September 26, 2024 • 28 mins
When people go through Worker's Compensation, or any insurance claim, they are assigned a Case Manager (sometimes called a Claims Manager). Together, the injured worker and the Case Manager are supposed to work through the process together to see a healthier worker return to the workforce.
So what's it like being a Case Manager, what are the pressures and how do they see working with injured workers?
In this episode, Dr Caroline Howe is in conversation with Alicia Gibbs, who has a long history as a Rehabilitation Expert and also a Case Manager, who also trains Case Managers. Her insights give us an understanding that we otherwise don't get access to.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
S1 (00:01):
Hello and welcome to the My Social Support Network podcast,
a series to guide you along the path to recovery
while on workers compensation. In this series, we will answer
questions from you and provide information from experts and people
with lived experience currently going through worker's compensation and those
who have made their way to the other side. Through
these interactions, we'll be giving you tools, advice, but most importantly,
(00:24):
encouragement on what can be a stressful time when you're
also recovering from an injury sustained in your workplace.
S2 (00:30):
Whilst it's not the responsibility of the unwell or the
injured person or claim, often the person that's managing your
claim is responsible for a lot of different people and
they're being pushed in different directions. The role of a
case manager a claims assessor is hard.
S3 (00:46):
Today we're talking to Alicia Gibbs, who has been a
rehabilitation counsellor for a long time. Not as long as me,
but a long time. Our curiosity in speaking with her
is to get the perspective of what's life like on
the insurance side to be able to understand why holistic
perspectives in helping people return back to work are really important.
(01:07):
And also, if there was one thing that she could change,
what would that be? Alicia, thank you for coming today
to to have a chat to us. The reason that
I was so excited about talking to you is that
for start, you have been in the rehab industry for
a very long time, and there are a few people
that stick to this industry as well as try and
(01:31):
make it better. So I'm really curious on not only
your thoughts about how we could make rehab better, but
from that perspective of what you've seen, change over time,
what things you think are great and you had this
incredible step into this wellness space for yourself. Tell us
(01:51):
a little bit about your background, and then we'll fly
into an incredible array of questions.
S2 (01:58):
Love it. Happy to help. So all good.
S3 (02:00):
So tell us a little bit about how you have
sustained your enthusiasm for rehabilitation and injury recovery or illness
recovery for so long.
S2 (02:11):
I think I really kind of fell in love with, um,
and fell in love with and got a buzz out of, uh,
helping people when other help starts to move away. So
I always talk about rehabilitation counselors coming in at that
third tertiary stage of rehabilitation. Right. So somebody had a
(02:33):
car accident. They're in hospital. It's very acute. Uh, then
maybe they've had surgery and they've had their physiotherapy, but
their life might look completely different than how it did before.
And as this other support starts to move away, that's
when rehabilitation counselors shine because they come in and go, what?
(02:56):
What does life look like now for you and let's
navigate and work through this change. So I really enjoy
the time that I've spent doing adjustment to disability counseling.
So what's the new normal? What does that look like?
And why can't that be as fantastic as what life
(03:17):
was like before? Why is different worse? Why can't different
be the same or better? So from there, um, you know,
from a rehabilitation counseling perspective and, um, my journey, naturally,
I have ended up spending a lot of time in
the mental health and wellbeing space. Um, and so that
(03:39):
has been quite a journey as well, understanding, you know, how, uh,
whilst we're very much trained in vocational counseling and work
and supporting people to return to work, um, the view
that I've now landed on is that Unless you are well,
whether that's physical or mental, regardless of what your actual
(04:04):
medical condition is, the happier and better you will be
at work and in life. So I've really come to
quite a holistic place as far as what rehabilitation counseling
is and what it looks like in practice, and have
spent some time to navigating the challenges of the different
insurance schemes as well.
