Understanding the Alternative Realities of a Total Disability State of Mind

18 Jun, 2012 Bob Wilson


Let's face it. It sucks being injured. And it sucks being on workers' comp. Your income stops, or may be greatly reduced. You are clueless as to what comes next. You're assigned an “adjuster” who works for a company you probably never heard of, and who may or may not return your calls. You see a doctor who may or may not listen to you, and who may or may not return your calls. You may wait weeks, even months for treatment, as the investigation process and legal wrangling churns on. You have to deal with IME's and a host of other strangers as you navigate your claim. You've lost control over your life. And then you hire an attorney, who may or may not return your calls.

No, being injured and out on comp is not where one should want to be.

To this point in the story, injured workers reading this likely agree with me. This will shock them, as I am to some of them a clueless scumbag who clearly doesn't “get it”. Not to worry, I am about to leave the rails of harmonic convergence, and firmly re-establish my clueless scumbag persona in their minds.

I write today of a particular type of claim. The ideas I express here are not intended to be applicable to all situations or all injured workers. This article is not intended to address the catastrophic claim, or the relatively light injury where 100% recovery is expected. No, today I discuss those claims that leave a person with a partial rating, where they are left with a partial disability but physically should be able to return to work of some kind. Specifically we will discuss a subset of those cases, where the person in recovery is afflicted with a secondary condition, which I call the “total disability state of mind”. The concept I convey is not rife with details - it instead concentrates on the main point; changing our mindset in order to change theirs.

We have a problem in this country with disability. The definition of “Total Disability” is expanding, if not in legal and medical circles, in the minds of some who experience it. According to the National Bureau of Economic Research, “The share of the U.S. population receiving Social Security Disability Insurance (DI) benefits has risen rapidly over the past two decades, from 2.2 percent of adults age 25 to 64 in 1985 to 4.1 percent in 2005.” According to NBER, in 2005 cash payments for SSDI were more than $85 Billion. Since that time the growth rate has dramatically increased. Indeed, applications for SSDI rose 21 percent, to 2.8 million, from 2008 to 2009.

Some injured workers have come to believe that a partial disability rating means their productive earning years are over; they will never be able to work again. This is their alternative reality from a “total disability state of mind”.

These people have a true disability. Many suffer chronic pain. And while there are things they can do, they do not believe they can work.

Most suffer in relative obscurity. A few of them are quite vocal. They can show up at government hearings to protest or testify. They can place a myriad of videos about their plight on YouTube. They can post a multitude of comments on this site (most of which we don't publish as they are not relevant to the topic, or they call specific people names). We know of at least one of them who can chop their own firewood.

But none of them can get a job. Their disability prevents that.

Now this is the important part. Whether obscure or vocal, the people I am talking about today are generally not frauds. They are not fakers. They are not malingerers. They truly believe that they are completely unable to work, to participate in society as they once had. This is the “Total Disability State of Mind”, and in a world where perception is reality, the alternative this mindset produces is quite real for them. Whether it be pain, anger, entitlement mentality or a combination of all, they are convinced that their disability is complete, total and final. A fait accompli, if you will.

This is quite sad, in my view, and a complete waste of human talent and potential.  Studies show that people heal faster and live longer when they can return to some level of work. A recent study just announced last week shows that working through pain may actually reduce it: and not just on emotional and intellectual level, but at a physical level as well.

The cycle of dependency for workers trapped in this reality just does not have to be.

Many of us read about and saw the inspirational video about an injured veteran who had been told he was disabled, and would never recover. He believed them, and for years he was. But one fateful day, deep down, he decided enough was enough, and his transformation was both miraculous and inspiring.

So how do get the same victory in traditional workers' comp claims? How do we avoid this trap? And can we salvage those already entrenched in their own anger and misguided lack of faith in themselves? I'll address the latter first by saying, sadly, it is unlikely. For many the anger, depression, even drug dependency is too entrenched, and the damage too severe. The trust has been shattered for many of these people, and it will take a self guided miracle for them to come around. After all, no one can make you believe in yourself.

However, we can change the approaches we take to make a difference in future cases, to target and destroy the negative practices and influences that take some people down this path. I wrote recently about changing the industry mindset from one of “Claims Handling” to that of “Recovery Management”. What I suggest simply expands upon that concept, and is a fundamental shift from the view we hold today. For the cases likely to end up with a partial rating and possibly looking at a modified or different job than the pre injury position, I suggest CURE: Communication, Understanding, Return to Work Structured Agreement, and Education.

  1. COMMUNICATION - This is the most important criteria, and it requires commitment from all the players. Employers, Doctors, NCM's – everyone involved in the recovery - needs to be honest, clear and concise with the recovering worker. Recovery Specialists (formerly known as Adjusters) need to coordinate and assure that information moves promptly and accurately. I am referring to something much more complex than the traditional "Three Points of Contact". That method is reliable at retrieving information, but by itself often fails in the critical element of sharing information with the injured and their employer. It might not have been designed that way, but in today's claim management approach, it is often the net result. Employers have to be engaged as well, and to the extent they must understand what is at stake, the Recovery Specialist may need to drive that process.

  2. UNDERSTANDING - This is a two sided coin. It is imperative that all parties involved with the recovery process of an injured worker make every effort to understand what they are feeling, what they are thinking and what they want. This is an area where our processes are severely lacking today. Employers need to be engaged and fully aware of what is happening with the current process. All others working the file, not the least of which would be the Recovery Specialist, must LISTEN to what the injured person' s questions and concerns are, and be prepared to honestly address them. Remember, part of having empathy requires direct honesty; you cannot sugar coat or mislead the injured worker in this process. On the other side of the coin, the injured worker must also understand the realities of their situation, and the limitations of the comp system. The very first thing they need to understand is, with very few exceptions, their time in the system is temporary, and they WILL be returning to work. It is up to their employers and professionals in the system to make that reality known to and understood by them.

  3. RETURN TO WORK STRUCTURED AGREEMENTS – If I were King for a day, the word “settlement”, at least as it applies to indemnity for these cases, would be forever banned from the workers' compensation lexicon. From the outset of a claim, an injured worker would know that there is not a settlement awaiting them. They will however, receive supplemental compensation IN THE EVENT they cannot perform the position they held prior, and have lower earning capabilities as a result of the injury. This supplemental compensation would be offered as part of a Return to Work Structured Agreement, and would be available as part of the package when they returned to a job.

  4. EDUCATION – One of the responsibilities of the Recovery Specialist is to educate the injured worker as to the processes and procedures they are about to embark on. What is your Plan of action? This is something the person "in recovery" needs to know. They have to understand the process, and that it is simply designed to assist them, not pay their way. The overriding goal of the process is to get the injured worker treated and back on the job, or another job if the situation requires it. That needs to be clear from the outset.

I certainly understand that this cannot apply to all cases of this type. There are extenuating circumstances where people may not be able to return to a position. These will often be more attributable to a lack of education, usable skills or language barriers than the injury itself, but they will of course still exist. Other external influences such as unions, doctors and claimants attorneys will hamper these efforts. I am suggesting however, that an overall change in the recovery mindset will lead to a more effective and ultimately healthier process, as well as a reduction in litigated cases. I even believe that some of the answers to our growing opioid issues can be found in this fundamental shift in strategy.

It is a change we must make if we are to successfully battle the growing sense of entitlement that helps create the “total disability state of mind”.



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