prior to injury or illness of equality, fairness,
safety, support and a bully-free environment – fostering a positive culture
3. Relationship with the organisation… highlighting the importance of the relationship between the
employer and the employee prior to the illness and injury, as well as the relative stability of the
organisation, how the employee fits into the organisation, their motivation to get back to work and the
length of time off
4. Personality traits… individual characteristics that influence the way in which individuals behave,
such as resilience, empowerment, self-esteem, etc.
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Four key claimant typologies emerged…
High Empowerment
Strivers
Victims
(Temporarily)
Floored
Low Trust
High Trust
Defensive &
Entitled
Low Empowerment
Strivers… one of the most resilient groups. Strivers tend to be more empowered, maintain a level of
control over their recovery journey as well as their ability to return to the working environment and have a
good level of trust in the organisation and its role in their recovery.
They work collaboratively with others (employers, healthcare professionals, Comcare) to get themselves
better and back to work. Most, if not all, of those who participated in the Delays in Claiming fell into this
category – they took their injury into their own hands from the outset truly believing they could recover
well and quickly.
Some of those respondents, as with others in the Strivers group, descended into Victims (see page 16)
during the course of their journey.
Case Study 11
Individual has a strong work ethic and a positive attitude towards work – it provides a sense of
identity, and there is a strong fit with the team and a sense of community.
Whilst, returning to work too quickly meant he had one failed attempt and needed longer to
recover, the individual spoke of a strong sense of personal responsibility in recovering and
returning to work, and his self-discipline and proactivity is a source of pride for him. For this
individual, there was no option but to succeed in returning to work.
Gender: Male
Claim: physical followed by mental
illness
Status: Successful RTW
Time off work: 2 weeks
RTW attempts: 2
“If I can work I will work.”
“The pain is going to be the same at home or work, there’s nothing to stop me working with it.”
“The system is there to get you going while you’re healing – it’s not meant to be a crutch.”
“When you injure yourself... you take the support if it’s offered but it’s your responsibility to get yourself well.”
Page 14 of 30
Temporarily Floored… have a lower level of empowerment and a greater dependency on organisational
help. They have a high level of trust that the organisation will help them through the journey, and if this
doesn’t happen, the fragility of the typology means that they can easily migrate towards a ‘Victim’ (see
below).
Case Study 12
The Individual had minimal trust in the organisation following initial attempts to RTW. However,
trust in her organisation has developed following perceived changes in management’s attitudes
and approach to her and to RTW in general.
There was a sense of personal disempowerment and fragility following long-term injury and
multiple failed RTW attempts. However, the individual recognises that the organisation impacts
this, and her own sense of empowerment is improving with her increased trust in her
organisation. Desire for support with RTW from both her organisation and Comcare is strong.
Gender: Female
Claim: Musculoskeletal Ganglion
Status: Unsuccessful RTW
Time off work: 2 years
RTW attempts: 5
“You feel helpless, frustrated, and lonely sometimes. You just have to rely on everyone.”
“I got depressed over it, was on antidepressants for 3-4 years… now it’s a different story, because my mentality has changed. It should be compulsory
that when you RTW you have support.”
“I’ve got to remain positive, to say yes, I am in recovery.”
“Over the last few years my workplace has been very supportive; management has changed. They are finally seeing how much work I actually do and
how much knowledge I have. I now feel that they trust me. It would have helped if this had happened years ago.”
Defensive and Entitled… personally empowered to look after themselves, and appear to be very much
in control, which is why they ensure that they know what they are entitled to in order to recover. Their
