Transcript Managing Claims for Psychological Injury Presented by: Greg Larkin Melanie Pickering Gallagher Bassett  A third party administrator  Agent for the NSW WorkCover Scheme  Provide customised.

Managing Claims for Psychological
Injury
Presented by:
Greg Larkin
Melanie Pickering
Gallagher Bassett
 A third party administrator
 Agent for the NSW WorkCover Scheme
 Provide customised claim and risk mitigation
solutions
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Overview
- OHS & Workers Compensation Legislation
- Psychological hazards in a risk management framework
- Non-work related factors
- Types of psychological claims
- Dealing with your insurer
- Return to Work
- Financial impact
- Psychology framework
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OHS Regulation 2001 – an employer must:
Review &
Monitor
Identify
Work Practices
Objects
Work Environment
Eliminate or
Control
Assess
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OHS Regulation 2001
An employer must take reasonable care to identify any
foreseeable hazard that may arise from the conduct of the
employer’s undertaking and that has the potential to harm
the health or safety of:
(2) In particular identify hazards arising from:
(b) work practices, work systems and shift working arrangements
(including hazardous processes, psychological hazards and fatigue
related hazards), and
(j) the potential for workplace violence.
OHS Regulation 2001 - Chapter 2 (9)
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Prevention – is it possible?
The alternate to risk management is
risky management!
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Identify psychological hazards
Can be difficult to do as:
- People make assumptions about something that is
‘psychological’
- Attitudes towards who is responsible for psychological
issues
- Psychological hazards are not always tangible
- Lack of suitable strategies to confront psychological
issues
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Factors to consider
Identify:
Organisational factors
Interpersonal relationships at work
Individual’s role within the organisation
Career development, status and pay
Home/ work demands
Physical work environment and equipment
Work demands (including load, pace and hours)
Supervision
Information, instruction and training
Work Safe VIC – StressWise
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Risk Assessment
- What are the circumstances when/ where the hazard
occurs?
- Frequency and duration of exposure?
- What feedback to employees give?
RISK = frequency x likelihood x consequence
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Risk Controls
Prevention Strategies and Early Intervention are key!
 Train managers and supervisors; to identify stressors/ hazards
and performance manage employees
 An implemented Anti-bullying policy
 EAP services
 Critical Incident Planning to include counselling
 Independent mediation services where required
 Flexible workplace solutions
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Individuals at Risk
People may be exposed to psychological
injury risks
outside of the workplace.
It is important to recognise this!
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Risk Controls
Controls can be short or long term:
Identify psychological hazards
Assess risk & establish action plan
Make necessary changes
Educate & inform staff –
check understanding regularly
communicate
& consult
with
your
Employees
Manage, monitor & review
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Claims Process – Workers Comp Act 1987
1. Assessment
Section 9:
Has the worker
sustained
an injury?
Section 9a:
Was work a “substantial”
contributing factor?
Section 11a:
Exclusionary factors;
“reasonable action”
of employer
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Sec 9a: Was work a “substantial” contributing
factor ?
-“a” not “the”
-Time, place, nature of work etc
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Sec 11a : Reasonable action by an employer
- Compensation not payable if the injury “was or
predominantly caused by the reasonable action
taken or proposed to be taken by or on behalf of
the employer with respect to transfer, demotion,
promotion, performance appraisal, discipline,
retrenchment or dismissal of workers or provision
of employment benefits to workers: - section 11A(1)
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Decision making
1. Does the worker suffer from a recognised
psychological or psychiatric disorder ?
2. Was employment a substantial contributing
factor to the psychological injury ?
3. Does section 11A (1) apply ?
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React
versus
Respond
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How do you respond as an employer to a
potential psychological injury claim ?
1. Blunt psychological trauma e.g. assault, armed
hold ups,
What is your response ?
2. Workplace incidents e.g. harassment, bullying,
What is your response ?
3. Normal workplace behaviours e.g. performance
appraisal
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Return to Work
1.
2.
3.
4.
5.
6.
Get involved from the outset
Establish contact with treatment providers
Develop a return to work plan
Document . . . . . Document
Workplace rehabilitation has a start and an end
Utilise external resources
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Dealing with your agent / insurer
General guidelines
-Establish communication with your Case Manager
-Employers must actively coordinate and manage
return to work
-Understand the cost (“business of health”)
-Document conversations, letters, meetings etc
-Realise that decisions are made within the context
of legislation
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Dealing with your agent / insurer
Specifically regarding psychological injury claims:
-Meet with your Case Manager
-Submit any supporting documents you may have
-Understand that factual investigations may be initiated
-Continue to manage the return to work
-Stay involved and hold Case Managers to account
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Statistics – 2006/07
Psychological Injury
Average cost: $28 952
Average lost time: 18 weeks
All Injuries
Average cost: $17 914 (with half costing $6 705 or less)
Average lost time: 9.7 weeks
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Financial Impact
- Claims have a cost (actual, anticipated)
- Understand the effect on your premium
-Ask for cost projections based on a number of
scenarios e.g. return to pre – injury duties,
providing suitable duties or not.
- Disputes and legal costs
- Termination of injured workers
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NSW WorkCover Psychology Framework for
Treatment
Draft framework with proposed gazettal by NSW
Parliament by early 2010.
Fees regulated
Requirement for treatment plans to be developed
and submitted for approval.
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Questions and Discussion
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