Comments on the Comcare review

April 1, 2013

The Comcare review released in February 2013 has important implications for psychiatrists (click here for the complete review) . There is understandable concern about the growth in claims for psychological injury.  Between 2006–07 and 2009–10, psychological injury claims accounted for 10 % of all claims under the Comcare scheme. However, those claims represented 35 % of the total cost of claims. During 2010–11, psychological injury claims accounted for 12 % of all claims and 32 % of the total cost of claims. In 2010–11, the average duration of incapacity for injured employees with claims for psychological injuries was 12.3 months. By contrast, the duration for other types of injuries was as follows:

(a) falls, slips and trips: 4.1 months;

(b) body stressing: 3.6 months;

(c) vehicle incidents: 3.2 months;

(d) hitting / being hit by objects: 2.0 months; and

(e) other injuries and diseases: 4.2 month

The review recognises that psychological injuries can  cover a range of conditions, including stress, adjustment disorder, anxiety, post-traumatic stress disorder and depreand that there can be difficulties diagnosing psychological injuries, over and above the difficulties of diagnosis involved with physical injuries; and the diagnosis often involves subjective as well as objective elements. Furthermore, multiple factors often contribute to the onset of psychological conditions (for example, underlying personality disorders, relationship problems and financial pressures, as well as work-related pressures) and it can be difficult to isolate the employment contribution to the injury.
The review makes the point that psychological  injuries can also arise from an employee’s perception of and reaction to external events, which can be different to other employees’ perception of and reaction to the same events.

The reviewers also note that the rate of claims for psychological injuries for premium payers has increased by 30 % in the past three years and is four times higher than the incidence among licensees. This suggests that psychological injuries may be more of an issue in the public sector than the private sector.

The increased incidence of psychological injury claims has been attributed to a range of causes, including the increased pressures of work life, employment instability, increases in employee expectations and a more litigious society. It may be reasonable to suggest that a principal explanation for the increased incidence of psychological injury claims can be found in the increasing demands placed on employees through such mechanisms as efficiency dividends, constant performance evaluation and the restructuring of employment arrangements. A further explanation may be found in poor management practices, which might be said to reflect a low priority given to preventing or resolving workplace stress.

The reviewers point out that the various Australian workers compensation schemes use different guides to assess permanent impairment, the majority based on the fourth or fifth edition of the American Medical Association guides. The diversity in approach to assessment means that benefits can vary significantly from one scheme to another, and that there is little capacity for scheme administrators to learn from shared experience. Medical assessors also have difficulty in developing assessment skills that can be used across the schemes.

The threshold level for psychiatric injury ranges between 1% in Queensland,5% in the Northern Territory,10% in Comcare,15% inNew South Wales and in Western Australia and 30% in Victoria.There is no lump sum payment for Psychiatric injury in South Australia and the ACT. This is clearly inequitable but a reflection of the fear of governments that claims for psychological injury will overwhelm the system.

The  review notes that permanent impairment claims  in 2011-2012 totalled 250 of which 88 were for  psychological injury.

The reviewers also discussed whether or not medical panels or tribunals would assist the process, because there are medical members of the AAT and because there is such a wide geographic range for ComCare claimants medical panels or tribunals would not be helpful. They included a table      this table summarises what is done with regard to medical tribunals and panels and panels in the different states and territories.

Impairment Guide 

The reviewer noted that the Strategic Issues Group on Workers’ Compensation (the SIG WC) has agreed to seek endorsement from Safe Work Australia members in March 2013 on a national permanent impairment assessment guide (the proposed National Guide) and a proposed permanent impairment assessor document. The proposed National Guide is based on AMA5, as amended by the New South Wales scheme.  They recommend that  the threshold be kept at 10% for both physical and psychological injuries and that the proposed National Guide be used.

My condern with regards to the prposed National Guide is that this will cement in place the PIRS as the only impairment method the determing psychological injury. I have written extensively about the PIRS elsewhere .

There does not seem to be any indication about whether or the issue of secondary and non-secondary psychiatric impairment is being considered.

I understand the reasons for the review and recognise the significant increase in psychological injury claims especially arising from “workplace bullying “. The concern is that if something is not done to rein in the costs then psychological injury will no longer be included in such schemes to the detriment of workers. My major concern is that people be claimants be treated equitably. My additional concern is the metastatic growth of the  PIRS, an instrument that I regard as deeply flawed .

There was a Comcare review some years previously that led me to develop the RAPID MSE,  This is a psychiatric impairment rating system dependent on the mental state examination that is not subject to gaming and measures impairment rather than disability .  I encourage you to have a look at it.







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