Regulating Workers Compensation: The Medico Legal Evaluation of Injured Workers in Victoria

Abstract

Sociological research on occupational injury has been dominated by perspectives from the social organisation of work and the labour process. What is missing from this literature is an explanation of the actual experiences at the individual worker within the processes of legitimation of occupational injury. This study explores the experiences of injured workers as they move through the medico‐legal process. Medical reports and clients perspectives were used to expose the positions of doctors, insurance companies, lawyers and workers compensation bureaucrats as they form a complex intersection of power and interest in the regulation of injured workers. In particular, the conflicting roles of doctors as both gatekeepers and service providers were highlighted in the maintenance of stigmatised damaged workers.

Mapping first‐line health care providers' roles, practices, and impacts on care for workers with compensable musculoskeletal disorders in four jurisdictions: A critical interpretive synthesis

“…Many articles touched upon the large variety of roles held by first‐line HCPs and potential conflicts associated with them. Roles most commonly addressed were: assessing the injury and communicating with the WCB, gatekeeping (ie, mediating access to benefits or care), providing care and treating the workers, planning and facilitating the return‐to‐work process, and advocating for/with the workers . Some articles highlighted the difficulties associated with holding a medico‐legal role, such as being a gatekeeper for the worker's benefits while at the same time being the principal HCP and advocating for the patient .…”

“…Roles most commonly addressed were: assessing the injury and communicating with the WCB, gatekeeping (ie, mediating access to benefits or care), providing care and treating the workers, planning and facilitating the return‐to‐work process, and advocating for/with the workers . Some articles highlighted the difficulties associated with holding a medico‐legal role, such as being a gatekeeper for the worker's benefits while at the same time being the principal HCP and advocating for the patient . Shaw and collaborators highlighted the knowledge brokering role of HCPs and the barriers to adequately fulfilling this role, such as information mistrust, lack of system support, lack of continuity and coherence between stakeholders and lack of expertize of HCPs about the actual knowledge transfer process.…”

“…Shaw and collaborators highlighted the knowledge brokering role of HCPs and the barriers to adequately fulfilling this role, such as information mistrust, lack of system support, lack of continuity and coherence between stakeholders and lack of expertize of HCPs about the actual knowledge transfer process. Other researchers showed how HCPs' roles and practices are highly constrained by systemic features, such as workers' compensation forms and policies or their location of practice (eg, company doctors) . Several articles investigated first‐line HCPs' injury certification practices.…”

“…Lippel and colleagues also found that there existed a therapeutic effect provided by the support of HCPs in the workers' care and the workers' claim, and that this support was maximized when it came from a person in a position of influence . Conversely, issues regarding mistrust of first‐line HCPs when they work in a company setting or because they hold both the role of gatekeepers to benefits and treating HCP for the patients were described as problematic by some authors …”

Employers' perceptions of claims/injury management and rehabilitation in South Australia

“…There are examples in literature of the critical and complex role of treating medical practitioners as the 'gatekeeper' in the rehabilitation and return-towork process (Baer 1997;Cameron 1996;Gribich, McGartland and Polgar 1998;Morrison, Wood and Munrowd 1998;RACP 2001;Wood, Ying, Morrison and Munrowd 1999). Therefore it is not unusual for employers to perceive medical practitioners as the drivers of the claim.…”