How many times have you heard an injured worker say, “I wish you could see what this injury has done to my life! Nothing will ever make up for what I have gone through.” Statements like these are a common retort in conversations with injured workers. We need to look beyond this type of assertion by the injured worker and “peel the onion skin” to determine what motivations or considerations drive their attitudes.

We need to consider the dynamics behind the attitudes. Psychosocial behaviors have a significant impact on the management of the injured worker. Clinical research has addressed much of the role of psychosocial factors in recovery and rehabilitation outcomes. However, it is essential to identify and classify the behaviors to better understand how to respond to them.

I recently had the opportunity to attend a seminar by an organization specializing in biopsychosocial rehabilitation.

This seminar reviewed some familiar psychosocial factors and the effects on workers’ compensation claim management techniques that are worth discussing.

Having been a clinician of occupational medicine for over 50 years, I’m aware that many different circumstances drive a claim response to an injury, but it is helpful to logically organize the grouping of post-injury behaviors.

Four basic post-injury behaviors emerge:

1. Catastrophic thinking, an excessively negative orientation toward one’s symptoms and health status, causing symptom magnification and the feeling of being powerless to control these thoughts.
2. Fear, which leads to escape and avoidance tactics, both linked to disability.
3. Disability beliefs, which lead to perceptions concerning the magnitude of the limitations that the injured worker experiences in relation to the debilitating health condition.
   In essence, beliefs are central determinants of behavior! If the worker believes they are disabled, they become disabled.
4. Perceived injustice, the feeling of experiencing unnecessary suffering as a result of another’s actions: “Why me when it is your (boss, coworker, wife, husband, children, the world’s) fault?” All psychosocial behaviors have these characteristics in common:
   • Treatment resistance
   • Severity and duration of disability
   • Symptom severity
   • Susceptibility to other mental health issues·
   • Lack of participation in rehab
   • Delayed return to work
   • Litigation!

In the past, we in the industry have always followed the rule of “rest to recovery” as the rationale for recommending the reduction of an injured worker’s involvement in life functions. However, recent studies have shown that inactivity promotes the slowing of recovery, resulting in worsened health status.

Moving away from an excessive focus on symptom management and moving toward maximizing participation is essential to the recovery from any disability. This shift in focus is key to the interaction between the injured worker and the administrative team of claims handlers and medical providers to reduce the treatment resistance and delayed return to work.

The big question is, how do we do this? It starts with the first contact between the injured worker and the claims adjuster or triage person. The approach to first contact must be to project a sense of caring and a sense of “How can I help you,” rather than project a sense of being in an adversarial posture.

Secondly, as stated above, it is imperative to have the injured worker participate in their recovery. The payor, clinician, and managed care provider must move the injured worker toward maximizing participation in their medical care. Managing the injured worker back to full activity as soon as possible can be achieved by utilizing a nurse case manager or trained counselor for the facilitation of a collaborative communication process. Finally, those involved in the management of the claim and medical care must strive to understand the factors of the injured worker’s disability and related issues to help in both the injured worker’s recovery and the avoidance of prolonged litigated claims.

Whenever the opportunity arises to employ the techniques of negotiating the minefield of psychosocial impacts, care providers must address these issues with understanding and empathy for the injured worker. The present focus on psychosocial risk factors for a pronounced and prolonged disability should not be interpreted as a neglect of the medical, physical, social, and organizational influences on disability.
Psychosocial influences represent only one of the dimensions of recovery.

• The approach to first contact with the injured worker must be to project a sense of caring.
• Payor, clinician and managed care provider must move the injured worker toward maximizing participation in their medical care.
• Those involved in the management of the claim and medical care must strive to understand the factors of the injured worker’s disability and related issues.