level of trust in their organisation is much lower (they have a strong level of cynicism that the organisation
is working in their best interests) and recovery is therefore on their terms.
They can appear uncooperative and difficult, and their entitlement focus can lead the organisation to
believe that they aren’t being ‘legitimate’.
Case Study 13
This individual had suffered an injury in the late 1980’s (“Golfers Elbow”), which led to three
months off work. She believes that she was poorly managed by her organisation; she didn’t feel
she had the right level of care and was asked to carry out tasks that she didn’t think were suitable
Gender: Female
Claim: RSI
for her injury. This experience was pivotal to how she approached a subsequent (but different)
Status: Successful RTW (but
injury in 2010. After the introduction of a new computer system throughout the office, along with
since taken redundancy)
increased pressure to achieve KPIs, she ended up suffering repetitive strain injury.
She highlighted that her experience in the 1980s gave her the confidence to “stick up for herself”
this time round. As soon as the injury occurred, she went straight to the GP and was signed off on
Time off work: 6 months
RTW attempts: 2
sick leave. She refused a case manager, opting to manage her own RTW as she didn’t trust that
the organisation would ‘get it right’. She believes she took control of her own situation, refusing to
return to work until she felt ready. When eventually she did return back to the workplace, she was
quick to place parameters around her abilities to ensure that she would be able to recover (i.e.
taking breaks throughout the day, avoiding duties that could exacerbate the injury).
Eventually, she was offered a redundancy package, which she felt was a way to get rid of her
because of her limitations and her stricter approach to recovery. Nevertheless, she maintains that
it was the correct approach for her personal injury
“I said point blank that it would be a graduated return”
“It was up to me to find things that I could do. I thought, “what can I do?” we had set up automatic macros, where you only have to type in a few
things… I could do certain things, it would take a while, but I could do it”
Page 15 of 30
Victims… have a very low level of personal empowerment - everything is done to them, rather than them
taking control of their situation.
Mistrust in the organisation means they are unlikely to work cooperatively, and a strong disbelief that their
illness (or injury) has incapacitated them to the degree that they will not be able to return to work
Case Study 14
The Individual developed anxiety following phone room co-workers’ complaints of the volume
of his voice, and management’s failure to address the situation. The Individual felt that the
organisation was unsympathetic and unsupportive towards mental illness, and that his anxiety
was exacerbated as a result of this.
The Individual feels no trust at all towards his organisation, due to their failure to take his
mental illness seriously. He also feels damaged by the whole experience, and identifies as a
victim who has been disempowered by anxiety and his interactions with his employer. His trust
in employers in general has been eroded to such an extent that he cannot envisage returning
Gender: Male
Claim: Anxiety
Status: Unsuccessful RTW (Long
duration claim)
Time off work: 5+ years
RTW attempts: 0
to work in any form, a view that has been endorsed by his psychologist.
“It was how they dealt with the situation overall. Over the course of time, it built up the level of anxiety... until I couldn’t
hack it anymore.”
“The head of the health services area was of an older generation – she believed that people with mental illness were a
bunch of fakers and it was all a bunch of codswallop. She said that to me and others.”
“…the overwhelming sense of ‘can I trust them?’ – I wouldn’t be able to trust an ordinary employer.”
“I thought one of [my managers] was helping me out, but he wasn’t, he was trying to extract information to use against
me.”
“It’s a constant battle… because I pushed myself too hard; my body doesn’t cope with stress at all. Even a small amount
of anxiety turns into a panic attack.”
“My psychologist was blunt with me – said I would never go back to work. I was upset about that. What’s the point of
continuing on?”
Key to driving success…

