Why Delayed Recoveries are Driving Up Costs and What You Can Do About Them

About Delayed Recovery

“Sometimes you have these claims that don’t progress, and you don’t know why.” That statement from Denise Gillen-Algire, director of Risk Initiatives for Albertsons Safeway is an excellent description of delayed recovery claims.

Delayed recoveries comprise a small minority of claims, about 6-10%, but they consume an estimated 80% or more of medical and indemnity resources. Often these claims are not readily apparent until someone happens to notice them. The low back strain, the stiff shoulder, or the broken wrist that should have healed long ago continue consuming money for surgeries, procedures and medications with no pain resolution for the injured worker. But proper screening and intervention can help prevent this.

These claims are not dependent on any particular injury or illness. They are diagnosis/injury agnostic. The underlying reasons for a seemingly simple claim to go south are varied and relate to multiple psychosocial factors:

• Catastrophic thinking is one of the main issues affecting injured workers with delayed recovery. Despite the injury or illness, the person believes he is beyond the ability to recover.
• Fear avoidance is another. The patient is so concerned he will further injure his body that he avoids doing anything that might exacerbate the pain- such as move.
• Anger and perceived injustice are often present. Regardless of how long the person has worked at his company, he feels a disservice has been done to him.
• External locus of control occurs, meaning the worker relies on his medical providers and others to fix him, rather than taking any responsibility for his own recovery.

Unfortunately, the medical system often legitimizes this thinking. The treating physician easily accepts the injured worker’s external locus of control and focuses only on the physical diagnosis and pain. Multiple MRIs and other tests, unnecessary surgeries and finally the prescribing of opioids is often the treatment with the final common pathway being chronic pain and polypharmacy. The injury has become medicalized when the delayed recovery and overutilization are driven by inadequate coping skills and a lack of knowledge of the pain generator.

ID Early

Injured workers with hyperalgesia are more fortunate than others on long-term opioid therapy in that the positive effects of being off the drugs are experienced almost immediately. While others may go through various types of withdrawal symptoms, injured workers with hyperalgesia may have few, if any before they’re already feeling better. Regardless of how easy it is for them to wean, they still need to be monitored as they taper off the medications. There may be other factors going on and other withdrawal symptoms may be present. By and large though, they are the quickest to resume living productive lives.

Conclusion

The value of identifying workers at risk of delayed recovery early in the claims process is crucial. The injured workers included in the Albertsons Safeway study who scored high or very high risk were offered the choice to undergo CBT intervention. In an upcoming blog, I’ll discuss the treatment and results.

By Michael Coupland

Courtesy of The IMCS Group