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We have all seen cases involving a “simple” back sprain claim that we don’t pay much attention to, only to find ourselves with the claim remaining open a few years later with no sign of the claimant ever returning to preinjury functional level. What is the difference between this claim and a similar one that closed as expected? The “disability mindset.”

Injuries pull us out of our routine. Some people begin focusing on negative events or possibilities, develop anxiety, and lose contact with coworkers. As this continues, they develop a negative perception of the disability process; they may catastrophize about a cascade of successively worse outcomes.

The longer a routine is broken, the harder it is to get back into it. For some, this leads to the disability mindset in which the injury is no longer just an injury. It is the defining thing that makes the person who they are, taking on a life of its own.

Identifying claimants who are likely to develop the disability mindset is critical in the early stages of a claim. Research points to certain factors that tend to indicate a higher propensity for delays due to psychosocial factors, hence a higher risk of developing the disability mindset.

Some more obvious factors include preinjury mental health issues, such as generalized anxiety disorder, major depressive disorder, and post-traumatic stress disorder. Less obvious factors include a history of smoking, low education level, lack of a good social support system, and resilience barriers such as limited self-efficacy and poor coping strategies.¹ Other indicators that biopsychosocial barriers are likely to impact recovery include high body mass index, low income, and other comorbid health conditions.

While all these factors can have a significant impact on disability durations, some simple strategies can turn the tide for a more positive outcome. One best practice is having the supervisor contact the claimant in the first few days to ask how they are doing, offering modified duty that allows the claimant to recover while working, and fostering a workplace that doesn’t stigmatize employees with injuries.

Supervisors often say they cannot contact the claimant because it could be seen as infringing on their recovery or could be used against them should the claimant get an attorney. However, this approach establishes an adversarial relationship and supports a claimant’s perception that they are disabled and their employer is not on their side, something that is often simply not true.

Setting the stage before the disability by creating a culture of support can have a positive impact if and when disabilities do occur. It is important to identify traits of a supportive workplace as well as encourage the use of the employee assistance program and other tools available in the workplace to support mental health. Ultimately, it is the claimant’s perception of their condition, contributed to by the workplace culture, that determines their recovery — and not the injury itself. Create a positive work environment before the disability and avoid the disability mindset.

– Jamie LaPaglia, RN, CCM, ODG Manager of Implementation and Clinical Education

This article was previously published in Disability Management Employer Coalition (DMEC) magazine @Work as the author of their May 2020 column, “A Clinician’s Viewpoint.”

Photo courtesy Shutterstock/Gorodenkoff

Reference:

1. American Academy of Orthopedic Surgeons. Clinical Practice Guideline for Evaluation of Psychosocial Factors Influencing Recovery from Adult Orthopedic Trauma. Dec. 6, 2019.
   Retrieved from https://www.aaos.org/globalassets/quality-and-practice-resources/dod/prfcpg-final-12-20-19.pdf

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