S3 (04:24):
Know you know what I loved? Absolutely loved about what
you said. And this comes up a lot. Why can't
different be better? And you and I would see that
from sitting outside the impact of an injury. We can
see that journey of this was life. Here is a
big event at a crushing event that that I always
(04:46):
have explained it like a jigsaw puzzle. You had a
perfect jigsaw puzzle in your mind. The event comes in,
it smashes it to pieces, and then you have to
put that back together and it will not look the same,
but it doesn't have to be worse than before it started.
But it will be different. And I love that you're
speaking that language, because I fail to see a lot
(05:09):
of that when we work in the various schemes. As
far as what good looks like, there's this real pressure
to try and get people back to the way it was,
and it doesn't exist. I mean, if it did, they
wouldn't end up with rehab counsellors acknowledging that is just fantastic.
If you, you know, had that magic crystal ball to
(05:32):
look at, what would be one thing that would make
our job easier?
S2 (05:37):
Um, that's a great question. Sometimes, you know, the product
or the insurance policy is actually at the detriment to
the individual. Um, so I think that we know that
work is good for us. Work is good. Uh, even
if it is a few days or a few hours
a week, we know and are kind of moving away.
(06:00):
And one of the big changes I've seen is that,
you know, rest is good for you and you need
to rest to recover. Now, I'm not suggesting that if
you broke your leg yesterday, you're going out dancing tomorrow,
but at the end of the day, that movement and
and and re-engaging in work and life is really, really important.
(06:22):
And even now we're seeing, you know, post knee replacements,
getting people up and out of bed really quickly. Unfortunately,
a lot of these insurance schemes require individuals to advocate
for their disability. And what happens with the language in
our minds is the more that we we speak or
think about a certain thing, often the more it's amplified.
(06:44):
So if we have to justify why or how we're unwell,
then that can amplify how we're actually feeling and recovering.
So in the income protection space, in life insurance, there's
waiting periods on policies. So for somebody to actually put
in a claim, they have to be completely off work
(07:07):
for a period of time, which varies, you know, and then, um,
part of that return to work process, uh, can be
kind of hampered by how the different insurance products work.
So if I could wave a magic wand and look
at what we could do differently, I think, um, I
(07:27):
would love to actually just throw a lot of the
insurance products that we've got out the window and start again. Um,
over my career, I've been involved in a lot of
different conversations about what should an insurance product look like,
how can we support somebody and their health and wellbeing,
but also, you know, support their income or support them
(07:47):
financially while they're unwell? And I think that's still very, very,
very important. But what we've ended up in is a very,
very complex system where we've added and massaged and shifted
a product that primarily was based on very simple physical
conditions where you have an accident, you fall off a ladder,
(08:08):
you break your ankle and you get better, and you
go back to work in in life insurance and income protection.
The condition doesn't even have to be related to work
or an accident. So, you know, we're supporting people who
have Parkinson's or Ms. or, um, cancer. I'm really actually
trying to move away from even using the word recovery because,
(08:30):
you know, not everybody recovers. But that doesn't mean that
people can't work. And as an example, I remember a
case that I worked on of a lawyer who had Ms..
And we had rehab involved on that claim for a
long time to keep him at work and to work
out what what did it look like practicing law in
a wheelchair? And how much longer could he do that?
(08:53):
But then eventually, as his condition declined, he ceased work.
And that was okay. That's what the product is there for.
But individuals are put in this really awful position where
they're having to advocate for themselves and for their illness
or sickness, which then amplifies that and delays them improving.
(09:14):
So if I could, I would just start again with
a product that focused on first and firstly and foremost,
financial support when somebody's sick or injured. But secondly, um,
better positively, looking at what that journey to cease that
claim looks like.
S3 (09:34):
You're so right. Because as you so rightly acknowledged, I
have been around for quite some time. I now have
to work with clients who were born after I started
in rehab. I can let everybody do the sums on that. But,
you know, even from my perspective, we have with good
intention schemes that were designed and this is across the schemes.
(09:59):
You know, they were designed for physical injury with a
start and a stop, and they were designed to replace
wages and get people back to work. But you're absolutely right.
These schemes have turned into a place where people feel
that they need to justify their injury, and unfortunately, that
(10:20):
is at the top of the list. When you're talking
about a psychological injury or something that you can't see.
