Claimants’ perceptions of fair treatment linked to lower odds of poor mental health

IWH study found claimants who said case managers treated them with dignity, and gave them needed information, had lower risks of psychological distress

Published: November 5, 2019

In recent years, several studies have suggested that being physically injured at work and making a workers’ compensation claim may give rise to poorer mental health. However, little is known about what part of the claims process may be contributing to worsening mental health.

A new study by the Institute for Work & Health (IWH) now suggests that claimants’ perceptions of fairness in their interactions with case managers are an important factor affecting their mental well-being.

The study, which examined the experiences of workers’ compensation claimants for 12 months, focused on the extent to which claimants felt they were treated with dignity and respect by their case managers and were given the information they needed.

We’ve seen in past studies that certain elements of the workers’ compensation process are linked with claimants’ mental health, says Christa Orchard, lead author of the study, which was published in July in the Journal of Occupational Rehabilitation (

This study highlights the fact that the information provided by claims agents—as well as the tone they use in interactions with claimants—are two things that can be improved to the benefit of injured workers’ mental health, adds Orchard, a PhD candidate in epidemiology at the University of Toronto. She completed this work as part of a summer practicum at IWH, working with Senior Scientist and Scientific Co-Director Dr. Peter Smith.

12-month follow-up

For her study, Orchard turned to data collected by a research team based in Victoria, Australia. It looked at a group of injured workers who had made a workers’ compensation claim for a musculoskeletal injury. In Victoria, where 85 per cent of the workforce is covered by WorkSafe Victoria, people who miss 10 or more days of work due to a work-related injury are eligible for compensation. Their claims are assessed and managed by one of five claims-agent organizations, as determined by their workplace insurance provider.

The claimants in this study were interviewed by phone three times over a 12-month period in 2014-2015. Due to the time it took for claims to be processed and for claimants to then be recruited into the study, claimants were typically interviewed for the first time about three or four months after they were injured. The second and third interviews were held about six and 12 months after the first.

Nearly 600 claimants were asked about a broad range of outcomes. Orchard’s study focused on claimants’ assessments of their interactions with claims agents (also known as case managers) and of their own mental health.

With respect to interactions with claims agents, claimants were asked to indicate, on a five-point scale, the degree to which they agreed or disagreed with seven statements about their case managers. They were asked whether their case managers:

  • treated them in a polite manner;
  • treated them with respect and dignity;
  • provided the information needed;
  • were open and truthful in communications;
  • explained the return-to-work process carefully and completely;
  • communicated details at appropriate times; and
  • seemed to consider their specific needs in communicating with them.

(This work builds on a 2009 IWH studydoi:10.1007/s12207-009-9053-4—that found low fairness scores on these questions were linked to a lower likelihood of claim acceptance, greater delay before a claim decision, and greater likelihood that claimants believed they were back at work too soon and their accommodation period was too short.)

With regards to their mental health, claimants were asked—in all three interviews—how often in the previous 30 days they experienced six symptoms associated with psychological distress (i.e. feeling nervous, hopeless, restless, worthless, so depressed that nothing cheers them up and like everything is an effort). These questions came from the Kessler psychological distress scale, which provides a five-point range for each item—from 0 for none of the time to 4 for all of the time. The Kessler scale considers a total score of 13 or more as indication of a serious mental health issue.

Interview results suggest the vast majority of claimants felt they were treated fairly by case managers, both interpersonally (around 90 per cent) and in getting the information they needed (75 to 85 per cent). However, those who felt they were treated unfairly were more likely to indicate having a serious mental health issue—and the greater the degree of perceived unfairness, the greater the likelihood of indicating poor mental health.

On questions of interpersonal fairness, a one-point change for the worse in the mean score (on a five-point scale) was linked to a 28 per cent greater likelihood of claimants indicating poor mental health. On informational fairness, each one-point change for the worse was linked to a 20 per cent greater likelihood of poor mental health. The effect of perceived injustice on mental health at baseline persisted, to a lesser degree, six and 12 months down the road.

We’ve seen growing evidence that perceived injustice in the experience of claiming for compensation for a work-related injury may contribute to worsening mental health. This study points to two areas that should be targeted for improvement: treating claimants with respect and providing them with the right information at the right time, says Orchard.

We think that most workers’ compensation service providers would want claimants to agree they were treated well in their interactions with case managers. It’s not an unachievable goal, adds Smith. If service providers can ensure that people will reply positively to the questions asked in the interview, based on our results, it would lead to meaningful reductions in the prevalence of psychological distress among people whose injuries are primarily physical in nature.