Concurrent Synopses

AI and Injury Claims

Paul Beinat

We examine several use cases in the use of analytics and technology in better managing compensation claims and facilitating optimal decision-making to promote recovery:  

• Early identification of severe bodily injury claims. A comparison between human expertise and machine learning derived analytical models.
• Using knowledge-based text mining to discover new information in workers’ compensation claims. It has been used to identify “jumper claims” (which look benign but eventually become large losses). We will examine the construction of the analytical system and its performance. It is currently used by a number of US state funds.
• Using the joint probability distribution of workers compensation claims to discover the treatment differences in a large claims portfolio by comparing two distinct time periods. We will look at the technology that enables this discovery.

Lost cause: Getting at causation in our datasets

Hugh Miller

We live in a world where we often have incredibly good data, but limited ability to use it to directly answer the questions that we most care about. Can we find the impact of legal representation if more severe claims are more likely to be represented? What is the impact of an operational change if it is only applied to a certain subset of the population? What fraction of an improvement in outcomes is attributable to management versus external factors? Answering such questions requires a deeper understanding of the data than straight descriptive statistics.

Traditional predictive modelling will assign effects, but many of these will be correlative rather than causative. However, significant progress has been made in types of causal modelling which aim to get at actual effects. While formal experiments such as randomised controlled trials remain the gold standard for many applications, other types of causal estimates can be made from quasi-experimental designs such as regression discontinuity, instrumental variable, comparative interrupted time series or propensity scoring. This paper introduces quasi-experimental designs and provides some examples of how we have applied them in actuarial contexts. Examples will draw on quasi-experimental evidence in injury schemes, welfare policy and housing.

Being able to estimate the actual impacts of underlying factors significantly improves actuaries’ ability to provide quality advice.

Strains, veins and automobiles - a study of motor accident injury experience through COVID-19

Paul Driessen, Ramona Meyricke

COVID-19 has been devastating for people worldwide. Even in Australia, which weathered 2020 relatively unscathed compared to other countries, a timeline of events including lockdowns, closures and restrictions disrupted lives across all states and territories. Accompanying these events were radically changed traffic patterns. For example, COVID-19 led to an increase in people working from home, where it was possible to do so, which reduced commuter traffic. Other types of traffic – such as home delivery of groceries and/or heavy vehicle traffic – increased in many parts of Australia. COVID-19 also changed consumer travel preferences, incentivising some people to switch from public transport to active transport activities, such as walking and cycling, or to driving. Many of these effects were localised to specific regions of Australian cities.

Yet despite the drastically changed traffic patterns, fatalities on Australia’s roads in 2020 were only slightly less than in 2019. In this presentation we examine motor accident injury experience throughout 2020 across Australia. We describe a model of motor accident injury claims commissioned by the NSW State Insurance Regulatory Authority (SIRA) which predicts claim numbers by claim severity, based on relative traffic volumes measured at the postcode-level. We describe interesting features of the analysis such as differences by region and road type. Finally, we consider the lessons that can be learnt from motor accident injury experience during COVID-19 which can be applied to potential future changes in traffic conditions – e.g. changed working patterns, consumer travel preferences, or further localised lockdowns.

Technological solutions changing the face of recovery across schemes and sectors

Ari Pianta

The time is right to take the way we view and undertake injury management to the next level.  With many of Australia’s worker’s compensation schemes experiencing enormous pressure and escalating costs, with an increasing complexity being experienced in the nature of the claims that we see amongst injured Australians and with a chronic shortage for employers in the sector for both case management and allied health staff, the time for change is upon us.

The use of technology to support the way we undertake service provision is exponentially increasing our capacity as injury management providers to provide the “right service, at the right time” to our clients.  App based and AI informed technologies are allowing us to review claims to show which ones will benefit from the tailored interventions of external rehabilitation providers, which services will make a difference on which claims and this can be topped off by technological advancements that make an employment goal achievable faster than ever. 

This presentation will explore three new technologies being piloted by Konekt Workcare to help take the work we do supporting injured worker’s to the next level – allowing us to achieve outcomes more quickly and thereby save claims costs.  The technologies for exploration include:

1. My Recovery Partner – AI informed technology that reviews the biopsychosocial data gathered by surveying a client and establishes which claims will recover without intervention and which claims require deeper triage provided by an allied health professional.  In this way, only the claims that will truly benefit from receiving intervention services receive them and in particular, the right services that are known to statistically enhance recovery in similar cases (identified using multiple data points)
   
   
2. Driven – is an app that has been proven to enhance resilience by using micro-learning opportunities, repeated often, to influence the brains neuroplasticity and create improvements in resilience.  Using app-based, bot driven technology, Driven encourages an individual that uses it to undertake multiple short, daily tasks that train an individual in behaviours that will improve the factors that make up their resilience.  The app is targeted at an individuals’ needs based on their responses to the PR6 tool that measures the 6 domain’s of resilience. 
   
   Whilst Driven has been proven to improve resilience in the general population, Konekt are currently piloting its use with injured workers who are in compensable schemes.  Noting Comcare’s previous research that has found that individuals’ with higher resilience recover better from injury, Konekt are using this technology to keep worker resilience as high as possible during the return to work process and thereby maximise the opportunity for recovery
   
   
3. Employable Me – is also app-based technology.  Used to support workers to find a role as quickly as possible once job-ready, the app matches diversity and inclusivity focused employers with available job-roles, with job-matched workers’ seeking a new employer outcome.  Within the app is the ability for worker’s to undertake transferrable skills analysis, understand more about job roles, develop job-searching skills such as interview techniques and resume development.  For the employer, the app enables them to identify a worker, who they are aware may need some enhanced supports, together with the ability to ensure that the worker is safely, physically matched to the role that they have available.  With applicability in both the Disability Employment environment and the compensable RTW space, this technology has the ability to revolutionise the speed in which New Employer outcomes are secured for Australian workers
   

The presentation will discuss the scope and capabilities of these technologies to change the way we do things in the injury management space, but most importantly, the ways that the speed with which we act to support and assist worker’s through the recovery process, can be enhanced assisting not only the worker, their family and workplace; but also the schemes currently over-burdened from a capacity and cost perspective.

