EBM Insights podcast series is a deep dive into current issues surrounding insurance and risk management in today’s ever-changing world.
In this episode we got the chance to speak with Dr Richard Kane and Tracie Papotto from Complete Corporate Health, an occupational health service provider, who provide some advice on how to best assist your staff through a workplace injury claim.
A transcript of the interview with Complete Corporate Health is below. The complete EBM Insights podcast series is available here.
Introduction:
Our first podcast for 2023 is available! We are joined by Dr Richard Kane and Tracie Papotto from Complete Corporate Health, an occupational health service provider.
The episode touches on how to support an employee during an injury claim, how to reduce the duration of a claim, and the value of a good quality pre-employment medical report prior to onboarding new staff.
00:00:00 Speaker 1 – Disclaimer
In this podcast, we have provided general advice only and not personal advice in giving this advice we have not considered your personal circumstances.
00:00:13 Speaker 2 – Sandy Cattley (Senior Marketing Specialist, EBM Insurance & Risk)
Welcome to EBM Insights. In this podcast we will be discussing how you, as an employer, can assist your staff through a workplace injury claim. We will also touch on how to minimise the case duration for all parties.
Joining me today is Doctor Richard Kane and Tracie Papotto from Complete Corporate Health, an occupational health service provider committed to looking after the health and well-being of companies and individuals.
I thought a good place to start is with an overview of what effective injury management in the workplace is.
Can you take us through your thoughts on this please?
00:00:48 Speaker 3 – Richard Kane (Complete Corporate Health)
Thanks, Sandy. As I see it, effective injury management means early identification by the employer of any worker who has, or potentially has an occupational injury or illness. And I’ll just highlight illness, because that often sometimes we just think of the injury per say rather than some of the workplace injury illnesses that can occur and on top of that, you need early medical assessment of any injured workers, preferably by a designated occupational medical team which provides excellent care management and early return to work and. And of course, this has all got to be bound together with excellent communication between all parties.
00:01:27 Speaker 4 – Tracie Papotto (Complete Corporate Health)
I was just going to add to that as well, Richard, that I think that at CCH, one thing that we do particularly well is that we do work together with the employer. What special is that our team will pick up the phone. You work with our doctors directly. You can e-mail our doctors directly and we will work with injury management coordinators or HR or whoever is needed to make sure that we’re getting the best outcome for the injured worker.
00:01:56 Speaker 2 – Sandy
Thanks. You mentioned the injured worker. Do you have specific tools to help them understand the claims process and be more confident and involved in their recovery.
00:02:09 Speaker 3 – Richard
For me the big ticket item is education. Fear and anxiety often abounds when people are injured, they go to work feeling wonderful and life is sweet, and then suddenly they have things happen to them. They’re in pain, they don’t know what the outlook is like. So, educating them what’s happening, the process is really important, but it’s not just from the doctor, it’s from every aspect of that.
So, from potentially the first aider at site, I’m being very positive, and through to being accompanied down to CCH or any other designated medical provider. The medical team obviously, as well as the insurer has a big part to play in giving them the information they need regarding the workers compensation claims.
A great source of information is obviously from WorkCover WA. On their website, they have patient pamphlets. I would suggest to the companies out there that perhaps they could adapt them slightly and I would ensure that what you give to your employees it has something about their responsibilities in there. It becomes quite a passive system at time though. WorkCover WA and the capacity form, so I’m reminding them that their responsibility is to return to work as quickly as they’re able to and setting some clear expectations about that. Also, in something like that you have a clear description about WorkCover WA and I saw a really good one from one of the Insurance companies, the other day that had a flow diagram that I thought was very good.
Often with a disgruntled injured worker, they feel that the agenda is just to get them back to work and have no real understanding what benefit that is to them. They think it’s benefiting the insurer and work, but they don’t often perceive that there’s clear statistics to say that they will do both physically and emotionally better if they get back to work. And then we come into the doctor and it’s another reason why I suggest you choose your weapons with care, who you’re going to trust them with medical care and because a lot just because symptoms occurred at work doesn’t mean that work caused them, and I think that if you don’t go to an occupational trained Doctor, they don’t understand that concept.
Causation of an injury is not because they happen to be at work at the time, so if they don’t see their GP, their family doctor and they get that patient advocate role going in the first medical certificate and you’re already halfway through a claim before the insurer may be pending that claim or shutting their client down or not accepting that. So once again, there’s some really good moment to stop, pause and give some really good feedback to injured workers.
Motivational interviewing technique, so doctors can play a huge role. We’re talking about positivity before and part of that is also is avoiding medicalization, so using long, big medical terms which are very frightening and sound very scary and also the skilled communicator that can convey, and allay people’s fears are very vital.
00:05:54 Speaker 2 – Sandy
At times there may be some difficult cases that come up. For example, there are no witnesses to the injury or the person has only just started with the business and is now injured. So how can the employer navigate these types of situations?
