Rehabilitation and return to work of employers' liability claimants.

Examination of employers' liability (workers' compensation) claims files confirms that accidents at work, resulting in major injury, continue to present a significant challenge to rehabilitation. This review of 209 patients who have pursued such claims describes them from relevant socio-economic, clinical and occupational perspectives; records their return to work; examines medical opinion on their residual disabilities and potential occupational handicap and traces their involvement with rehabilitation and resettlement services. A major finding is an interval of almost two years, on average, between patients' discharge from medical treatment and settlement of their claims. Given the severity of injuries, length of absences from work and the relatively high proportions who either lost their jobs or who were advised to seek less physically demanding alternative occupations, the rate of referral to specialist vocational rehabilitation services during this period was very low. Timely and effective delivery of relevant rehabilitation and resettlement services to such patients should be made a priority for future policy and practice. One half of the sample returned to work before settlement, with more who were unsuccessful in their attempts to do so. The adversarial climate of personal injury claims negotiation in Great Britain therefore may be a less formidable barrier to return to work than is sometimes supposed. Nevertheless, conventional practices and procedures in medicine, law and insurance may still delay or prevent resettlement in some cases. Any attempt to enhance the effectiveness of the present medicolegal system should pay at least as much attention to these iatrogenic factors as to the psychological explanations that have dominated previous thinking on this subject.