The Slow Train - to better injury and disability schemes

Estelle Pearson

In 1991, I wrote and presented my first paper at the Accident Compensation Seminar in Canberra.  The World Wide Web was only publicly released in August 1991 and there was no Google so my research on the history of common law in accident compensation schemes was undertaken at the State Library using books and micro-fiche.  The after-dinner speaker was part of the Very Fast Train Project and excited us by the prospect of fast train travel between Sydney and Canberra!

Fast forward to the 2021 Injury and Disability Seminar in Canberra and the world is a very different place.  However, there is no fast train travel (although it seems to be back on the agenda) and I use this as a metaphor to reflect on the progress (or lack of progress) made with respect to accident compensation and disability schemes over the last 30 years. 

I also look forward 30 years to the 2051 Injury and Disability Scheme Seminar and, comfortable in the knowledge that I am unlikely to be presenting at that future seminar, I will make predictions about what our future schemes will look like and whether we will be travelling to the Canberra seminar on a very fast train.

A novel approach: Outcomes and learnings from the pilot of Queensland’s Workers’ Psychological Support Service

Janene Hillhouse

Work-related primary and secondary psychological injuries are projected to increase around eight per cent per year in 2021-2022 and 2022-23. Further, psychological injuries are recognised as more complicated to treat and manage due to the varying and subjective experiences and treatment requirements of each individual. 

To address this, Queensland Office of Industrial Relations (OIR) has invested in a range of policy initiatives designed to support workers experiencing work-related psychological injuries. This includes improving ease of access to workers’ compensation claims to reduce severity, duration and re-occurrence of psychological injuries; contributing to a national initiative to develop and implement clinical guidelines to assist GPs to diagnose and manage patients with work-related mental health injuries; contributing to presumptive workers’ compensation legislative amendments to include first responders with post-traumatic stress disorder; and working to develop a Code of Practice for the management of workers’ compensation claims for psychological injury.

In addition, OIR has administered a pilot program of a new service to provide person-centered support for workers affected by a work-related psychological injury. The Workers’ Psychological Support Service (WPSS) provides free, confidential and independent specialist support to individuals experiencing a work-related psychological injury, connecting them with existing community support and advice services appropriate to their needs that they may not otherwise have been aware of. The WPSS fills an identified service gap by providing a first point of support for these workers, connecting them to community supports at the earliest opportunity, to promote an improved recovery trajectory. The model represents an innovative approach that has not previously been applied in Queensland or Australia.

The WPSS was established in February 2019, and as at June 2021, it has assisted more than 1400 workers across Queensland from a range of industries and occupations. Data and client and referrer feedback confirms that the WPSS provides value and is making a positive impact in assisting workers to manage the impacts of their work-related psychological injury. 

This presentation will provide an overview of OIR’s current goals, initiatives and outcomes received to date in supporting workers with psychological injuries, and explore the outcomes and learnings from the pilot program of the WPSS. 

Connect & Care: Best Practice Support to workers experiencing a complex injury

Maddi Bailes, Farah Shams

In 2019, approximately 20 Youth Justice employees at Frank Baxter Centre suffered both physical and psychological injuries as the result of an inmate riot. This terrible flash point gave experts from icare, QBE and the Department of Communities and Justice (DCJ) the impetus to create a best practice method to better handle the fallout of these incidents - which are all-too-common in some workplaces.

Research demonstrates that strengthening engagement between direct managers and psychologically injured workers improves return to work outcomes. With this knowledge as a base, Connect & Care was collaboratively developed with icare, QBE and DCJ as a way to strengthen leader-injured worker relationships in government agencies exposed to complex trauma.

Connect & Care includes experiential education interventions based on adult learning principles, a research and data supported tailored best practice checklist and an easily adaptable implementation template. The robust co-designed program helps leaders and managers provide support to workers experiencing a complex injury, particularly those at risk of a psychological injury.

Harnessing the expert knowledge of high injury risk NSW Government agencies, icare client engagement managers, icare and QBE workers compensation claims specialists, education and instructional design specialists, the program has seen positive results across pilots run at DCJ and NSW Department of Health. These include NPS scores of +86, +89 and two +100s.

As the data bank grows, it’s showing that managers who have completed Connect & Care find the program to be highly valuable, and are taking real ownership to ensure success through the co-design process by deploying the learnt skills and process into their day-to-day working activities. Workers who suffered a workplace injury have reported feeling much more supported by their workplace since the completion of the program. The organisations involved are experiencing a reduction in complex workplace injury claims, better return to work rates, and increased productivity and positive workplace engagement. The program has seen improvements in injury incidence rates, improved RTW rates and reductions in overall claims costs.

Fatigue and burnout takes its toll on healthcare workers

Janine McMillan, Petra Bywood, Karin du Plessis, Amanda Moo

Work-related fatigue is a known health risk for workers in the healthcare and social assistance (HCSA) industry due to job demands and work schedules. ISCRR undertook an Evidence Review of the prevalence and impact of fatigue and burnout in the HCSA industry, including potential interventions and prevention strategies.

Long hours and shift-work are common practice across all HCSA areas, both in Australia and internationally. Compassion fatigue and burnout was reported in 30-50 per cent of nurses and 20-40 per cent of physicians and specialists in Australia and overseas. Burnout and compassion fatigue were associated with musculoskeletal injury, sickness absenteeism/presenteeism, poor physical/mental health, job dissatisfaction, increased drug/alcohol use, staff turnover and intention to leave or change profession.

