Sep 27, 2021
Removing Barriers to Care in Workers’ Compensation
4 min read
According to the Bureau of Labor Statistics, the private sector has experienced 2.8 million nonfatal workplace injuries annually for the last few years. As you likely know, workers’ compensation is the best hope for most of these 2.8 million individuals.
Even so, many will likely get denied compensation, not receive the care they require, go through extended recovery periods or not even attempt to obtain the benefits they’re owed.
Why?
Because for many, four common barriers interfere. Educating yourself on these barriers and proactively addressing them is one of the best ways to minimize workers’ comp costs, increase success rates and boost work morale.
Psychosocial Barriers
Medical care accounts for a mere 20% of a client’s healthy outcome. The other 80% relies on social determinants of health, including “health-related behaviors, socioeconomic factors and environmental factors.”
Many workers’ compensation clients are unprepared for being unemployed. The sudden change and stress can make it difficult to feel motivated, leading to issues facing everyday life. Some may find it hard to interact with coworkers or family. Others may become addicted to prescribed pain killers.
But even when psychosocial barriers aren’t so intimidating or obvious, they can get in the way of a healthy recovery.
One common example is fear. Feeling fear, like the fear of returning to work or getting injured again, is counterproductive to a healthy recovery. One study found that the frequency of fear in claim notes was a more accurate predictor of a poor outcome than a lumbar fusion surgery.
Other examples of psychosocial barriers include pain catastrophizing, activity avoidance, a troubled home life, limited English proficiency, no modified return to work options and poor coping skills.
As industry workers become more aware of the presence and significance of psychosocial barriers, they are increasingly embracing advocacy-based processes for controlling these factors.
Advocacy-based claims focus on viewing and treating workers holistically as people. One Workers’ Compensation Benchmarking Study revealed that advocacy-based claims are more common in higher-performing claims organizations than compliance, adversarial or task-based styles.
A great way to identify the risk of psychosocial barriers with any given client is to screen them in advance. Consider asking questions like how long they expect recovery to take and why. It’s important to note that accurate results will depend on their level of trust and comfort with the screener.
One way to increase trust, apply advocacy and mitigate psychosocial barriers is to practice communication skills and empathy. The same benchmarking study revealed that training in these soft skills also leads to better client outcomes.
Another tip is to help injured workers in challenging financial situations by providing a list of local and national human service agencies and food pantries.
Employer Barriers
The claims process can be confusing and challenging, especially for someone who hasn’t dealt with it before. It’s why an injured worker’s employer often plays a key role in providing the information they need.
Still, it’s not uncommon for delays to result in an extended and overly expensive recovery that could have been avoided if the employer was prepared for handling workplace injuries. Paperwork errors, failing to complete initial documentation and giving incorrect medical provider information are common causes of substantial employer-caused delays.
Sometimes an employee may even be denied workers’ comp because they delayed treatment, paid out of pocket, saw a non-approved doctor or failed to file a claim in time – all because they weren’t informed with proper care.
To ensure excellent outcomes, workers’ comp insurers should recommend processes to the businesses they work with. Ideally, employers should have a dedicated return to work HR member on staff who can report injuries, take part in investigations and provide the necessary resources.
Access Barriers
All too often, patients miss medical appointments, delaying their recovery and impacting their claim. Timely care can be vital to the return to work process, especially as many doctors may not reschedule for weeks to come.
But missing an appointment, though sometimes a matter of simple forgetfulness, can also result from a barrier to access.
What if your client has transportation issues? What if they have one family car and can’t afford a long Uber ride? What if they have other responsibilities and can’t attend a 9-5 appointment? Or, what if they can’t drive due to a disability or their workplace injury?
These are all common scenarios that can prevent adequate care. Fortunately, there are simple solutions.
If one too many forgetful clients have set you back, consider setting up email and text reminders. If your patients can’t make appointment times, get familiar with telecare’s capabilities and limitations. Conducting appointments and therapy over video allows for cheaper, immediate and flexible care.
For the many patients that require an in-person assessment or treatment, there are transportation services that exist specifically for workers’ comp patients. The cost of providing transportation well makes up for itself in time and effort saved.
Communication Barriers
Due to the complicated nature of compensation claims, communication is critical to successful outcomes. Clients need to understand their injury, how to receive treatment, how to navigate and help the claims process and more.
For many clients who struggle to speak the English language, this presents a challenge in of itself – and almost 1 in 10 working-age adults in the US are considered LEP (Limited English Proficient).
On top of that, immigrant and LEP workers often work in harsher conditions that leave them more prone to injury, and therefore, workers comp claims.
Getting injured and dealing with legal processes is already a stressful and fear-inducing situation. Struggling to communicate and understand what is going on is likely to compound this fear and anxiety, make it harder to follow treatment plans and result in worse outcomes.
It also decreases one’s confidence in their ability to navigate the claims process, exacerbating other barriers as well.
As a result, the best way to tackle communication barriers for LEP clients is to take advantage of interpretation and translations services.
Professional interpreters translate conversations between you and your clients, allowing them to understand clearly and feel more relaxed and welcomed. Certified translators for the workers’ comp industry can also translate critical materials like legal and medical documents.
Even when you’re not dealing with an LEP client, it’s recommended that you learn how to communicate effectively with clients to reduce the risk of misunderstandings.
Making the Claims Process More Effective
When obstacles to care in workers’ compensation are addressed, all parties prosper. Clients receive the care they deserve and a higher chance of a successful recovery. Service providers protect themselves from legal accusations and streamline their work processes.
But overcoming these barriers isn’t just beneficial; it’s the right thing to do. And the point of workers’ comp, after all, is to help.