MEDICAL FACTORS

ARTICLE #5. CURRENT TRENDS IN STRESS CLAIMS

At a glance:
Stress-related compensation claims are a costly problem. They also represent suffering and lost productivity for workers. This review examined the research surrounding this issue.

Disability and stress have many causes. Physical, psychological, emotional and social factors can contribute.

Most stress-related compensation claims are genuine.

A person's experience of stress-related illness can be changed by unconscious psychological processes.

Compensation decreases the chance of overcoming the condition and returning to work.

Remaining on compensation has serious negative consequences for health and wellbeing.

Decisions about compensation need to be made with the claimant, not against them.

PERSPECTIVES:

Employee
Dealing with stress at work can be difficult. A person experiencing stress at work may not know how to deal with the situation, and having a compensation claim can make it even more challenging.

Litigation and compensation reduce the chances of a good recovery and early return to work. People involved in these processes often have higher levels of pain, disability and depression. Compensation is associated with poorer mental and physical health, and potential financial and social difficulties. These effects may be due to delays to treatment caused by the “red tape' of the compensation system, disruption of relationships at work, emotional strain and the difficulty of trying to get well while “always having to prove that you're ill."

This study found that a person's beliefs, understanding and approach play a major part in how they will recover from stress. People who are depressed are more likely to remain off work, as are people who have a compensation claim.

Stress situations are difficult for people to deal with. Make sure you get the best help you can. Work out how to communicate about your problem clearly. It is best to try to talk to someone in the organization who you think will listen, and people are more likely to take notice if you communicate positively and make suggestions about how to deal with the problem.

Employer
Employers often question stress claims. This study shows that most stress claims are made by workers with a real problem.

A workers perceptions influence how they approach the problem and communicate. Some people become distressed if they do not consider they are being heard or believed, and can communicate negatively and emphasize their symptoms. In turn this can lead employers to be more doubtful about the claim.

Compensation reduces the chances of good recovery, especially when there is a dispute about the claim. The workplace strongly influences whether the person will successfully return to work, or whether they will develop into a long-term problem.

This study and others have found that workplaces tend to be better at dealing with stress that arises from a single traumatic incident. Chronic problems, stemming from problems with workplace organization and relationships, can be harder to deal with. However, these issues have a stronger influence on stress and stress-related compensation claims in the workplace.

Early, open communication is important in dealing with stress, in order to understand the person, prevent the situation escalating, and minimize the chance of long term problems. If stress is recognized, acknowledged and managed early the problem can be dealt with before a claim needs to be lodged.

Treater
Determination of work disability is by its nature a difficult and unscientific process. Decisions about work need to be made in partnership with the patient, and the patient needs to know their long-term health can be affected by compensation.

Communication is vital in assisting patients to deal with a stress claim. Strategies that can help workers manage stress include:

• Requesting a written job description
• Meeting with the supervisor to discuss work/time management issues
• Changing jobs
• Filing a grievance complaint
• Seeking assistance with workload
• Requesting training
• Requesting regular staff meetings
• Requesting change in physical environment
• Organizing changes with co-workers

Insurer
An important finding of this study is that decisions about compensation should be made with the claimant and not against them.

Compensation is associated with poorer outcomes. This may be due to delays to health care and the strain of trying to navigate 'the system.' Needing to prove they are sick reinforces a person's position and suffering. Some of these problems can be overcome by encouraging the employer to respond early to stress in the workplace. Addressing issues at the workplace early on can prevent the need for a claim to be lodged. Positive communication and avoiding delays will improve outcomes

Original Article, Authors & Publication Details:
S. M Tisza1, J. R. Mottl III2 and D. B. Matthews1. (2003).

Current trends in workers compensation stress claims. Current Opinion in Psychiatry, 16:571-574

1Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii at Manoa
2Private law practice, Honolulu, Hawaii

Background, Study Objectives, How It Was Done:
Stress-related illnesses cause pain and suffering and decrease productivity. They are also extremely expensive. This 2003 review reported stress claims cost the United States $US66 billion per year (2% of the gross national product). Work-related stress is likely to remain a problem in the future, given current issues of job insecurity, changing skill demands and longer work hours.

One researcher described “work-related stress" as the problem experienced by a person when they recognize that they cannot cope with the demands of their work. Compensation claims for work-related stress are made when psychological distress at work causes mental harm.

As with physical or medical illnesses, people claiming compensation or taking legal action are less likely to have a successful recovery. The authors of this paper reviewed relevant research topics on work stress claims. The review examined trends in stress claims and factors that influence recovery and return to work.

Study Findings:
Are stress claims genuine?

People may be dubious about stress claims, as the harm isn't always obvious. This review of other studies reports that claims are rarely false. People with stress-related conditions may overstate their symptoms if they feel they are not being heard. A patient may experience physical pain as a result of their psychological distress. A patient in distress may also notice symptoms more and find them harder to cope with.

Factors influencing recovery and return to work:

• The review found a number of factors influence the outcome:
• Beliefs, feelings and expectations have a powerful effect on symptoms.
• Disability has many causes, including physical, psychological and social factors.
• Mental disabilities that are not associated with physical trauma are likely to be influenced by personality and other non-work factors.
• Patients with symptoms of depression are significantly less likely to return to work.
• Symptoms of post-traumatic stress disorder contribute to negative emotions. These symptoms are common in injured workers.
• Workers who are satisfied in their job return to work more quickly.
• Married workers are more likely to return to work.

People with chronic stress tend to have poorer outcomes than people whose stress resulted from a single, specific incident. Workplaces tend to respond more effectively to specific stress than chronic stress.

The role of compensation in recovery

Receiving compensation decreases the chance of recovery. One study suggested compensation induces feelings of ill-health. It changes the person's behavior and may cause dependency.

Judging whether a person's condition is disabling or permanent is not a scientific process, and a clear conclusion can't always be reached. Awarding permanent compensation may in some cases be seriously harmful to the person. Remaining off work is harmful to many aspects of physical, mental and social health and patients need to be informed about the benefits of returning to work. One study found that litigating patients had higher rates of depression, pain and disability than working patients. The study concluded that decisions about a person's future and financial benefits need to be made with the claimant not against them.

Conclusions:
This review examined research concerning workers compensation stress claims. Its main findings were:

• Disability has many causes, including physical, psychological, emotional and social factors.
• Mental disabilities that are not associated with physical trauma are likely to be influenced by personality and non-work factors.
• Chronic stress and stress that's related to a single incident need to be dealt with in different ways. Employers don't tend to respond as well to chronic stress problems.
• It is likely that most stress claims are genuine. However, a worker's experience of symptoms may be exaggerated due to unconscious psychological processes.
• Receiving compensation decreases a workers likelihood of returning to work.
• Remaining off work decreases physical and mental health.
• Judging whether a person has a “permanent disability' is not straightforward, but the decision can have serious consequences for the persons future.
• Decisions about compensation need to be made with the claimant, not against them.

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