Evidence showed that the optimal strategy to combat fatigue and burnout in HCSA workers is a multimodal upstream approach, with a strong emphasis on organisational-level preventive strategies. This includes modification of work schedules, provision of sufficient opportunities for rest between shifts, scheduled breaks during long work hours and adequate rest areas and facilities in the workplace. Interventions that enhance the workers’ ability to cope with fatigue (e.g. relaxation courses, resilience/coping training) may provide additional short-term benefits.

Improving understanding of mental health and injury in workers using unstructured data

Jonathan Cohen, Amy Clarke

Work-related mental injuries are the second most common cause of workers compensation claims in Australia. Both the number of Australians being compensated for work-related mental injuries, and the cost of this compensation is growing. Last year, 7,200 Australians were compensated $543 million, and spent long periods away from their jobs as a result of hazards such as work pressure, bullying and occupational violence.

Mental injury claims tend to be more complex than claims for physical injuries or illness, partly because the symptoms and treatments for various psychological illnesses can vary from individual to individual. Before effective action can be taken to prevent future mental injuries and protect those claimants already injured, a deeper understanding of mental health and injury in workers is required. There is significant opportunity to gain a more nuanced picture of mental injury expand our understand of mental injury in the workplace by using traditionally underutilised data sources.

In this presentation we will discuss how WorkSafe Victoria is using text mining of case notes, independent medical examination reports and medical advisory to better understand mental injury in its scheme. The results improve understanding of mental health and injury in workers by summarising the prevalence and profiles of:

    (a) Detailed mental health diagnoses (depression, anxiety, PTSD etc.)  

    (b) Psychosocial hazards leading to claim (e.g. work pressure, bullying)

    (c) Treatments used by claimants (including drug treatment and psychotherapies)

for a large sample of over 4,000 mental injury claims in the Victorian workers compensation scheme.

We find significant comorbidity, with most injured workers having more than one detailed mental health diagnoses. In many cases a combination of multiple psychosocial hazards will also contribute to the injury. We also find interesting time trends in treatment patterns for mental injury and discuss secondary mental injury amongst workers with a primary physical injury, drawing a distinction between mental injuries that arise concurrently with a physical injury and those that develop as a consequence of a physical injury. The combination of these results presents a richer view of mental injury that is being used to inform claims management.

Long Duration Psychological Claims – what can be done?

Sue Freeman

Long duration psychological claims are a significant cost driver in workers compensation. Worse still, they are growing at an alarming rate and there is almost universal acknowledgement that these pressures are likely to continue.

So, are long duration psych claims inevitable?

We will present data on a range of metrics (claim volumes, durations, industry mix, demographic factors, etc) and share our insights on the common causes of these claims, to explore what is driving the current trends and to hypothesize about where things are headed.

We will then consider some of the ways to help to reduce this burden on schemes – both to reduce the number of claims that occur, and to reduce their severity and duration when they do occur:

• Targeted prevention strategies – using claims data to better understand where problems are happening and focusing strategies on the workers and scenarios that are highest risk
• Ensuring the claims management model is ‘fit for purpose’ for these types of claims:
• What are the best practice principles when it comes to psychological claims?
• What are the claims management approaches that help facilitate earlier RTW?
• Ensuring that the claims management model is actually being delivered as intended
• How can technology and analytics be used to help evaluate actual claims management practices?
• How can lasting improvements in management strategies be made and measured?

Suicide and self-harm following work injury and disability: A global evidence review

Alex Collie, Shannon Gray

Work disability occurs when a health condition limits the ability of a worker to participate in paid employment. Work disability is common. For every 1000 working age Australians, an estimated 49.4 received income support for a period of work disability from a government or private sector (i.e., not their employer) benefit scheme during the 2015/16 year (1).

Several lines of evidence suggest that people experiencing work disability are at increased risk of suicide and self-harm. Risk factors for suicide in people with work disability include detachment from employment (2-3), high prevalence of mental health conditions (4), involvement in stressful administrative benefit processes (6-8), experience of financial distress (9), changes in social support networks during periods of disability (10-11), and lack of access to treatment (12). Suicide and self-harm are important public health and social problems, and warrant close attention.

The objective of this systematic review is to assess and summarise the global research evidence base regarding the relationship between work disability and subsequent suicide or deliberate self-harm. This review aims to answer the following research question “What is the relationship between work disability and subsequent suicide or deliberate self-harm in working age people?”. The review also seeks to answer a number of sub-questions, including “Is there evidence that certain approaches to the provision of social support (financial assistance) for people with work disability are associated with subsequent suicide or deliberate self-harm?”

The authors searched multiple medical and social science databases for studies published in English since the year 2000. Studies of work disabled adults (16 years or older) that included suicide or self-harm outcomes were identified. Two independent screeners assessed study titles, abstracts as well as full texts of relevant sources. From 510 potentially relevant studies, 50 met criteria for full-text review of which 35 were included in the review. Data was extracted and mapped in a tabular and graphical form accompanied by a narrative summary that aligns with the objective of the review.

A diverse range of populations, research designs were included. Identified studies included population-based registry studies from northern European disability-based compensation schemes, as well as cohort, cross-sectional and data linkage studies from North American and Asian cause-based workers’ compensation schemes. Multiple studies were in samples of people with work disability subsequent to mental health conditions, with others inclusive of samples with a broader range of conditions, including musculoskeletal conditions.

Preliminary data synthesis suggests that the risk of completed suicide is increased in people who have a prior episode of work disability. There are very few studies related to self-harm outcomes. There is potential to intervene in the pathway to suicide early in the work injury/disability process, including through actions of systems providing financial and healthcare support for people experiencing episodes of work disability.  At the time of submission, data analysis is continuing, and the presentation at IDSS 2021 will include a detailed presentation of study findings.