00:06:10 Speaker 3 – Richard
If it’s possible, one suggestion that I put forward is to send any candidates to your designated medical organisation that you trust to also undertake your pre employment medicals. This means that when an injured worker comes down after an injury that one, they know the building and have met the front staff before. They may have met the clinicians and that really can help, compared to going into the emergency department, where you might wait for five hours.
People are running around, there’s sirens going on, so it can really lower that pressure. But once again, because they’ve done the pre-employment there, the doctor has instant access to that as well. My colleague and I were talking about it the other day and this exact thing happened. Someone came in and they said on the pre-employment ‘you’ve written something about a back injury before’ and he said, ‘oh had I’ and ‘yeah you put here you’d had an MRI, right where was that done” and she then went into one of the radiological portals and brought that up.
That quickly dampened down something that might have gone on to a claim and it was just a brief exacerbation and everyone was very happy about that, but the employee was grateful about that because we had that data. Even at the workplace, as long as it’s not a dire emergency, and that whether it’s first aider or the injury management coordinator taking a detailed history while it’s fresh, it’s really useful because things can change over time. But the first person there that takes the detail record really is – it has to be the best record and then also as people transition through to see the Doctor, see the physio or maybe see a Specialist, people can keep, you know, the communication that comes back. You can keep checking that history hasn’t changed over time, which can sometimes be a flag that maybe that’s not as genuine as we first thought.
Look to the trusted medical provider for guidance and also hopefully you can ring them. At Complete Corporate Health you can ring our front desk and you can be put straight through. If all the doctors are busy, you’ll be put through to the nurse at least, and you can share those concerns even before the injured worker actually arrives at our doorstep.
But the first Medical Certificate of Capacity in the work up of the WA system is a legal requirement, one that the person signs off on it, that this is legitimate, two that they have agreed to share confidential medical information regarding that with their employee and then sure, so that’s important too. But that the third line down is whether the doctor has to make a decision of whether the mechanisms of injury and what they’ve observed on clinical examination is consistent with what the patients telling them and their responses to that is, no, yes or uncertain.
Now, the therapeutic relationship breaks down very quickly when you put no. The injured worker knows very quickly that you don’t believe them, and that’s probably the last time you see them. So virtually anyone in their occupational sphere if worried will put uncertain, and that should be a flag for the employer and the insurer that there is some doubt there.
00:09:46 Speaker 4 – Tracie
Richard, just wondering if you could share your thoughts on why a diagnosis might change over time.
00:09:55 Speaker 3 – Richard
Thanks Tracie, well I guess they talk about practising the art of medicine and the difficulty about medicine is the patient comes in, there’s fear, there is anxiety and sometimes when we assess them, it’s not obvious or abundantly clear of what the injury is, and often we look for the mechanisms of injury and then we look at the symptoms they’re talking about in the clinical expression not there but within overlay. As I sign off anxiety, worry and things like that. Things can get a bit confused at times so the diagnosis which you initially form is only a differential diagnosis and it may and often does change over time.
In fact, I think if the diagnosis is changed or changing ensure to know about it because they may have already accepted a claim for one thing and then sometimes, we find it’s actually not bad communication between the doctor and the injured worker. The doctor and the company, and then sure then you can get a flowing dialogue rather than a model of what’s happening.
00:11:14 Speaker 4 – Tracie
And it becomes a bit of a delicate balance in that conversation between all of the interested parties and that line of communication becomes quite critical in these difficult cases?
00:11:29 Speaker 3
Oh, it’s vital. At Complete Corporate Health we use the phone, we use emails and we’re often asked to write reports which we spend a lot of time addressing fully so that everyone understands across the board, what’s going on.
00:11:46 Speaker 2 – Sandy
Great thank you, thank you and you’d be aware of the current limitations around the labour market and this is seeing some businesses choosing to onboard higher risk employees to fill gaps in their resourcing. So, for example, this maybe someone with a pre-existing condition or a person that needs on the job training, as there isn’t someone more suitable at the time. How much does prevention management play in these situations, and what are your thoughts on it?
00:12:13 Speaker 3 – Richard
I might flip back and start with the pre-employment medical because that’s often a great place. And while it’s the start of a job often, by definition a pre-employment medical is a discriminatory assessment to find the best candidate for the role. And part of that is you only get one chance to prevent bad actors or employing bad actors and them potentially rolling out to claims of unfair dismissal when you’re trying to exit them from your company.
When a pre-employment medical is not a pass fail assessment, it’s a risk analysis document really and from that one part of the entry into an organisation, and at the end of the day you’re looking for the best person, and the best person is going to be the person with the most experience, the best job history, the skills that you need and part of that also is how they went on the functional assessment and the physical assessment. So, from that, any hiring agencies should be looking for the best candidate. If the person was suboptimal, functional and pre-employment medical is the best candidate, that you desperately need them for the role, then you have to manage what you get and any good occupational medical provider can give you that. But you’re going to have to ask them often, because they’re engaged to provide a risk analysis.