So it could be in income protection, it could be
a mental illness episode, or it could be, you know,
post-natal depression. You know, it's something that we can't see.
Whereas if I trip over and I break my leg,
there are really clear guidelines on what best recovery is
(10:40):
and what I have seen over the last 18 months
in my social support network, because we have 99.2% of
our whole portfolio are psychological injury claims there is no
one path of recovery. The cyclical nature of recovery. Collapse. Recovery.
(11:00):
Collapse and there are no structures in place that allow
people to actually try as well as they could without
that fear that I might get chucked out. And that
really becomes problematic because you want people to be brave
and courageous, and the schemes struggle to allow people to
do that.
S2 (11:20):
Even with mental health particularly. And I mentioned before moving
away from the language of recovery or resolve or get better,
you know, 1 in 2 Australians over their lifetime will
have a mental health episode, you know, so it's actually
really common. And, uh, you know, whether it's anxiety, depression, even,
(11:42):
you know, post-traumatic stress disorder, there are hundreds of thousands
of Australians working full time every day with these mental
health conditions. What what we see or what I see
is that life gets hard sometimes. And those environmental factors.
So what I mean by that is, you know, a
relationship breakdown, a death of a close family member, problems
(12:06):
at work absolutely impact that individual who may have had
a diagnosed mental health condition. Or this might be the
first time that they're getting diagnosed with this condition. But
if we're setting an expectation that they need to get
better and not have these symptoms ever again, that's actually
not the reality. What we should be aiming for is
stability and making sure that that symptom management is ongoing
(12:32):
and that we're supporting that individual. So it can be
really challenging to. And speaking as someone who's spent a
lot of time working with people in what we call
the new employer space, so people who are out of work,
I have lots of conversations about, uh, well, how do
I know if this workplace is going to be safe
(12:53):
for my mental health if I haven't stepped into it yet?
How can I actually assess that? And, you know, it's
different for everybody. So, you know, I'm not going to
go into that. But it's sometimes it's about that individual
having those coping mechanisms to actually navigate whatever that workplace is,
rather than seeking a workplace that fits them. But the
(13:16):
system we're in, even the rehab framework isn't necessarily designed
for that. So it's it's a combination of like a
systems thinking approach. How can we change the world around us,
and how can we also have autonomy and control in
what we do to support moving away from being unwell,
whatever that looks like for us? And like you, Carolyn,
(13:39):
I'm sure you've had thousands of conversations with people who go,
I don't want to be out of work. And, and,
you know, beholden to this insurance scheme, whatever that scheme is.
I want to get on with my life and this,
this sense of being stuck. Um, just becomes sort of
overwhelming for people. Uh, and that's, that's really challenging. And
(14:01):
as we know, the longer you're out of work, the
more your mental health is actually going to decline. So
having a period out of the workplace for more than, say,
three months is going to start to really actually impact
you negatively, even if you're doing your best to recover,
taking your medication, seeing your psychologist doing all of those things. Um,
(14:22):
just that lack of structure and routine and a sense
of purpose is really, really challenging.
S3 (14:28):
And, and I think that the disconnection from that community because,
you know, the longer that you're away from people, it
feels like a chasm that just opens up. And it
is a hard, big step to go from this fear
and anxiety and then go, oh, I'll just jump in
and I'll just be at work with people. Why do
(14:49):
you think that insurance thing? Because it's interesting. Because you
have always from a career perspective. Well, in the last
couple of years worked from an insurance perspective. Yeah. I
now have jumped into the provider space. So I've got
a whole new perspective of things that happen. Why do
you think that the perspective of insurers is generally negative,
(15:14):
when what you try and do is help people back
to being feeling supported?
S2 (15:22):
The answer to that, I think, is complex. So there's
a couple of different things that's worth touching on there.
One is capability of the actual individual case manager or
claims assessor. So um, whilst it's not, uh, you know,
the responsibility of the unwell or the injured person on claim.