Workers' comp doesn't work - from Kafka and pirates to quantum mechanics: thoughts for the 21st century

David Gifford

From its beginnings in pirate days (100 pieces of eight for the loss of an eye1) through Otto von Bismarck in the 19th century2, to today, the world has changed around workers’ compensation. Originally established to provide compensation for demonstrable physical injuries, when injuries were essentially binary, in terms of both causality and reality, it has evolved to become virtually unrecognisable, with a large proportion of claims today involving either primary or secondary psychological injuries, which are less binary on both dimensions.

Mental injury claims are harder to prevent, hard to assess for eligibility, hard to manage, more expensive5, get poor outcomes, growing in number6, and tie up inordinate levels of resource in workers’ compensation systems7. As people’s work and lives become more and more intertwined, especially since the pandemic, the fundamental need to binarise whether injuries are work-related becomes more and more problematic, and detrimental to workers.

This paper will consider the evolution of workers’ compensation systems, with a specific focus on psychological injuries, consider the evidence around what works and what doesn’t in relation to eligibility and management, interactions with broader health systems and the mental health system in particular, and provide thoughts and ideas as to how workers’ compensation systems can continue to meet the needs of today’s (non-pirate) customers.

Collaborative Partnership to Improve Work Participation – Where to from here? Part 1

Dr Jason Thompson, Associate Professor Ross Isles, Geniere Aplin
Chair: Natalie Bekis

The Partnership’s current program of work, 2020-22 builds on the work undertaken in 2018-20 in four areas:

• System alignment
• Employer capability
• Facilitation of GPs, employers and individuals working together
• Community attitudes to health benefits of good work.

In this session the latest findings of work in these four areas will be presented, and then a panel discussion will be held with senior representatives of the Partnership’s member organisations to explore the potential application to the schemes and benefit programs across the work disability support system.

A model of Australia’s work disability support systems – what could it tell us?

Jason and Ross will present a model of the work disability support system in Australia, comprised of different schemes/benefit systems, and draw out some of the findings to date.  They will set up exploration of how this model might help actuaries and other policy makers in the future.

Transition support for people moving between two systems – what works?

Geniere will present the results of a pioneer program whereby people leaving a workers compensation scheme were offered support to transition, and address the question, what were the active ingredients for success?

Collaborative Partnership to Improve Work Participation – Where to from here? Part 2

Professor Niki Ellis, Dr Robin Chase
Chair: Natalie Bekis

Role of General Practitioners

Robin will briefly outline the three principles developed in this project, that will form the basis of new competences in RACGP training, and then summarise the outcomes of national workshops involving health care providers, schemes/benefits systems, employers and unions to consider how these principles could best be implemented. 

Panel discussion facilitated by Professor Niki Ellis

Senior representatives from the organisations that comprise the Partnership - Comcare,  Department of Social Services, EML, Insurance Council of Australia, Australian Council of Trade Unions, Department of Health, NDIA, Australasian Faculty of Occupational and Environmental Medicine.

The panel, with questions and ideas from the audience, will consider the potential applications of the latest findings for their systems, and collaboration across the sector. 

Employment outcomes for National Disability Insurance Scheme participants

Sally Galbraith, Sarah Johnson, Renata Morello, Lizzie Smith

Employment has a considerable positive impact on the overall wellbeing of all people, including those with disability. Participation in paid employment not only increases an individual’s level of financial independence, it can also lead to a greater sense of identity and social inclusion. These improvements in overall wellbeing may, in turn, lead to positive physical and mental health impacts for people with disability who engage in the workforce.^[1] More broadly, improved employment outcomes for people with disability and their families and carers are expected to contribute long-term economic benefits for Australia through increased labour force participation and reduced costs of disability income supports.[2]^,[3]

Australians with disability experience poorer employment outcomes compared to Australians without disability, and this has not improved in recent years. For example, according to the Australian Bureau of Statistics Survey of Disability, Ageing and Carers (SDAC), whilst the employment to population ratio for people aged 15 to 64 without disability increased from 78.6% in 2009 to 80.3% in 2018, for people with disability it declined from 50.0% to 47.8%.[4]

Increasing the number of people with disability in work is a key priority for the Australian Government. In 2018, the Australian Government established the Participant Employment Taskforce to improve employment outcomes for people with disability, by connecting and supporting them to pursue their employment goals. The National Disability Insurance Scheme (NDIS) Participant Employment Strategy (2019-2022), a key deliverable of the Taskforce, sets out the National Disability Insurance Agency’s commitment and roadmap for supporting NDIS participants to find and maintain meaningful employment.[5]

The purpose of this presentation is to summarise key findings from recent quantitative and qualitative research into employment outcomes for NDIS participants. The aims of the research were to investigate trends in employment outcomes over time, and to explore barriers and enablers to gaining and maintaining paid employment for NDIS participants, thus informing the development of targeted strategies for improving employment outcomes.

The quantitative research is based on participants’ responses to the NDIS outcomes framework questionnaires. Participants respond to the same questions at baseline (entry to the Scheme) and at each plan review, enabling longitudinal analysis of outcomes over time. The presentation will consider both baseline outcomes and longitudinal change, for participants aged 15 and over.

Baseline analysis will include calendar time trends in employment status for both NDIS participants and the general population, including the impact of the COVID-19 pandemic. Results of multiple regression modelling will highlight the key factors affecting baseline employment outcomes.

Longitudinal analysis will consider aggregate changes over time, and how participants transition between employment states. Results from longitudinal modelling of employment transitions, using generalised estimating equations to account for the correlation between responses from the same person, will also be presented. Participant and plan characteristics, calendar time effects, and Scheme duration can all be included in the longitudinal modelling.

Whilst the quantitative modelling provides valuable insights into how employment outcomes are tracking, and can identify factors that are associated with outcomes, it is not able to definitively answer the question of “why”: that is the role of qualitative research.