They give you the risk analysis, show you your risk. The next step is how you’re going to manage that risk. You can ask them for that and they should be able to give you that. Also, this is a great time to actually use the general practice, because the General Practitioner, because these are classically chronic illnesses and chronic illness management like hypertension, heart disease, diabetes and a good GP will have a health management plan which you can Co-opt in to well these the KPI’s that we need you to meet if we’re going to take you on. There’s a lot of chronic illnesses and we all know of them, and we’ve got an ageing population and musculoskeletal degeneration, shoulders and knees. Spines very common. We’ve got the obesity pandemic and with some people overweight and at increased risk of hurting themselves.
A good organisation with a good engagement can take a person that’s suboptimal, but once you take them, you take them warts and all. Also, you need a good management programme for them, and particularly try and take them away from the risk. So, if it’s musculoskeletal, you want to make them a supervisor or give them a role where they’re not manually handling all day long.
00:15:38 Speaker 4 – Tracie
I think another important point that we should address in this sort of this situation, as you said, your pre-employment medical is really important, but a good quality pre-employment medical with a good organisation done properly actually prevents an employer from potential discrimination claims. Down the track and I think that’s something that CCH does particularly well because it’s very important that if you have a person with particular disabilities or medical conditions that in line with a good medical practitioner’s recommendations could potentially be accommodated in the workplace. But, the way that that’s documented and the way that that is presented back to the organisation is critical to prevent those discrimination claims. Is that fair to say Richard?
00:16:26 Speaker 3 – Richard
Absolutely, we’re not allowed to discriminate, so you can’t say this person got a BMI – this guy I saw the other day at 62. You know, could he do the task? He was a young man in this. And yes he could do the task. Was he at risk of damaging himself – absolutely yes. He was high risk for a manually intensive role, so you can’t then turn around and say you didn’t get the job because your obese, it’s like you’ve got high risk for damaging your ankles, your knees, your hips, your back, your shoulders and then or so from that will you take them or will you look for someone that has less of a risk profile?
00:17:07 Speaker 2 – Sandy
Thank you, thank you, that’s great information. I mentioned at the start, that the podcast would also touch on how to minimise the duration of a claim as this would assist all parties involved. What tips or strategies do you suggest to help streamline the claim and limit the amount of time?
00:16:38 Speaker 3 – Richard
The first one would be get as I, this is repeating from earlier on, is get an injured worker assessed early by a good clinician. From that get a firm diagnosis, from that a prognosis and a management plan. Monitor them carefully and make sure they’re moving along the expectation to recovery. If they’re going with their GP and you’re getting poor results, seek a second opinion from a trusted Occupational Medical Group which is entirely within your rights as an employer.
Employ the SPICE model at work. Communicate early and often with your injured workers. Make sure that everyone knows the plan and shore up boundaries moving towards the goal. One that we found the other day is understand the patterns of presentation within your whole workforce and implement group strategies that might impact individual claims.
We found there was a subgroup within an organisation recently that had a cultural view on injury management and my colleague spent considerable time nutting that out and working with them and having a round table conversation until they came to a solution to that.
Almost immediately, the claims all started to drop off with a clear plan for any early issues there may be. Choosing the right Doctor who can identify and communicate any issues that may be unforeseen or evolving. Pay attention, invest early in cases where flags have been raised, understanding that the extra cost and time spent with these cases early on can decrease the duration of the claim and approved for return to work outcomes. Encourage case conferences that include all parties.
It appears to get different message coming from different people or breakdown in communication. And lastly, consider employing an independent medical examination.
When things are not going well and you have assessed the biological, psychological and social factors involved and you’re still not coming up with an answer, tapping into another provider specialist provided to give you some of those for everyone, from the employer to the insurer, to the treating medical clinicians is really useful.
00:19:53 Speaker 2 – Sandy
Thank you.
00:19:55 Speaker 4 – Tracie
Richard, would it be fair to sort of summarise that by saying that a small investment of time and effort upfront often reduces the value and duration of the claim.
00:20:09 Speaker 3 – Richard
Absolutely. So just going back, companies that care and invest in their employees, their injured workers do very well.
00:20:18 Speaker 4 – Tracie
One thing that we are particularly proud of at CCH is that we have a strong, collaborative and collegial approach to the way that we work so you know when you deal with one of our doctors, not only are you getting the benefit of their knowledge and their experience.
You also get the benefit of all of our extended specialist team, our Allied Health Network, and I think that we are very much a sort of can do organisation, so we certainly look to get the best outcomes for everyone that’s involved.
The initial parts of any sort of claim are really important and, well, I think what we’ve talked a lot about in the podcast already is that the initial stages of the claim are vital.
It can be really hard to get a complex case back to a reasonable point. If you get it wrong in the early stages.
00:21:27 Speaker 2 – Sandy
So, thank you again to Richard and Tracie from Complete Corporate Health for joining me today. If you would like more information on what they’ve discussed, please visit their website, which is completecorporatehealth.com. That is all one word.
And also, if you’d like to access our entire podcast series, please head to Spotify, plus we have links to each episode on ebm.com.au.
Thank you to Richard and Tracie.