Understanding the individual situation, their characteristics and their relationship with the
organisation is as important as understanding the injury itself

In addition, fostering a positive organisational culture is an important aspect to help build trust
amongst individuals prior to any injury or illness. This essentially sets the tone for when
injury/illness occurs
Page 16 of 30
Successful/Unsuccessful Return to Work
There is an expectation that successfully being able to return back into the workforce will be facilitated by
the organisation. Initial attempts to return to work are often entered into somewhat blindly – employees
can be shocked at the difficulty they experience.
For many, a successful return to work attempt means…
Returning to and remaining in a reasonable place of employment, into a meaningful role that mitigates the
chance of exacerbating the illness/injury and/or preventing efficient recovery
However, problems occur when upon returning to work, they experience…

Physically unsuitable duties

Downgraded expertise (i.e. duties that are considered ‘beneath’ them)

Nothing to do at all

Isolated environment

Unsupportive environment
Key to Driving Success…

Ensure that the individual is aware and understanding of the challenges they will inevitably
face

The organisation needs to foster an environment that is sympathetic to their needs, that their
tasks and duties are valued and the wider team are understanding and treat individuals with
respect.
Page 17 of 30
The Organisation
Employers viewed return to work as a serious organisational issue that has to be managed on an ongoing
basis. They believe there is always room for improvement and advancement in their processes but, at the
same time, are acutely aware of two challenges…

The role the individual plays in the process and;

The inherent constraints that an organisation is faced with when trying to accommodate individual
needs
Employers talk about a range of different approaches to managing return to work and the apparent conflict
between return to work and productivity, which, over the years appear to have evolved into much more
knowledgeable and sophisticated means of helping individuals back into their role.
In considering the responses of both employees and employers, it was clear that employers’ attitudes at
some point in the past fell into three categories…

Avoidance… minimal effort to address the issue and genuinely accommodate the individual’s needs
(employee perspective)

Scepticism…. refusal to accept the case as genuine

‘Manage out’ the individual… actively trying to manage the individual out of the organisation
through enforced retirement (extreme cases only)
These attitudes certainly appear to have evolved somewhat over the years as organisations become more
experienced and capable of returning individuals back to work.
Key Factors Influencing Organisational Approach to RTW
Findings from this study suggest there are three predominant factors that influence an organisations’
ability to achieve a ‘progressive’ status…
1. Corporate culture and prevalence of return to work stigma… individuals may endure
pain/discomfort for longer in order to avoid notifying the organisation of an illness/injury and/or be
concerned about returning to an environment that is perceived to foster negative attitudes to those
who experience workplace illness/injury
2. Skills and commitment of management… actions and attitudes of middle-management become
tangible ‘proof’ of the organisational approach to Comcare cases. This directly impacts expectations of
how employees will be treated at all levels of the organisation. However, management are also
challenged in their ability to engender a positive approach, as they have to balance employee needs
with performance measure demands. Their interpersonal skills, experience, and the support they
receive from senior management are critical to help them positively manage their situation
3. Flexibility of the organisation… organisations have to work within the confines of what’s feasible
(i.e. the scope they have to provide what is required for individuals returning to work). This can be
dependent on the size of the organisation, seniority of the claimant, the desire for consistency
(returning to the same role, in the same department), and the type of injury
Page 18 of 30
Successful/Unsuccessful Return to Work
The definition of successful return to work can be understood to be largely dependent upon three factors:

The organisations’ approach to return to work,

The volumes of employees going through the process, and

The diversity and focus of the organisation.
Success cannot be viewed in black and white terms but rather in degrees of success, ideally seeing the
individual return back to their original hours and duties, with restricted hours/lighter duties considered a
suitable alternative, when necessary.
Unsuccessful return to work is seen as not being able to facilitate getting an employee back to the
organisation in any capacity.
Employers were often able to identify traits, or attitudes linked to those who are more likely to fall into the
‘unsuccessful’ category. The presence of these traits doesn’t make it impossible to return an individual to
work, it simply requires more effort, strategy and persistence by all parties involved. Key traits include…

An entitlement mindset… may be associated with ‘defensive and entitled’

Learned helplessness/strong identification as the victim… associated with ‘victims’
typology

A pessimistic attitude towards return to work from the outset… influenced by doctors,
rehabilitation providers, psychologists and case managers who some employers believe can
disrupt the organisational process