Qualitative research for this project explored the barriers and enablers to gaining and maintaining paid employment for NDIS participants who have an intellectual disability, are on the autism spectrum, and/or have a psychosocial disability. These are the three largest groups of NDIS participants by disability type (together representing about 62% of participants).

The qualitative research obtained the voice of NDIS participants, their families, carers and supporters, and of NDIS service delivery staff, using in-depth interviews, focus groups, and an online survey. Themes and topics emerging from these interactions have been analysed and pathways to employment for NDIS participants summarised.

The presentation will summarise findings from the qualitative research, and compare and contrast with findings from the quantitative research.

[1] Australian Human Rights Commission. 2015. Issues paper: Employment discrimination against Australians with disability p. 7

[2] Deloitte Access Economics. 2018. Increased labour force engagement among Australians with a disability. Report prepared for the NDIA, September 2018.

[3] Productivity Commission. 2011. Disability Care and Support.

[4] Disability, Ageing and Carers, Australia: Summary of Findings, 2018 | Australian Bureau of Statistics (abs.gov.au)

[5] NDIS. 2019. NDIS Participant Employment Strategy – 2019-2022. <https://www.ndis.gov.au/about-us/strategies/participant-employment-strategy>. Accessed 23/03/2021.

Framework to help guide the development and efficacy of outcome measures from a client, stakeholder, and scheme health perspective

Andrew Fronsko, Ross Isles

In the early 1900s, the key outcome that injury compensation scheme stakeholders focused upon was ‘administrative efficiency’ and more broadly the proportion of premium ultimately directed as claimant benefits.  In the 1970s – 1980s many injury compensation schemes underwent reform with a complimentary focus on ‘recovery and rehabilitation outcomes being measured (e.g. medical recovery and return to work), in addition to premium affordability. . In the mid-late 1990s, public monopoly schemes also began to measure ‘customer satisfaction’, later complemented by broader measures of ‘customer experience’ as used by private-sector insurers.  By the 2000s disability sector practices had progressively been adopted such as seeking the development of ‘person-centric planning’ and monitoring outcomes surrounding independence and attainment of goal/life area objectives.

With a large diverse range of potential outcome measures, schemes (and insurers) face the challenge of deciding what outcomes should be measured, and ensuring relevance to the target audience(s). Moreover, a key issue is how the monitoring and reporting outcomes can be used to guide continual improvement of practices that lead to quality client and stakeholder outcomes, and more generally provide assurance of ‘overall scheme health’.

In constructing this paper, case studies are presented on measuring ‘return-to-work outcomes’, and a comparison of outcomes measures reported by Australian and New Zealand compensation schemes. In addition, the paper will draw upon recent findings from the ‘COMpensation Policy And Return to work Effectiveness (COMPARE)’ project at Monash University.

In the above context, the benefits that can be derived from outcome monitoring and reporting are examined.  The paper presents a contemporary framework to help guide practitioners in the development and refinement of outcome measurement regimes.

Initial customer contact – how harnessing the power of behavioural science, data and analytics can drive better outcomes for the injured

Ben Edwards, David Bacon

The initial contact with our claims is an important opportunity to build rapport, provide information on the claims process, and gather information crucial to successful management of the claim. However, QBE’s Behavioural Insights team identified aspects of initial contact with claimants that can negatively impact claims outcomes and customer experience, including:

• Delays in seeking or having access to appropriate treatment.
• Delays or inability to identifying psychosocial risk factors that can lead to adverse impacts on the claimants’ experience, recovery and outcomes of injury.
• Case managers who frequently speak to injured people are susceptible to ‘empathy fatigue’, missing cues that provide an opportunity to improve customer experience.
• Cognitive overload for injured persons and case managers, which can result in claimants’ being unable to process the information.

At QBE, we aim to be the best at helping people bring their lives back together after an injury. We do this by being good people, supported by science and analytics. It’s the science of behaviour change, and a desire to bring this to bear to improve claims outcomes and customer experience, that has driven QBE to launch an innovative approach to the initial contact with people injured in motor and workplace accidents.

The program, called My Recovery, brings a new approach to our initial contact with injured people. It involves:

• Sending an interactive and personalised video to injured people at first notification
• Pre-approval of access to treatment services based on questions answered
• Using behaviourally optimised written communication to the injured person summarising the initial phone contact and important information.

In addition to this, the My Recovery program facilitates collection of self-reported, psychosocial data at scale and uses machine learning and analytics to identify psychosocial risk factors early in a claim. By understanding psychosocial risk factors and combining this structured data set with compensation data risk identification is improved. This allows improved support to be provided for the injured person such as instant access to appropriate, evidence-based treatment.

In a joint presentation with Quantium at the IDSS we will outline why and how the program was designed, how we have approached evaluating the impact of the program on recovery outcomes, and the benefits we have seen since its launch.

Lifetime Care Schemes: Setting, Achieving and Measuring Participant Outcomes (a follow up)

Claire White

Australia’s lifetime Care schemes and the NDIS have ‘participant outcomes’ as one of their key goals. These schemes use a participant’s own goals and aspirations as part of the treatment and recovery plan with the aim of achieving participant specific outcomes and efficiency in treatment expenditure for the scheme.

The 2019 Injury and Disability Scheme seminar paper ‘Lifetime Care Schemes: Setting, Achieving and Measuring Participant Outcomes’ surveyed Australia’s lifetime care schemes to compare how participant based outcomes are being measured.

The 2021 paper expands on this survey, with a series of follow up questions including how schemes are thinking about participants’ return to economic participation where appropriate.

Finally we will propose a ‘national dataset’ for lifetime care schemes being a series of comparable metrics focusing on participant outcomes that all schemes can collect and benchmark.

