Thoughts on Healthcare in Workers' Compensation

Written by It Pays to Care's Dr Mary Wyatt and Tanya Cambey. Tanya and Mary's articles on this topic can be found on RTWMatters.org.

David Bacon wrote a candid LinkedIn post about failed opioid interventions in workers’ compensation schemes deserves our attention - not just for what it reveals about one challenge, but for what it signals about healthcare delivery in workers' compensation.

The patterns we all see

Healthcare providers discuss these issues regularly. We shake our heads at what unfolds, knowing that routine practices delivered through healthcare often trigger cascades beyond our control. Failures with opioids are one thread in a larger pattern.

Healthcare in workers' compensation flows like water through a riverbed carved over decades. Every upstream pressure - 10-minute consultations, fee-for-service models, skills gaps in occupational health - has cut the channel deeper. By the time an injured worker enters this system, the current is already set.

The water flows predictably:

• Quick-turnaround medicine means it's faster to order a scan than explain why one isn't needed.
• Limited time and training leaves GPs managing complex compensation requirements alongside clinical care.
• Fragmented funding rewards activity over outcomes.
• Administrative complexity creates delays that become treatment gaps.

Then compensation processes slow everything down - approvals, assessments, verifications - creating eddies where harm accumulates. Workers wait and confidence erodes. Simple injuries drift toward complexity.

What the evidence shows

Published as a series of articles for RTWMatters, we have been exploring the evidence and data, as much as is available, on how our current standard approaches contribute to harm.

• Early imaging: Workers receiving MRI scans within 30 days stay off work for a median of 174 days, compared to 21 days without early imaging. A significant percentage hear age-related scan findings as pathologies or barriers to recovery.
• Opioid prescribing: 20-30% of Australian injured workers receive opioids within 90 days. Of these, over 60% meet criteria for high-risk prescribing.
• Assessment burden: Workers with positive claim experiences have 2.5 times higher odds of returning to work. Each additional assessment, each delay, each adversarial interaction predicts poorer outcomes.
• Administrative delays: Jurisdictional data, to the extent it is available through research, showed 40% wait more than 10 days for treatment approvals. While waiting, imaging gets ordered, medications prescribed, fear grows.

Why individual interventions struggle

QBE Insurance’s experiments with GP remuneration and clinical support represent exactly the thinking we need - creating new channels within constraints. But as discovered, even well-funded interventions struggle against the current.

Decades of upstream pressures have carved channels that individual programs can't easily redirect. This isn't failure - it's recognition that system problems need system solutions.

Our series has been documenting these patterns with evidence. Recent articles have examined how imaging creates disability, why assessment processes delay recovery, and how young workers are particularly vulnerable to these cascades. We're not prescribing solutions - we're making visible what's happening so stakeholders can see clearly.

The opportunity in honesty

Most injured workers receive appropriate care and recover well. But for a significant minority -perhaps 20-30% - healthcare becomes part of the problem. These cases consume disproportionate resources and represent most of the human suffering in our systems.

David challenges our colleagues across healthcare, academia, and compensation: "Come on - we can and must do better on this problem!"

Yes. And the first step is acknowledging what we're all seeing. The question isn't whether healthcare in workers' compensation can cause harm. The evidence is clear. The question is whether we'll use what we know to create genuine change.