Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia.
Australian Centre for Justice Innovation, Faculty of Law, Monash University, Wellington Road, Clayton, Victoria, 3770, Australia.
BMC Public Health. 2019 Jul 10;19(1):927. doi: 10.1186/s12889-019-7251-x.
Insurance claims management practices may have a significant impact on the health and experiences of injured workers claiming in workers' compensation systems. There are few multi-jurisdictional studies of the way workers experience compensation processes, and limited data on the association between claims experience and return to work outcomes. This study sought to identify worker, claim and injury related factors associated with injured worker experiences of workers' compensation claims management processes, and to examine associations between claims experience and return to work.
A national, cross-sectional survey of injured workers involved in ten Australian workers' compensation schemes. A total of 10,946 workers completed a telephone survey at 6 to 24 months post claim acceptance. Predictors of positive or negative/neutral claims experience were examined using logistic regression. Associations between claims experience, return to work status and duration of time loss were examined using logistic regression.
Nearly one-quarter (23.0%, n = 2515) of workers reported a negative or neutral claims experience. Injury type, jurisdiction of claim, and time to lodge claim were most strongly associated with claims experience. Having a positive claims experience was strongly associated with having returned to work after accounting for injury, worker, claim and employer factors.
There is a strong positive association between worker experiences of the insurance claims process and self-reported return to work status. Revision and reform of workers' compensation claims management practices to enhance worker experience and the fairness of procedures may contribute to improved return to work outcomes.
保险理赔管理实践可能对工人赔偿系统中受伤工人的健康和体验产生重大影响。很少有关于工人在赔偿过程中的体验的多司法管辖区研究，也缺乏关于理赔体验与重返工作岗位结果之间关联的有限数据。本研究旨在确定与受伤工人在工人赔偿理赔管理过程中的体验相关的工人、理赔和伤害相关因素，并检验理赔体验与重返工作岗位之间的关联。
对参与澳大利亚十个工人赔偿计划的受伤工人进行全国性、横断面调查。共有 10946 名工人在理赔受理后 6 至 24 个月通过电话调查完成了调查。使用逻辑回归检验了积极或消极/中性理赔体验的预测因素。使用逻辑回归检验了理赔体验、重返工作岗位状况和损失时间持续时间之间的关联。
近四分之一（23.0%，n=2515）的工人报告了消极或中性的理赔体验。受伤类型、理赔管辖范围和提出理赔的时间与理赔体验最密切相关。在考虑了受伤、工人、理赔和雇主因素后，有积极理赔体验与重返工作岗位有很强的关联。
工人对保险理赔流程的体验与自我报告的重返工作岗位状况之间存在很强的正相关关系。对工人赔偿理赔管理实践进行修订和改革，以增强工人的体验和程序的公平性，可能有助于改善重返工作岗位的结果。