(15:43):
Often the person that's managing your claim is responsible for
a lot of different people, and they're being pushed in
different directions. From my experience sitting in a claims department,
the role of a case manager or a claims assessor
is hard. In life insurance, they have to calculate complex
financial pieces of information. We work with lots of people
(16:04):
that are self-employed, so it can be quite complicated. They
have to understand literally every single medical medical condition or
pull in support to understand those medical conditions. So what
happens is you become a generalist. You're not a specialist
in any one medical condition because how could you be? Um,
they also have to understand legal frameworks and policies and
(16:27):
how the process works as well. Um, and unfortunately, because
of that spread, it draws lots of different people with
lots of different experience. So then there's a lot of
different capability levels across insurance schemes so people can come
from a call centre background. I've worked with ex-police officers
(16:48):
Ex-lawyers other allied health professionals as well. So these individuals
all have their strengths and weaknesses. Um, so so that's
one thing. The other thing that happens is you get
a lot of staff turnover and burnout in this industry.
So then it's it's unfortunately you're dealing with people who
are always learning. Um, and you don't want to be
(17:09):
the person that's causing that learning to happen. But sometimes
that's the case as as the claimant. So as far
as you know, why insurers see injured workers or unwell
individuals or whatever we want to call them, we call
them in life insurance customers negatively. Um, I would challenge that. Um,
(17:30):
and I would say that because of that lack of capability,
sometimes maybe it feels like that because, um, people have
different strengths and weaknesses. When I moved from occupational rehabilitation
into life insurance, I had that concern. I had a
concern that I was working for the big bad insurance company,
and all I would be doing is working out how
(17:53):
not to pay claims. And I saw my role as
a rehab professional at a life insurer as being the
advocate for the customer. Right now, in the years that
I've worked in insurance, I can tell you 90% of
the time I'm sitting in a room with people working
out how to pay a claim. So often we come
(18:17):
across in life insurance, medical conditions that might not neatly
fit into a box or very subjective symptoms. Or it
might be quite complex what their occupation was. And we're
often working out how how we can support that person,
what that ex-gratia payment might look like or that process. Now,
(18:37):
those conversations that we have in that room sometimes don't
leak out through to that individual customer at the other
end who's receiving that phone call. Hey, your forms are
due on this day. We need this information, otherwise you
won't get paid. Right. So, um, I appreciate that, but
a lot of the time that I'm now spending in
(18:58):
my current job is actually training up claims assessors to
be better in their communication. Um, and I think that's
where that, that potentially that negative perception comes through when
I'm training claims staff and they go, look, you know,
sometimes I'm dealing, I'm speaking to a customer and they're being,
(19:18):
you know, difficult. And I'm putting air quotes there around difficult.
But you know, they're demanding things or they're they're stressed.
I go, yeah, it's a really full on time in
their lives. So it's likely that they're going to be
more anxious and find this process stressful. Right. And the
way I visualize that, I said, it's like you're sitting
(19:39):
there behind the other end of a phone or behind
a computer screen with a big bag of money, and
this person feels like they've got to jump through hoops
to get what they need from you in that moment. Now,
that interaction, unfortunately, just naturally creates conflict. And so it's
about kind of unpacking that. Unfortunately there's also an element
(20:00):
of compassion fatigue. So if you work in a job
where every single day you're speaking to somebody who is very,
very sick, maybe they have cancer, maybe someone in their
family has just died, you know, maybe they've had a
really catastrophic accident. But you're doing that, you know, eight
hours a day, five days a week. Unfortunately, what can
(20:23):
happen is that those case managers start to experience compassion fatigue.
And that's when that lack of empathy drops. One of
the pieces of guidance that I gave to the claim
staff is if you are stopping to care about what
you're doing and how you're supporting your customers, you need
a break. Yeah.
S3 (20:40):
Because when you describe the role, I made a little
mark on my page for every role and three different people,
and that's always been a problem. You know, a finance
person isn't necessarily a wellness person. So if then that
case manager in charge is looking at someone who is
now restructuring and getting their coping mechanisms in place, how
(21:04):
does that then differ from becoming well, and how do
you then become well and then help them either move
forward or how do you help if they have to
move back into that old workplace?
