Return to work after injury or illness is a behavior influenced by physical, psychological, and social factors. Disability research lacks a conceptual framework for combining these factors in the study of the return-to-work process. Two extant theoretical models withinthe social context are considered as they apply to the behavior of returning to work: 1) the Readiness for Change Model originating from the field of health promotion and addressing the issue of motivation for behavior change, and 2) the Phase Model of Disability developed for the epidemiological study of occupational disability addressing the developmental and temporal aspects of disability. A new Readiness for Return-to-Work Model is proposed focusing on the interpersonal context of the work-disabled employee. Employee interactions with the workplace, the health care, and insurance systems are considered as they impact the three defining dimensions of change—decisional balance, self-efficacy, and change processes. The evidence for their impact on return-to-work is examined within the framework of the Phase Model of Disability, which puts forth the phase-specificity of symptoms, risks, and interventions for disability. The Readiness for Return-to-Work Model has the potential to account for individual variation in optimal stage-specific timing of interventions based on an individual's readiness for return-to-work. The model therefore complements the Phase Model of Disability by allowing for an individual-level staging of the disability and recovery process within the broader group-level-derived framework of occupational disability phases. This link between the two models needs to be empirically tested in future research.

Readiness for return to work following injury or illness: conceptualizing the interpersonal impact of health care, workplace, and insurance factors.

https://ruor.uottawa.ca/bitstream/10393/38255/1/lippel-crsh-ijlp_postprint_ruor.pdf

Workers describe the effect of the workers' compensation process on their health: a Québec study.

Economists use the term moral hazard to describe the tendency for insurance plans to encourage behavior that increases the risk of insured loss. Numerous economic studies have examined moral hazard...

Moral hazard: a question of morality?

Introduction Work-related injury is a major public health problem and a worker’s recovery can be shaped by their interactions with employers, healthcare providers and the workers’ compensation system. Most research on the effects of compensation has concentrated on examining outcomes rather than considering the compensation process itself. There has been little attention paid to the interactions between stakeholders and only recently has the client’s view been considered as worthy of investigation. This systematic review aimed to identify and synthesize findings from peer reviewed qualitative studies that investigated injured workers interactions with insurers in workers’ compensation systems. Method A search of six electronic library databases revealed 1,006 articles. After screening for relevance, 18 articles were read in full and a search of those bibliographies revealed a further nine relevant articles. Quality assessment of the 27 studies resulted in a final 13 articles of medium and high quality being retained for data extraction. Results Included studies focused mainly on experiences of injured workers, many of whom had long term claims. Findings were synthesized using a meta-ethnographic approach. Six themes were identified which characterised the interactions between insurers and injured workers. The majority of interactions were negative and resulted in considerable psychosocial consequences for injured workers. Positive interactions were less frequently reported and included respectful, understanding and supportive communication and efficient service from insurers. Conclusion Findings from this synthesis support the growing consensus that involvement in compensation systems contributes to poorer outcomes for claimants. Interactions between insurers and injured workers were interwoven in cyclical and pathogenic relationships, which influence the development of secondary injury in the form of psychosocial consequences instead of fostering recovery of injured workers. This review suggests that further research is required to investigate positive interactions and identify mechanisms to better support and prevent secondary psychosocial harm to injured workers.

Interactions Between Injured Workers and Insurers in Workers’ Compensation Systems: A Systematic Review of Qualitative Research Literature

