Regulators and insurers can ensure a healthy scheme being one which provides:
- Leadership: positive psychosocial influences on claims are promoted in legislation, standards, culture, scheme oversight and delivery and dispute systems.
- Collaboration: integration and collaboration between healthcare, workplace accommodation and case management.
- Fairness: workers who perceive they have been treated fairly have better outcomes
- Health of workers: treatment needs to be evidence-based and workers require access to appropriate, timely, high quality care.
- Active and responsive case management: individuals need to be supported and managed fairly, in a timely manner and proactively
- Effective communication: positive communication between stakeholders improve return to work outcomes and reduce costs.
- Long term thinking: enables a focus on evidence informed practice and promotes a more sustainable personal injury industry.
Regulators and insurers influence the culture, attitudes and behaviour of work injury schemes via their approaches, communication styles, and policies and procedures. Policy settings and approaches can improve collaboration and cooperation by enhancing workforce skills and scheme interactions. When all players work towards a shared goal, return to work is more likely.
Methods to encourage positive behaviours, trust and cooperation in schemes include:
- Stated principles and expectations of standards of service such as being fair, treating others with respect, and being reasonable, efficient, proactive, responsive, transparent and accountable;
- Measuring claimants’ experiences, including factors that influence recovery and return to work and scheme culture and levels of trust between participants;
- Adopting a biopsychosocial approach to the management of claims
- Transparent sharing of scheme data;
- An explicit focus on engagement, via an explicit stakeholder strategy, outreach, conferences or meetings that bring different scheme participants together; and
- Avoidance of unnecessary delays, particularly with initial claim notifications, and unnecessary disputes.