Mental illness as the reason for requiring time off work… it appears that psychological
injuries/illnesses are, for the most part, associated with the greatest difficulty in getting an
employee back to work
The following example provided by one employer illustrates this point:
“We had someone off work who is lonely, and who wanted attention from
everyone. It was a physical injury. She’d been through 6 rehab providers, 5
pain management clinics – for a case that’s started in 2010. She was seeing a
physio, the physio would say ‘I think you need this’ – but I think the person
was driving it, saying ‘I need this’ – and the doctor would approve it without
questioning it. Then Comcare approve it because the doctor recommended it.
That person was doing 6 hours a day because that suited them. The physio said
they should do 1 minute of typing every15 minutes, so they would do that and
then literally just stop and sit there, instead of pushing through the pain
barrier. Then they would go back to the physio, and it’s a lot of treatment for
something the medical professionals were saying was healed. This person lives
by themselves, and their cultural background would require them to be
married with children by now. So I think that person was lonely and that drove
a lot of the issues. But with my intervention we’ve got this person back to 7
hours per day, they’re having 5 physio treatments per three months; we’ve got
them back to doing actual work not just sitting at their desk. I think it came
down to we’ve helped you a lot, you got better, we need to keep helping you.”
Page 19 of 30
At a more extreme level, a minority of ‘problem’ employees were placed into a different category by
employers. Those categories can be understood to comprise serial claimants, multi-taskers (i.e. taking on
another job whilst receiving compensation), workplace blamers and bludgers (it is worth noting that we
didn’t interview any individuals that fell into these categories, therefore they are not linked to any
typologies). These extreme cases require significant effort to manage, and employers appear to have
developed wariness and even cynicism in some cases around return to work as a response to the effort
they have to expend. This cynicism may not be overt, however any cue that an individual is going to be
‘particularly difficult’ does trigger an emotional reaction which arguably influences how the employer (i.e.
line manager/supervisor, etc.) manages the case.
The RTW Process
Across the board, the return to work process followed a similar structure within organisations...

Notification… employee or supervisor notifies the HR/wellbeing department if an injury has occurred
(prior to claim). In many cases an incident form is completed – especially for a one-off physical injury
(e.g. broken arm).

The Challenge: fear of the ‘stigma’ and those with mental health concerns can make some
less likely to report issues at an early stage and, as a result, the injury/illness is in danger
of escalating. Fear is minimised when the injury is visible and ‘acceptable’ more so than
some physical injuries and all mental illnesses that can’t be seen

Response… the organisation responds to the notification. For some this is taking immediate action of
placing an individual on restricted or no duties. Most commonly the organisation assigns a case
manager at this stage, though, in some cases the notification seems to fall on deaf ears (as reported
by some mental health claimants)

The Challenge: employee may not accept the case manager, making early intervention
difficult

Assessment… initial needs assessment is conducted by the organisation in conjunction with the
Health Care Professional and early intervention strategies are implemented in an attempt to manage
the injury/illness within the organisation.

The Challenge: difficult to put in place early intervention strategies for mental illnesses
where employees are less likely to report, and/or management are more apprehensive to
step in

The Challenge: some strategies put in place are deemed inappropriate by the employee
placing them almost immediately on the ‘back foot’

The Challenge: some employees take the assessment into their own hands resulting in a
delayed claim or worsening of an injury / illness if they don’t take proper action

Claim Filed… employee files a Comcare claim (where necessary). This can come after some time
during the assessment period.

The Challenge: the illness/injury may have been exacerbated into something more serious
by this stage. Danger of increased tensions within working environment (by colleagues,
line managers, etc.)

Return to work… employers look to get the employee back to work as quickly as possible

The Challenge: being able to work with the personal challenges of the individual (see the
individual section) and the limitations of the organisation
Page 20 of 30
Key to Driving Success …

Culture… genuine commitment, embraced at all levels of the organisation, and a base level of trust
between the employee and the employer

Flexibility… allowing line managers to challenge processes where needed, taking a broader, crossorganisational perspective

Early intervention… to prevent exacerbation (or even injury)

Pro-active case management… to positively shape employees’ expectations, making them feel that
they are being well looked after

Collaborative approach… with the employee to ensure there is planning around return to work and
transparency in the steps taken and the decisions made

Regular communication… between supervisor and employee

Process… good documentation from the reporting of the injury until the closure of the return to work
case.