S2 (21:17):
Yeah. So often people want quick solutions, right? So what
we want as as working in a claims department, is
to tick the boxes to pay the customer the money
they need. And, you know, one, two, three, they go
through the process and they go back to work. And
I move on to the next case right now. I
think we can agree that's not the reality. Uh, but
(21:39):
what that forces from a rehab or return to work.
Perspective is wanting very clear black and white. What is
the date? Do you return to work? What is the
job or the duties that you're doing? Um, and what I,
what I would suggest as far as that process to
get well and to recover is, you know, having a
(21:59):
good occupational rehab provider that can actually support that person
in the middle to advocate for them can be really,
really helpful. Um, because it's overwhelming even going back into
the same workplace where, you know, you've worked for a
long time, but you've been out of that work for
six months or 12 months. Often we see or I
(22:19):
see and I would pull up rehab providers on graduated
return to work plans and make sure that the person
was doing meaningful work. Going back in and spending three
weeks catching up on your compliance training, ticking boxes and
watching videos, you know, is that actually good for your
mental health? Do you feel like you're contributing as part
of that return to work process? Um, so yeah, to
(22:42):
answer your question, I think occupational rehab can be really
helpful there. Um, I think just understanding the mindset of
the claims assessor can actually be helpful. Um, you know,
so if I was almost like coaching a person on claim,
I'd say, what do you need to do to satisfy
the requirements of this claim? And can you gather that
(23:03):
information and have your your treaters around you as supports?
And then how can you focus on getting well, and
what are your next steps? And communicating that, you know,
transparently to the insurer? Um, because they want to hear
that you're moving forward, too. And, you know, again, speaking
from the life insurance industry, there are a lot of
different services that we can offer our customers. And it's
(23:26):
not just about return to work. There's a lot of
health and wellbeing offerings now. So even for a mental
health claim, um, you know, you can get exercise physiology
to help you move better and recover. And we know
that exercise is good for mental health. So, you know,
I would very much advocate for people to say, well,
what's included as part of my policy. You know, what
(23:48):
services do you have? You know, I.
S3 (23:50):
Love that you have mentioned that because I think that
there are so many facets to recovery. Mhm. You know,
as a star. But when you mention the compassion fatigue
and case managers, what happens on the side of the insurers.
Because I agree with you 100%. The role of that
claims manager, case manager, whatever title that you know the
various schemes give, it is absolutely critical to the outcome
(24:15):
for someone who has become injured or unwell. If that
is not a good relationship, it falls apart. So if
you now have someone who is very psychologically and physiologically
close to, everything's on edge, right? And it's very easy
to become really reactive to things. And then you have
a case manager who is just as reactive. But the
difference is they haven't put in a claim. So what
(24:37):
happens to support the case managers.
S2 (24:40):
To be honest, I think it's something that the industry
could be doing better. My hope is actually, and this
is a bit left of field, that the technology will
make things easier for claims staff. At the moment they're
having to read a lot of documents. Um, there's a
lot of manual processes, and then there's that human element
of engaging with that unwell person as well. So I
(25:05):
do some of that, that training, um, from a wellbeing perspective. Um,
I do a lot of talk about self-care and, you know,
supporting your own self-care as part of your job. And
that can apply to anyone you know, whether they've been
unwell or off work or not. Um, ultimately, you can't
control that other person if they're not feeling resilient or
(25:28):
they're being short with you on the phone or whatever
it is. Right. Or you can do is have an
awareness of maybe what their day has looked like. maybe
you're the 15th person they've spoke to who has depression
and who's saying they're struggling to get out of bed. Um,
and focus on yourself and your own journey and what
that looks like, rather than getting caught up in the
(25:52):
service that you're receiving and what that looks like.
