Same Video, Different Reports: How Assumptions about Pain Shape Observations

Article 4 – The Employer’s Perspective 

There’s a classic learning activity used widely in schools and organizations in which a teacher or facilitator asks a group to watch a short video. Each attendee is then asked to describe aloud to the group what they saw. Even though everyone watched the same video, each person shares a different account. In fact, some observers may report a completely different version.

Why?

Each retelling is shaped not just by what someone saw, but by their own assumptions, fears, and life experiences. I participated in this activity during a graduate education class and found it to be quite startling. How could we see the same thing and yet have different reports? We don’t always see things as they are -- we see them as we are.  Our assumptions, biases, and personal experiences color the ‘facts’ we think we’re reporting. The facts may be hidden beneath layers of perception and misperception.

Could this be occurring with workplace low back injury? I believe the answer is yes! 

This series of articles asserts that achieving a successful outcome following low back injury depends on open dialogue and communication to surface biases, challenge assumptions, and address misconceptions or knowledge gaps. All parties involved -- the injured worker, the provider(s), the payer, the employer, and potentially, the attorney -- make decisions based on education and professional background, life experiences, and potentially individual bias, judgments, and assumptions. This fourth article in the series will explore the employer’s perspective. 

Pre-Injury Assumptions Matter 

An employee’s perspective and sense of connectedness at hire and in day-to-day culture matters. Creating a sense of connection and having open lines of communication between employees, supervisors, and company leadership are pivotal factors in an employee’s response to workplace injury. Research by the Workers Compensation Research Institute (WCRI) indicates that employees who fear losing their job or don’t understand the claims process following workplace injury are far more likely to seek legal representation.¹

That fear typically arises from a lack of information and connection -- not from the severity of the injury itself. Waiting until an injury occurs to explain the workers’ compensation process or establish lines of communication isn’t wise. An employee in pain, under stress, and feeling isolated is more likely to misinterpret silence as indifference. A strategy by employers to address assumptions, fears, and bias early and often -- prior to a workplace low back injury -- is highly recommended. 

Lifestyle Factors and Recognizing Warning Signs 

Tom Slattery, CSP, ARM, is the Corporate Director of Safety for Norfolk Iron & Metal, one of the nation’s largest carbon, aluminum, and steel providers. With more than 30 years of experience in ergonomic assessment, risk management, and workers’ compensation, he’s aware that low back pain is one of the most prevalent medical conditions in worker’s compensation. He recognizes that many employees are unaware of the broad range of risk factors for low back injury and can mistakenly assume that physical workload factors are the sole contributor.

Age-related spinal changes and minor cumulative low back injury -- both in and outside of work -- are contributory. Lifestyle and modifiable factors such as eating and exercise habits, stress level, relationship and emotional demands, and financial pressures play a role in low back health and potential injury. Mr. Slattery recognizes that these knowledge gaps may cause an employee to miss warning signs that could have prevented injury. He regularly encourages early reporting to a manager or supervisor.

"Don’t wait until you’re on your knees in pain," Mr. Slattery advises. "Recognize the warning signs and speak up before an injury occurs."

Are Most Back Injuries the Result of Cumulative Trauma? 

Mr. Slattery shared an analogy: "If an employee with years of cumulative trauma to the low back picks up a bath towel from the floor at home and that motion is sufficient to result in low back injury, the employee’s medical insurance plan covers the injury. However, if that same employee injures the low back by retrieving a pencil from the floor at work, it results in a workers’ compensation claim."

A common misperception he sees is that employees consider the "moment of injury" as solely causative instead of the cumulation of activities, movements and myriad other risk factors throughout their lifetimes which are contributory.  

Put Away Judgment 

When a low back injury occurs, Mr. Slattery encourages managers and supervisors to put aside judgments, bias, and assumptions.

"Questioning if the injury is legitimate or if an employee’s symptoms are real is a judgment that isn’t valuable," according to Mr. Slattery. Instead, he recommends focusing on the facts.