Background Workers’ compensation systems are among the most generous disability insurance systems in North America, although they are also known to be potentially adversarial and may have iatrogenic effects on claimants. This article examines issues to be considered to ensure fair compensation provided in a way that respects the dignity of workers. Methods An overview of the literature on characteristics and effects of workers’ compensation systems is followed by an analysis based on classic legal methods, including those of comparative law, complemented with interview data to examine three models of disability compensation. Results The first part of the article identifies cross cutting issues to be considered in the examination of the equity of compensation systems and the protection of the dignity of claimants. These include three underpinnings of workers’ compensation: the links between a ‘‘no-fault’’ system and the adversarial process, the appropriate use of medical and scientific evidence in the determination of compensability and the application of appropriate measures for promoting return to work. The second part looks at accident compensation in New Zealand, where compensation is available regardless of the cause of the accident, and disability insurance in the Netherlands, where compensation is available regardless of the cause of the disability. It then describes a composite of characteristics favorable to equity drawn from the thirteen workers’ compensation systems in Canada. Conclusion Systems that succeed in reducing opportunities for adversarial interactions and that provide substantive protection could better promote the dignity of claimants. Am. J. Ind. Med. 55:519–536, 2012. 2012 Wiley Periodicals, Inc.

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Preserving Workers' Dignity in Workers' Compensation Systems: An International Perspective

In the contemporary context of workers' compensation in Canada, there is probably nothing that is so fervently supported or so little understood as experience rating. Proposals for the widespread expansion of experience rating have been made and adopted, yet with no analysis of the consequences and with no reasons being given that could withstand serious reflection. It is as if a political steam-roller has made the widespread expansion of experience rating a part of inevitable destiny regardless of the consequences. In this climate, any questioning of the movement might be seen as irrelevant, perhaps even recalcitrant. Nevertheless, the aim of this paper is to contribute to an understanding of the significance of experience rating.

https://papers.ssrn.com/sol3/Delivery.cfm?abstractid=2129183

The Significance of Experience Rating

/pdf/the-significance-of-experience-rating-4fhz0af1sn.pdf

This article deals with the therapeutic significance of claims for damages and other types of compensation, and of the processes relating to claims. It examines the influences of legal structures and processes in promoting the recovery of a patient/client from disablement, or in alleviating or aggravating the development of a disability. It is concerned in particular with the spill-over influences of claims on the formation of medical opinions, on the selection of treatment, on patients' responses to treatment, and on rehabilitation. The article examines the assumption that compensation systems promote a widespread psychological problem of "secondary gain", "monetary gain", or "compensation neurosis". The author explains why the assumption exists and he examines its validity. The article provides a commentary relevant to the conduct of claims, and it also seeks to identify the therapeutic significance of structural alternatives in the design of compensation systems .

https://papers.ssrn.com/sol3/Delivery.cfm/SSRN_ID2094428_code1736057.pdf?abstractid=2094428&mirid=4

The Therapeutic Significance of Compensation Structures

This article deals with the therapeutic significance of claims for damages and
other types of compensation, and of the processes relating to claims. It examines
the influences of legal structures and processes in promoting the recovery of a
patient/client from disablement, or in alleviating or aggravating the development
of a disability. It is concerned in particular with the spill-over influences of claims on the formation of medical opinions, on the selection of treatment, on patients' responses to treatment, and on rehabilitation.
The article examines the assumption that compensation systems promote a widespread psychological problem of "secondary gain", "monetary gain", or "compensation neurosis". The author explains why the assumption exists and he examines its validity.
The article provides a commentary relevant to the conduct of claims, and it
also seeks to identify the therapeutic significance of structural alternatives in the design of compensation systems.

/pdf/the-therapeutic-significance-of-compensation-structures-5b7vppl2jj.pdf

Workers' compensation has entered a period of rising complexity and increasing pressures for system change. This article explains the extent to which important assumptions and assertions made in this process are historically correct. The discussion includes the historical interaction of tort liability with workers' compensation, and the current proposals for "privatization."

https://papers.ssrn.com/sol3/Delivery.cfm/SSRN_ID2128777_code1736057.pdf?abstractid=2128777&mirid=5

Terence G. Ison

Papers

The Significance of Experience Rating

The Significance of Experience Rating

The Therapeutic Significance of Compensation Structures

The Therapeutic Significance of Compensation Structures

A Historical Perspective on Contemporary Challenges in Workers' Compensation