S3 (25:54):
One of the reasons that I really want to talk
to you is because you had sort of jumped out of,
you know, a structured insurance, and then you were doing
your career in wellbeing. Tell me a little bit about that. Like,
it was the thing that you most wanted to change
by being able to do that.
S4 (26:10):
Mhm.
S2 (26:10):
Yeah. Um so just a little, a little bit of context.
So um, I'd gone through a process of exploration looking
at what that next career move look like for me
and having some sort of I call it career hygiene,
which I think is very valuable and very important. And
I came to the conclusion that the organisation that I
was at didn't have any opportunities that fitted with what
(26:32):
I was passionate about. So there were opportunities, but it
just quite didn't fit. And um, one of the things
that I'd read a lot about that's now come in
place across, I think, most states in Australia, stuff around work,
health and safety legislation around psychosocial risk and looking at
the impact on our mental health of work, the same
(26:53):
way that we look at physical conditions and looking at
ways to better support people in the workplace with their
mental wellbeing, so not their mental health or mental illness,
but just their mental wellbeing at work. And I saw
a real gap around when you've spent a lot of
time working with people who've been unwell and off work
(27:13):
for a really long time, you know, you'd always want
to jump back and go, imagine if I'd met this
person before this had happened. And even if we use
workplace bullying and harassment as an example. Imagine if I'd
worked with this person just as they were experiencing this
toxic workplace. And what could I have done to support
(27:36):
them to not end up being out of work for
two years, which is where I'm talking about finding a
whole different career.
S3 (27:43):
We want to thank Alicia for coming on to the
My Social Support Network podcast today. It's been such an
interesting perspective for me because just seeing it from the
other side, what is it like to be a rehabilitation counselor?
What is it like to experience this world through the
lens of a case manager? And we're really excited because
(28:04):
what we're going to do is we've split this particular
episode in half, and we're going to come back and
talk to Alicia again about burnout. So stay tuned and
get very excited.
S1 (28:14):
While you've been listening, you may have found some of
these concepts challenging, so please reach out to lifeline on
13 1114 Beyondblue on one 302 24636. The 24 hour
mental health access line, which is one 800 015, double one.
Thank you for joining us. And we'll be back next time.
Hello and welcome to the My Social Support Network podcast,
a series to guide you along the path to recovery
while on workers compensation. In this series, we will answer
questions from you and provide information from experts and people
with lived experience currently going through worker's compensation and those
who have made their way to the other side. Through
these interactions, we'll be giving you tools, advice, but most importantly,
(00:24):
encouragement on what can be a stressful time when you're
also recovering from an injury sustained in your workplace.
S2 (00:30):
Whilst it's not the responsibility of the unwell or the
injured person or claim, often the person that's managing your
claim is responsible for a lot of different people and
they're being pushed in different directions. The role of a
case manager a claims assessor is hard.
S3 (00:46):
Today we're talking to Alicia Gibbs, who has been a
rehabilitation counsellor for a long time. Not as long as me,
but a long time. Our curiosity in speaking with her
is to get the perspective of what's life like on
the insurance side to be able to understand why holistic
perspectives in helping people return back to work are really important.
(01:07):
And also, if there was one thing that she could change,
what would that be? Alicia, thank you for coming today
to to have a chat to us. The reason that
I was so excited about talking to you is that
for start, you have been in the rehab industry for
a very long time, and there are a few people
that stick to this industry as well as try and
(01:31):
make it better. So I'm really curious on not only
your thoughts about how we could make rehab better, but
from that perspective of what you've seen, change over time,
what things you think are great and you had this
incredible step into this wellness space for yourself. Tell us
(01:51):
a little bit about your background, and then we'll fly
into an incredible array of questions.
S2 (01:58):
Love it. Happy to help. So all good.
S3 (02:00):
So tell us a little bit about how you have
sustained your enthusiasm for rehabilitation and injury recovery or illness
recovery for so long.
S2 (02:11):
I think I really kind of fell in love with, um,
and fell in love with and got a buzz out of, uh,
helping people when other help starts to move away. So
I always talk about rehabilitation counselors coming in at that
third tertiary stage of rehabilitation. Right. So somebody had a
(02:33):
car accident. They're in hospital. It's very acute. Uh, then
maybe they've had surgery and they've had their physiotherapy, but
their life might look completely different than how it did before.