An experienced team… the level of experience of the HR/case management team in the field of
return to work impacts on the organisations’ overall approach to return to work and workplace injury
as well as the organisations’ success rate in getting employees back to work.

Expectation management… managing the expectations of employees to ensure that they know what
is required of themselves, what the potential options are, allowing them to remain informed
throughout the process

Goal setting… making the return to work journey seem more achievable
Page 21 of 30
The Healthcare Professionals
A workplace injury or illness brings with it a multitude of appointments with a variety of different
healthcare professionals including rehabilitation providers, GP’s and Specialists.
Often the process appeared to be challenged by tensions around whether the healthcare providers were
perceived to be effectively working to the benefit of the individual and their health needs versus the
organisation and their desire to achieve a return to work outcome.
The Rehabilitation Provider

The key role of the rehabilitation provider is believed to be to get them back to work – employees
believe this is reasonable as they appreciate this practical organisational need. But, there is a clear
expectation that this will be balanced with the need to return them to health

The rehabilitation provider is seen as an ‘agent’ of the organisation. Positive or poor behaviour on
their behalf directly affects perceptions of the organisation’s standpoint on RTW

An effective rehabilitation provider understands the process, provides clear direction, delivers an
honest account back to the employer and facilitates both their return to health and work

When this works well, the rehabilitation provider becomes a powerful influencer in the process,
keeping the individual ‘on track’

When it unravels, the rehabilitation provider is perceived as a key frustrator, engendering distrust and
cynicism in the process and the organisation
The role of rehabilitation providers was seen to include:

Supporting Employees… by providing them with advice and information about their injury.
Employees become concerned when the rehabilitation provider places (sometimes excessive) pressure
on individuals to return to work, at a time when they still feel unable (or their GP has told them they
are not ready). In addition, limited or minimal contact and/or an accusatory attitude can also negatively
impact on employees experiences

Conducting home-based assessments… allows the organisation to understand employee needs
both in and outside of work, giving them a much more holistic perspective of each individual and
allowing them to make judgements much easier
Employees are accepting of these assessments, but negative experience or errors being made in
reports can cause undue stress

Mediating… between the employers and doctors and other treating professionals
Employees can feel this mediation is to the exclusion of them, that decisions are being made by other
parties, and they have no say over their own welfare – detracting from their level of control.
Conversely, the employer finds the rehabilitation provider an important and valuable resource, acting as a
‘translator’ between the GP and the organisation.
Page 22 of 30
The GP & Healthcare Professionals
The personal medical professional… essentially, personal (non-organisational appointed) GPs or
healthcare specialists (such as physiotherapists, psychologists, psychiatrists, chiropractors, etc.) are seen
to provide objective advice and direction to the benefit of the individual. In most instances, they lived up
to this professional standing.
However, their role is also a trigger for tension between the organisation and employees further
highlighting the dichotomy between the ‘return to work’ or ‘return to health’ scenario that exists between
organisations and individuals.

Trust: The employee places a great deal of trust in their GP - they believe they are looking out for their
welfare, rather than the interests of the organisation

Distrust: The employer can distrust the GP. Some expressed a desire for more clarity around GP
recommendations (especially as to the length of time someone is off work), and a concern around a
biased perspective of some GPs linked to ‘following employees orders’

Influence: The GP can also be influential towards the individuals, often switching the employee
perspective completely – to the point that if they are told they will never work again, they begin to
believe this