"The work we had them perform resulted in an injury," Mr. Slattery says. "Why wouldn’t we treat them well?"

Training for human resources teams and company supervisors encourages the mindset to "be that person. Be on their side."

Mr. Slattery points out that an injured worker home from work watching daytime TV will see commercials from attorneys planting doubt or fear, which can contribute to mistrust of the employer.

"If that happens, we didn’t do our job" Mr. Slattery says.

A physician who spoke at a workers’ compensation conference shared an analogy Mr. Slattery has never forgotten: "Visualize yourself handing an injured worker your credit card. Be personally invested in that employee’s care. It’s the moment of truth for your company and action is needed."  

Communication as a Formula for Success 

What does winning communication look like? 

Dr. Amy Garrett, PT, DPT, physical therapist at Nebraska Spine & Pain and recognized expert in spinal workplace injuries says, "The more communication between all parties seems to be the best. I’ve had several patients who would text or email their case manager, and it seems like approvals happened more quickly and there were fewer delays because the case manager was more aware of what was happening with the case."

Mr. Brad Brons, a seasoned claims adjuster licensed in nine states with an exceptional understanding of anatomy and medical conditions/injuries, shares similar advice.

"During the initial phone call with an injured worker, I go out of my way to explain the claims process. I encourage them to call me after every visit with a healthcare provider so we can discuss what happened and what the plan is," Mr. Brons advises.

This has a two-fold benefit -- it sets up an opportunity to answer questions, explain any medical jargon the injured worker may not understand, and discuss "next steps" in evaluation and/or treatment. Since Mr. Brons also manages authorizations as part of his claims handling duties, it speeds up the process since he knows to watch for a referral or orders from an evaluating or treating physician.     

Consider Your Audience  

Mr. Slattery says an unfortunate assumption is to speak above an injured workers’ level of education.   

Communication from claims adjusters or third-party administrators, for example, shouldn’t use industry-specific language in a formal letter that is beyond the 5^th grade level. Terms specific to workers’ compensation that aren’t defined and offer little to no explanation for "next steps" in the process create confusion.

He recalled a claim in which an injured worker bemoaned, "The claims adjuster used words I didn’t understand. I’m not even sure when I’ll get paid."

Modified Duty with an Individualized Approach 

Despite a common misconception that prolonged rest heals low back injury, it’s valuable to return an employee to work – as soon as possible – for a variety of reasons. Mr. Slattery reports that returning to work – modified duty, if necessary – maintains comradery with co-workers, contributes to a sense of control, and supports emotional well-being.

Dr. Garrett shares this view.

"It always seems to go better for the patient and the employer if there is some light duty or sedentary duty for the patient to participate in," according to Dr. Garrett.

Mr. Slattery points out that a mistake many companies make is not allowing any days away from work following low back injury.

"Sometimes, a day or two of rest isn’t always a bad thing," he recommends. "Be individualized in your approach.’  

Mr. Slattery recalled that when he previously worked for an insurance company as an underwriter, a prospective company wouldn’t be offered a quote if they wouldn’t offer light duty after injury because "it’s that important."

Summary  

And the short video shown as part of a learning activity in classrooms and organizations?

Assumptions, biases, and personal experiences may lead viewers to color the "facts" that are reported, potentially resulting in accounts that are completely different. Similarly, layers of perception and misperception exist for all parties involved in workplace low back injury – the injured worker, the provider(s), the payer, the employer, and potentially, the attorney.

Consideration for pre-injury assumptions, judgments by employers and supervisors, frequent communication at an appropriate level, and an individualized approach for return to work can contribute to a successful outcome for employers managing low back injury. The payer’s perspective will be considered in the next article in the series.

Stay tuned! 

References 

1. Workers Compensation Research Institute. Avoiding Litigation: What Can Employers, Insurers, and State Workers’ Compensation Agencies Do? WCRI Report WC-10-18. July 2010. 

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