And as this other support starts to move away, that's
when rehabilitation counselors shine because they come in and go, what?
(02:56):
What does life look like now for you and let's
navigate and work through this change. So I really enjoy
the time that I've spent doing adjustment to disability counseling.
So what's the new normal? What does that look like?
And why can't that be as fantastic as what life
(03:17):
was like before? Why is different worse? Why can't different
be the same or better? So from there, um, you know,
from a rehabilitation counseling perspective and, um, my journey, naturally,
I have ended up spending a lot of time in
the mental health and wellbeing space. Um, and so that
(03:39):
has been quite a journey as well, understanding, you know, how, uh,
whilst we're very much trained in vocational counseling and work
and supporting people to return to work, um, the view
that I've now landed on is that Unless you are well,
whether that's physical or mental, regardless of what your actual
(04:04):
medical condition is, the happier and better you will be
at work and in life. So I've really come to
quite a holistic place as far as what rehabilitation counseling
is and what it looks like in practice, and have
spent some time to navigating the challenges of the different
insurance schemes as well.
S3 (04:24):
Know you know what I loved? Absolutely loved about what
you said. And this comes up a lot. Why can't
different be better? And you and I would see that
from sitting outside the impact of an injury. We can
see that journey of this was life. Here is a
big event at a crushing event that that I always
(04:46):
have explained it like a jigsaw puzzle. You had a
perfect jigsaw puzzle in your mind. The event comes in,
it smashes it to pieces, and then you have to
put that back together and it will not look the same,
but it doesn't have to be worse than before it started.
But it will be different. And I love that you're
speaking that language, because I fail to see a lot
(05:09):
of that when we work in the various schemes. As
far as what good looks like, there's this real pressure
to try and get people back to the way it was,
and it doesn't exist. I mean, if it did, they
wouldn't end up with rehab counsellors acknowledging that is just fantastic.
If you, you know, had that magic crystal ball to
(05:32):
look at, what would be one thing that would make
our job easier?
S2 (05:37):
Um, that's a great question. Sometimes, you know, the product
or the insurance policy is actually at the detriment to
the individual. Um, so I think that we know that
work is good for us. Work is good. Uh, even
if it is a few days or a few hours
a week, we know and are kind of moving away.
(06:00):
And one of the big changes I've seen is that,
you know, rest is good for you and you need
to rest to recover. Now, I'm not suggesting that if
you broke your leg yesterday, you're going out dancing tomorrow,
but at the end of the day, that movement and
and and re-engaging in work and life is really, really important.
(06:22):
And even now we're seeing, you know, post knee replacements,
getting people up and out of bed really quickly. Unfortunately,
a lot of these insurance schemes require individuals to advocate
for their disability. And what happens with the language in
our minds is the more that we we speak or
think about a certain thing, often the more it's amplified.
(06:44):
So if we have to justify why or how we're unwell,
then that can amplify how we're actually feeling and recovering.
So in the income protection space, in life insurance, there's
waiting periods on policies. So for somebody to actually put
in a claim, they have to be completely off work
(07:07):
for a period of time, which varies, you know, and then, um,
part of that return to work process, uh, can be
kind of hampered by how the different insurance products work.
So if I could wave a magic wand and look
at what we could do differently, I think, um, I
(07:27):
would love to actually just throw a lot of the
insurance products that we've got out the window and start again. Um,
over my career, I've been involved in a lot of
different conversations about what should an insurance product look like,
how can we support somebody and their health and wellbeing,
but also, you know, support their income or support them
(07:47):
financially while they're unwell? And I think that's still very, very,
very important. But what we've ended up in is a very,
very complex system where we've added and massaged and shifted
a product that primarily was based on very simple physical
conditions where you have an accident, you fall off a ladder,
(08:08):
you break your ankle and you get better, and you
go back to work in in life insurance and income protection.