Importantly the GP or other healthcare specialists can influence an employee’s decision of whether or
not, or when, to submit a Comcare claim.
‒
Paperwork: in some cases the GP or healthcare specialist is concerned about the paperwork
involved with a Comcare submission
‒
Stigma: some also counsel employees away from submitting a claim for fear the individual will be
subject to negative repercussions or stigmas by their employer (mental health claims in
particular).
The ‘Approved’2 Specialist/Healthcare provider… perceived by employees to have an agenda,
potentially trying to disprove their claim, and often go against advice of the individuals own GP.
2
Employees did not differentiate employer or Comcare approved healthcare professionals – for them it was an
approved person they were directed to see and they did not known (nor care to know) under whose direction the
consultation was taking place
Page 23 of 30
Role of Comcare
Despite some misgivings about Comcare amongst individuals and employers, Comcare is respected for the
critical role it plays in RTW. For most cases, especially where the claims are straight forward, Comcare is
deemed reasonably effective.
Although Comcare appears to be delivering on its role as an administrator, there is a sense that it does not
have to be limited to this. In fact, both employees and employers expressed a desire for Comcare to take
a more proactive and pronounced role in RTW. Despite limited knowledge and awareness at the outset of
the RTW journey and despite some challenges with the current Comcare service, as an organisation,
Comcare is seen to have the credibility and capability of expanding its role to help positively influence RTW
success.
Perceptions of Comcare
Comcare was not discussed in detail as Comcare was simply not top of mind for many:

Employees… in premium paying agencies, workers compensation can be associated as a resource for
‘problem employees’ or bludgers and linked to the ‘death of a career’ (licensee employees were far less
familiar with Comcare)

Employers… Comcare is viewed much more objectively as the insurer and the provider of funds for
workers compensation cases. Concerns that there is limited understanding by Comcare of the
challenges that organisations face with individuals
Key driver for success…
Opportunity for Comcare to…

Increase the level of non-financial support for claimants throughout their contact with
the workers compensation system could help to take some of the pressure off the
organisation

Act as a mediator between the various government departments to facilitate appropriate
RTW roles and opportunities for injured workers
Understanding of the Scheme
Some awareness… there were a small number of employees who had experience with Comcare either
personally or through a close friend or family member. That prior knowledge set clear expectations that,
when met, served as a sense of comfort because something in their situation was ‘predictable’. When not
met, however, the individual easily leapt to the conclusion that they were seen as difficult or that the
challenges they were facing were ‘unfair.’
Lack of information and guidance… prior to initiating their claim, employees largely feel in the dark
about their entitlement and what is required of them. In some cases, this can be a driver to delaying their
claim. Their uncertainty often translates as a kind of fear given they are engaged with the system at a
highly vulnerable juncture in their lives and the process of learning about Comcare and how the workers
compensation system works was seen as lengthy and frustrating.
Page 24 of 30
Key driver for success…
Opportunity for Comcare to…

Provide guidance and information for individuals entering the scheme

Provide a rationale for particular actions (if not already done)
The Comcare Experience
Comcare can be an added pressure at a point when an individual is at their most vulnerable.
In many
cases, employees experienced challenges from the outset of their claim and throughout the process.

Whilst employees felt a need to defend themselves and prove their claim, employers felt Comcare was
too lenient, too slow and inconsistent with decision making

The administrative challenges of Comcare are easily translated as deliberately complicating the
process and being obtuse (i.e. errors and/or excessive paperwork)

Timing was also a key point of contention for both employees and employers. The length of time for
Comcare to respond to any claim or query was felt to be far too long. This uncertainty they face can be
an added stress and financial burden, knowing that they will need treatment, but feeling financially
bound by Comcare delays. In some cases the worsening of a condition was attributed to the delay in
receiving approval from Comcare

The case manager is a critical touch point3. Positive experiences with case managers can have a
strong impact on an individual’s experience with Comcare. However, the high turnover amongst case
managers, and an inconsistency in their approach can add to an individual’s frustration of the scheme,
as they face having to repeat their case history, and re-establish relationships

In addition, the case managers were highlighted as not having enough expertise in specific
injury/illnesses and/or having minimal understanding of the limitations and needs of the organisation

Communication is key, particularly for employees who are new to the scheme. A lack of
communication can lead them to believe that nothing is being done, and they have been forgotten
Key driver for success…
Opportunity for Comcare to…

Improve core processes to take away this additional hurdle that many individuals end up
facing at a time when they can be dealing with a number of other challenges (i.e. timing,
paperwork, communication and decision making)

