Outcomes worst for combined physical, psychological injuries

NSW State Insurance Regulatory Authority (SIRA) CEO Adam Dent has called on insurers to improve support for workers with a psychological injury as evidence shows they experience worse outcomes.

Around 11% of all active NSW workers’ compensation claims relate to a psychological injury, compared to 6% a decade ago, and they are less likely to return to work and more likely to experience an adversarial claims journey, Mr Dent says.

“People with a physical injury claim lose, on average, six weeks of work. For psychological claims, the average lost time is 20 weeks,” he says on the SIRA website.

“Alarmingly, people who access psychological services after a physical injury are off work for an average of 31 weeks.”

An Australian Council of Social Services report shows that one in 10 wage earners report high or very high levels of psychological distress, while SIRA’s customer experience research shows that one in five people with a workers’ compensation claim had a probable mental illness based on the Kessler 6 scale.

Mr Dent says changes to the state’s worker’s compensation scheme provide the opportunity to better address mental health conditions, but in the mean-time people must be better supported by the current system.

“There is plenty that insurers can and should be doing,” he says. “For example, they can screen for the risk of delayed return to work and psychological distress, and they can develop tailored pathways and hyper care arrangements where those risks exist.”

Insurers can also minimise exposure to friction points by focusing on the right things early in the claim, and can make attracting, training and retaining capable case managers a top priority, he says.

SIRA is actively considering case manager credentialling to lift the standard across the industry, has produced guidance notes and says it’s building the capability of health providers and targeting employers through advisory, compliance and enforcement efforts.

The regulator is also piloting an “outbound assistance service” in workers’ compensation, similar to that operating in the compulsory third party scheme.

“We are partnering with a number of insurers that agreed to participate, and the early indication is that workers value the contact and feel more confident about managing and navigating their claim as a result,” Mr Dent said.