Lumbar spinal fusion surgery outcomes in a cohort of injured workers in the Victorian workers’ compensation system

Janine McMillan, Mark Philips

Lumbar spinal fusion (LSF) surgery is a common clinical treatment for chronic lower back pain. However, patients’ functional, pain and disability outcomes are variable and spinal surgery for chronic low back pain remains controversial. LSF outcomes for workers’ compensation patients are worse than for the general population. The objectives of this study were to examine the long-term work capacity, opioid prescription and mental health outcomes of injured workers who have undergone LSF surgery in Victoria, Australia, and to identify demographic and pre- and post-operative characteristics associated with these outcomes.

A retrospective study of 874 injured workers receiving elective LSF from 2008 to 2016 in the Victorian workers’ compensation system was carried out. WorkSafe Victoria’s claims data were used to infer outcomes for recovery. Association of demographics, pre-surgery and surgery variables with outcomes were modelled using multivariate multinomial logistic regression analyses.

Twenty-four months after LSF surgery, 282 (32.3%) of the 874 injured workers had full work capacity, 388 (44.4%) were prescribed opioids, and 330 (37.8%) were receiving mental health treatment. Opioid prescription and limited work capacity before surgery were independent strong predictors of opioid prescription, reduced work capacity and mental health treatment 24 months after LSF. Pre-operative mental health treatment was associated with the use of mental health treatment at 24 months. Other predictors for poor outcomes included a greater than 12-month duration from injury to surgery, LSF re-operation, and common law or impairment benefit lodgement before surgery.

An association between pre-operative factors and post-operative outcomes after LSF in a Victorian workers’ compensation population was identified, suggesting that pre-operative status may influence outcomes and should be considered in LSF decisions. The high opioid use indicates that opioid management before and after surgery needs urgent review.

Participants with acquired brain injury, cerebral palsy or spinal cord injury in the NDIS

Nicole Stransky, Sarah Johnson

This presentation will be based on a report published by the NDIA in a quarterly series of releases as part of its commitment to sharing data.

As at 31 December 2020, 14,013 (3.2%) participants had a primary disability of acquired brain injury, 16,184 (3.7%) had a primary disability of cerebral palsy, and 4,914 (1.1%) had a primary disability of spinal cord injury. While the numbers may be small as a percentage relative to the Scheme as a whole, each disability type still represents a significant number of individuals.

The purpose of this presentation is to describe the profile and experience of participants with acquired brain injury, cerebral palsy or spinal cord injury and how this compares with other participants across the Scheme. Topics covered will include:

• the profile of participants with acquired brain injury, cerebral palsy or spinal cord injury across various participant characteristics such as age, Indigenous status and gender.
• measures of the Scheme as experienced by participants, including the rate of 'access met' decisions, rates of exits and of complaints
• average plan budgets, types of supports in participant plans and the utilisation of those supports.
• participant goals, and outcomes for participants and their families and carers.

Radical service planning - how person-centred practice saves scheme liability

Trudy Minett, Kylie Smith

Busting the myth that being person-centred is the same as being a push-over. Knowing and understanding a participant’s (or a client in the world of other personal injury schemes) hopes, dreams and aspirations, and establishing a relationship with each individual participant is key to:

• Setting expectations that become embedded in the decision-making process with an individual participant. So decisions are understood and accepted, with minimal disputation and sustainable scheme expenditure.
• Supporting the participant to reach their own level of maximum independence and transition to the community, minimising long term over-dependence on the scheme.
• Saying no successfully, protecting the long term sustainability of the scheme.

Being person-centred and kind with participants does not mean paying for everything. What it does mean is clear and candid discussions – clear about the boundaries and clear about what the scheme can fund. Being clear about the boundaries helps everyone.

Effective person-centred practice also means understanding the participant, as well as understanding how best to communicate and manage their expectations.

Trudy and Kylie will talk about the journey that the Lifetime Support Authority has embarked on to ensure consistent person-centred decision-making and practice is embedded.

Practice that is kind.

Trust, customer experience and outcomes

Petrina Casey

The experience people have in interacting with a compensation scheme can significantly impact their recovery. In 2019, SIRA commissioned an independent study to measure customer experience and health outcomes in the compulsory third party (CTP) and workers compensation schemes. A total of 893 people with CTP claims and 885 people with workers compensation claims participated in the baseline survey online or over the phone and a repeat survey has now been completed. The study goes well beyond standard customer satisfaction tests to measure customer experience with insurers, trust in the schemes, perceptions of justice, return to work and other activities, and health and social outcomes.

This study has revealed key insights into the factors that influence a person’s recovery from injury and their experience within the CTP or workers compensation schemes. Overall, certain groups of people tended to report poorer experience and outcomes – regardless of injury severity or scheme. This includes people who are in the schemes for longer, have symptoms of probable serious mental illness, or are experiencing moderate to severe pain.

Generally, people with a CTP claim were found to be more impacted by their injury than people with a workers compensation claim reporting more pain and discomfort, anxiety and depression, social isolation, and they were less likely to have their ‘life back on track’. In workers compensation, people with a psychological injury claim were more likely to have worse outcomes and experience than those with a physical injury claim. On most measures there were few differences in experience and outcomes between insurers in both the CTP and workers compensation schemes.

This study has identified areas to improve customer experience and outcomes. The lowest scoring Customer Service Conduct Principle for both schemes related to insurers resolving a person’s concerns quickly, presenting a tangible focus for insurers moving forward.  In terms of health outcomes, the early identification of probable mental illness and pain, as well as opportunities for safe return to work and activities, will facilitate improved recovery and experience.

Ageing with lifelong traumatic injuries - Research Program

Jade Hurst, Cameron Lucas

The TAC commissioned a program of research to better understand the prevalence, needs and scheme costs of clients ageing with traumatic transport accident injuries. Best practice interventions for prevention and management of age-related conditions and the aged care system itself were also investigated. The TAC is pleased to share the findings and how we are improving our operations to better meet the needs of ageing TAC clients.  