Ensure case managers are trained to a consistent level, that there are thorough hand-overs,
and that they are proactive in their approach to case management (i.e. providing updates on
progress of the claim/case)
3
It is worth noting here that when discussing “Case Managers”, individuals are actually referring to Claims Service
Officers (CSO’s), who’s role is process oriented, rather than management oriented. This raises the question – do
individuals need their claim to be managed, rather than passed through a process?
Page 25 of 30
Moving forward, there is opportunity for Comcare to play an important role with both individuals and
organisations moving through the return to work journey. The ‘neutral’ grounding (i.e. affiliated to neither
the organisation nor the individual), along with the expertise that Comcare holds with workers
compensation and return to work places Comcare in a unique position to positively influence the
experiences and needs of both the individuals and the organisations.
The opportunity is there for the taking, it is largely down to what role Comcare would like to play.
Page 26 of 30
Appendix 1: Objectives and Methodology
Page 27 of 30
Research Objectives
The detailed objectives for this research can be summarised as:
1.1. Failed Return to Work
Overall Aim
To identify the drivers and barriers associated with successful Return to Work in order to inform
Comcare’s policies and practices to improve recovery and RTW success.
The specific objectives were to explore and understand…

Attitudes and perceptions of the return to work experience

Drivers and barriers to return to work success

Keys to success (factors that have the greatest contribution to successful and unsuccessful RTW)

Maximising recovery and return to work
1.2. Long Duration
Overall Aim
To understand the drivers of injured workers’ long duration claims in order to minimise
entrenchment in the scheme and identify opportunities for practice and policy changes to better
support recovery and return to work
The specific objectives were to explore and understand…

The personal, social, financial and working context of the accident/illness

Expectations around the workers compensation and return to work process

Reasons why individuals stay on Comcare’s workers compensation for the longer term

Any opportunities for improving practices and policy changes to better support the recovery and return
to work of Comcare injured workers
1.3. Delays in claiming
Overall Aim
To understand the inhibitors to claim post injury / illness and what transpires during the delay
between injury / illness and lodgement of claim. To understand why the delay is even more
extended for mental stress claims
The specific objectives were to explore and understand…

The personal, social, financial and working context of the injury/illness

Strategies for managing the injury / illness & understanding Early Intervention

Drivers and barriers to submitting a Comcare claim

Opportunities for improvements
Page 28 of 30
Research Methodology
A total of 41 in-depth face to face interviews with employees and 6 interviews with employers were
undertaken across four locations. The interview structure is outlined below:
47 In-Depth interviews
VIC
ACT
NSW
QLD
Telephone
Total
Injured Workers – Successful
RTW
2
4
5
-
-
11
Injured Workers – Unsuccessful
RTW
4
3
1
2
-
10
Employers within the Comcare
Scheme
2
2
1
-
1
6
Long Duration
3
14
2
1
-
20
Delays in Claiming
2
3
1
13
26
10
TOTAL
6
3
1
53
1.4. Recruitment
Three separate sample lists (for Failed Return to Work, Long Duration and Delays in Claiming) were
provided to Sweeney by Comcare, which included the contact details of individuals (employees) who had
previously agreed to participate in research projects.
The sample included:

Name

Contact details

Organisation and position

Illness/injury
The total number of individuals listed was:

Injured Workers – Unsuccessful RTW: 83

Injured Workers – Successful RTW: 233

Long Duration – 198

Delays in Claiming - 430
In addition, Comcare provided 6 employer details, all of which were contacted and participated in the
research.
Research was conducted between December 2012 (excluding the Christmas period) and March 2013.
Page 29 of 30
1.5. A note on the sample
Before commencing recruitment, the structure was split evenly across three locations. However, due to a
skew to employees in Canberra in the sample list, as well as much more of a willingness to participate
(more so for the Long Duration claims), a higher proportion of the interviews were conducted with
employees in the ACT.
1.6. The Interview Process
Each interview with employees lasted approximately 1.5 hours. Each respondent was reimbursed with a
$100 Myer voucher as a thank you for taking part in the research.
Page 30 of 30