Improving service at the NDIS – the Participant Service Charter

David Gifford

The NDIS provides supports and services to Australians with a permanent and significant disability. Although being less than eight years old it is one of Australia’s largest organisations with nearly half a million participants and a budget for 2021-22 of more than $25 billion. Providing high quality, efficient and reliable service to participants in critical to the NDIS achieving its purpose, which is to support its participants to be more independent, and engage more socially and economically, while delivering a financially sustainable NDIS that builds genuinely connected and engaged communities and stakeholders.

In 2019 the NDIS introduced its Participant Service Charter, comprising the Participant Service Guarantee1 and Participant Service Improvement Plan2. These set out what the NDIS aimed to achieve in terms of service to participant, and how it intended to achieve it. Since introducing the Charter and Plan, the NDIS has demonstrated substantial improvement in service, with faster access decisions, plan approvals, review timelines and complaint resolution3. Critically, participant satisfaction has also improved.

This presentation will explore the actions undertaken by the NDIS to achieve its service objectives, the results achieved to date, and reflect on the learnings acquired through this journey.

N-of-1 Trials: Custom-built for patient-centred care

Janine McMillian, Petra Bywood, Mark Phillips

Evidence-based medicine is the cornerstone of clinical practice. However, in many cases, the evidence is lacking or inconsistent; or the individual patient has unique characteristics that raise questions about the suitability of conventional treatments. ISCRR examined the utility and methodology of N-of-1 trials to determine whether a treatment with insufficient evidence of effectiveness may be of benefit to an individual in specific circumstances.

The patient in an N-of-1 trial acts as their own control as they receive treatments or placebo in a randomised order. A key strength of the N-of-1 trial design is its flexibility to be tailored to an individual patient’s unique circumstances and preferences, while maintaining adequate scientific rigour. The essential criteria for conducting a trial include multiple crossover blocks of treatment and repeated outcome measures. Blinding, randomisation and appropriate washout periods also add strength to the model.

The N-of-1 trial design keeps the individual patient in focus throughout the trial. The clinician and patient jointly decide every aspect of the protocol, from study design and selection of appropriate measures to clinical decisions. This study design is particularly advantageous for complex cases with multiple co-morbidities or other complications; or for determining the effectiveness of ‘off label’ treatments in patients resistant to conventional treatment.

N-of-1 trials have been implemented in a wide range of areas including chronic pain, mental health and sleep disorders, chronic diseases, complementary and alternative medicines and therapies, and prescribing and de-prescribing. Although N-of-1 trials are relatively inexpensive compared with parallel group randomised controlled trials, they still require resourcing. Services that can assist with the design and management of trials; and mobile technologies that aid data collection would facilitate the trial processes.

Point to (which) point? A look at the impact of P2P and rideshare vehicles across CTP jurisdictions

Vivian Tse

The continued popularity of rideshare for passengers and drivers suggests they are firmly here to stay, and regulators across all jurisdictions have grappled with different approaches in incorporating such increasingly non-traditional vehicles into traditional pricing segments.  There are many aspects that require consideration including maintaining a level playing field for other scheme participants, pricing equity, system complexity, legislation and prospects of further disruption.

The purpose of our presentation and research will be to:

1. Summarise briefly the different approaches adopted across different Australian (and overseas) jurisdictions in terms of CTP pricing and other regulatory requirements, given rideshare vehicles and taxis can pay vastly different CTP premiums.  What is considered fair and equitable?  Consider the advantages and disadvantages of current approaches, and more importantly what learnings can be drawn. 

2. Request (non-public) granular claims and exposure information from different jurisdictions (including overseas where possible) in relation to rideshare, taxis and chauffeur driven vehicles, to enable analysis on the relative risk of these vehicles.  This may include analysis of exposure (i.e. popularity and trends), CTP claim frequency, accident profile (e.g. location, time, severity, nature, age) and consideration of the impact of COVID.  Currently, some analysis is performed in each jurisdiction but this is limited by low vehicle numbers.  We believe that aggregating either data or at least the analysis results will provide a body of evidence from which jurisdictions can reference, which will be of benefit to CTP scheme regulators. Interviews may be conducted with each scheme to better understand their experience and concerns, and validate findings.

3. Explore the possible future(s) of rideshare and the subsequent emerging risks, including variations such as peer-to-peer vehicles and autonomous vehicles.  Can anything be done to futureproof CTP scheme design?

What are the potential harms? Better measurement of opioid use in the NSW personal injury schemes

Dr Ian Cameron, Bronwyn Martin

There is international recognition that an “opioid epidemic” has occurred and this has been associated with work disability, deaths and other health problems. While opioid medications have a role in the treatment of severe pain soon after onset (“acute pain”) and pain associated with cancer, their role in chronic non cancer pain is controversial. Evidence of their effectiveness in chronic pain (which is pain lasting more than three months) is limited. These problems have been recognised and opioid use in general in Australia appears to have plateaued. Similar issues of limited effectiveness and harm are recognized for other prescribed medication types particularly psychotropic medications. Medicinal cannabis is an emerging area of controversy. The NSW State Insurance Regulatory Authority has developed a better practice guide to respond to these issues. Early insights are presented into the NSW workers compensation scheme data of opioids and other medications of concern.  Predictors of opioid use following motor vehicle crash are presented from the Factors Influencing Social and Health Outcomes study.

Working WISE(R) - 2020 Expansion of Work Injury Screening and Early intervention (WISE) study 

Leah Brown

Konekt Workcare with EML NSW undertook a pilot to expand the original WISE protocol based on the evidence from 2015-17 WISE pilot (EML, icare and Department of Health, University Sydney partnership).

The pilot, Working WISE(R) specifically targeted an early claims cohort, the expansion of the WISE protocol, targeted musculoskeletal injuries, applying the long-form OMPQ tool at initial assessment, mid-way and service end. Those with an OMPQ score >83 qualified for the pilot which aimed to;

• Predict the potential risk of delayed recovery or longer-term disability and failed return to pre-injury activity and work levels analysing the score and actual question responses
• Facilitate better return to work outcomes, duration, customer experience and reduction in overall claim costs
• Addressing the psycho-social precursors to chronic pain enabling a faster recovery and capacity to return to work and underlying psycho-social barriers effectively and mitigating a secondary psychological injury condition with up to 6 sessions with Psychologist to specifically address risk factors identified through the questionnaire
• Enabling faster recovery and capacity resumption
• Mitigate secondary psychological injury conditions

Outcomes

1.      Closed Case Outcomes All	100% RTW 14.5 weeks average duration $3,047.29 average cost
2.      WISE(R) Protocol Closed Case Outcomes	100% RTW 12.3 weeks average duration $3,760 average cost

                                                  

3.      43% reduction in OMPQ scores across all participants to low risk of delayed recovery or longer-term disability

* Further data maturity is required to see the full benefit of reduction in overall claims cost and of secondary psychological claims

Comparison to general claims cohort for same period (September to December 2020) demonstrating outstanding results

Evidence informed work injury scheme design and implementation helps people and reduces costs

Mary Wyatt

Recent media has highlighted the human and economic costs of work injury scheme dysfunction and highlighted the pressing case for change. But what are the changes needed, what systems need to be in place to support those changes?

Injury insurance schemes exist to help people in times of need.  However, health and return to work outcomes are worse for people who receive compensation than for those who do not. Systems that are designed to assist people at a time of need can actually make them worse.

Over the last 10 years the evidence-base for effective recovery and return to work principles has grown substantially.

The Australasian Faculty of Occupational and Environmental Medicine (AFOEM) of The Royal Australasian College of Physicians (RACP) has reviewed the evidence and developed policy outlining the key principles needed to improve recovery and return to work. 

This policy work extends the ten-year AFOEM/RACP Health Benefits of Work agenda.  The policy examines key aspects of evidence-based practice and what can be done to improve scheme delivery with respect to the four work injury domains: leadership and regulation, case management, the workplace and healthcare.

Through this work, AFOEM seeks to improve the care people receive following a work injury by advocating for better systems of care of people with a work injury. This requires identification and appropriate care to address psychosocial barriers to reduce distress and medicalisation/overtreatment that are more likely to occur when people are distressed. 

The main message of these papers is that two major reforms are required. These are to

• systematically capture psychosocial information for individual cases and proactively manage psychosocial risk by providing injured workers, workplaces and treatment providers with timely support according to need; and
• ensure that scheme cultures, systems and processes do not create unnecessary barriers to recovery, but instead encourage positive psychosocial factors (those known to assist recovery and return to work (RTW) – e.g. self-efficacy) whilst reducing negative psychosocial factors (those known to slow recovery and RTW – e.g. perceptions of unfairness).

Work injury schemes that focus on preventing system-induced psychosocial barriers reduce unnecessary disability and its associated consequences for the individual and their families, while simultaneously reducing scheme costs by reducing claim duration and lessening the number of long-term claims. 

This session presents the evidence on the case for change in work injury scheme design and delivery, including the health and financial benefits of incorporating evidence-informed case management practices at a system level. 

The challenges created by automated vehicles for motor accident injury insurance schemes

Peter Mulquiney, John Morgan

The introduction of driverless or automated vehicles onto Australian roads promises to bring substantial economic and social benefits. These include lower rates of injury and death from motor accidents, increased productivity due to more efficient travel times and being able to work during travel, decreased congestion and negative environmental impacts, and more inclusive forms of mobility for the elderly and people with disabilities.

However, the introduction of automated vehicles creates several new technological and legal challenges. One of these challenges is ensuring that people injured or killed on our roads in accidents involving automated vehicles receive appropriate treatment, care, and compensation.

Of concern is that people injured in accidents caused by automated vehicles may not have the same, or any, access to existing compensation under Australian Motor Accident Injury Insurance (MAII) Schemes.

Further, if MAII Schemes are amended to address this gap, two further challenges arise:

• Determining how fault is attributed in accidents involving automated vehicles
• Creating an effective recovery mechanism so that MAII insurers and operators can seek to recover claims costs from automated vehicle manufacturers for accidents caused by the failure of an automated vehicle.

  This presentation will cover:

• An overview of automated vehicles – what they promise and when may we expect to see them on our roads
• Why people injured or killed on our roads may not have the same, or any, access to existing compensation under MAII Schemes and a discussion of the policy recommendations that have been made to correct for this gap
• The legal and forensic challenges that MAII Schemes may face in seeking to attribute fault in accidents involving automated vehicles if MAII schemes are amended to cover accidents caused by automated vehicles.
• The legal and forensic challenges that MAII Schemes may face in seeking recoveries from automated vehicles manufacturers along with possible legislative approaches to enhance rights of recovery.

This presentation will draw on the work of the National Transport Commission and our own work on a project commissioned by the Heads of Motor Accident Injury Schemes on options

The Magic Pudding and the claim farmer – a never ending story

Raj Kanhai, Geoff Atkins

Claim farming is the practice of third party intermediaries initiating unsolicited contact, to encourage people to make insurance claims and who then refer or sell these claims on to a lawyer or claims management company. This behaviour has become significantly more prevalent within the CTP industry in the last few years, alongside increased efforts from CTP regulators to address this problem.

This paper examines the claim farming experience in different jurisdictions within Australia, including:

• How prevalent claim farming has been
• The number of operators
• The estimated impact on claim frequency
• The estimated impact on scheme premiums

We also explore the various strategies implemented by the various state regulators (most recently in Queensland), in order to understand and remedy CTP claim farming.

We also touch on the latest in the suite of Whiplash reforms in the UK, aimed at eliminating spurious and unmeritorious minor injury claims. After a decade of trying to deal with the problem, has the UK finally got it right?