The condition doesn't even have to be related to work
or an accident. So, you know, we're supporting people who
have Parkinson's or Ms. or, um, cancer. I'm really actually
trying to move away from even using the word recovery because,
(08:30):
you know, not everybody recovers. But that doesn't mean that
people can't work. And as an example, I remember a
case that I worked on of a lawyer who had Ms..
And we had rehab involved on that claim for a
long time to keep him at work and to work
out what what did it look like practicing law in
a wheelchair? And how much longer could he do that?
(08:53):
But then eventually, as his condition declined, he ceased work.
And that was okay. That's what the product is there for.
But individuals are put in this really awful position where
they're having to advocate for themselves and for their illness
or sickness, which then amplifies that and delays them improving.
(09:14):
So if I could, I would just start again with
a product that focused on first and firstly and foremost,
financial support when somebody's sick or injured. But secondly, um,
better positively, looking at what that journey to cease that
claim looks like.
S3 (09:34):
You're so right. Because as you so rightly acknowledged, I
have been around for quite some time. I now have
to work with clients who were born after I started
in rehab. I can let everybody do the sums on that. But,
you know, even from my perspective, we have with good
intention schemes that were designed and this is across the schemes.
(09:59):
You know, they were designed for physical injury with a
start and a stop, and they were designed to replace
wages and get people back to work. But you're absolutely right.
These schemes have turned into a place where people feel
that they need to justify their injury, and unfortunately, that
(10:20):
is at the top of the list. When you're talking
about a psychological injury or something that you can't see.
So it could be in income protection, it could be
a mental illness episode, or it could be, you know,
post-natal depression. You know, it's something that we can't see.
Whereas if I trip over and I break my leg,
there are really clear guidelines on what best recovery is
(10:40):
and what I have seen over the last 18 months
in my social support network, because we have 99.2% of
our whole portfolio are psychological injury claims there is no
one path of recovery. The cyclical nature of recovery. Collapse. Recovery.
(11:00):
Collapse and there are no structures in place that allow
people to actually try as well as they could without
that fear that I might get chucked out. And that
really becomes problematic because you want people to be brave
and courageous, and the schemes struggle to allow people to
do that.
S2 (11:20):
Even with mental health particularly. And I mentioned before moving
away from the language of recovery or resolve or get better,
you know, 1 in 2 Australians over their lifetime will
have a mental health episode, you know, so it's actually
really common. And, uh, you know, whether it's anxiety, depression, even,
(11:42):
you know, post-traumatic stress disorder, there are hundreds of thousands
of Australians working full time every day with these mental
health conditions. What what we see or what I see
is that life gets hard sometimes. And those environmental factors.
So what I mean by that is, you know, a
relationship breakdown, a death of a close family member, problems
(12:06):
at work absolutely impact that individual who may have had
a diagnosed mental health condition. Or this might be the
first time that they're getting diagnosed with this condition. But
if we're setting an expectation that they need to get
better and not have these symptoms ever again, that's actually
not the reality. What we should be aiming for is
stability and making sure that that symptom management is ongoing
(12:32):
and that we're supporting that individual. So it can be
really challenging to. And speaking as someone who's spent a
lot of time working with people in what we call
the new employer space, so people who are out of work,
I have lots of conversations about, uh, well, how do
I know if this workplace is going to be safe
(12:53):
for my mental health if I haven't stepped into it yet?
How can I actually assess that? And, you know, it's
different for everybody. So, you know, I'm not going to
go into that. But it's sometimes it's about that individual
having those coping mechanisms to actually navigate whatever that workplace is,
rather than seeking a workplace that fits them. But the
(13:16):
system we're in, even the rehab framework isn't necessarily designed
for that. So it's it's a combination of like a
systems thinking approach. How can we change the world around us,
and how can we also have autonomy and control in
what we do to support moving away from being unwell,
whatever that looks like for us? And like you, Carolyn,
(13:39):
I'm sure you've had thousands of conversations with people who go,
I don't want to be out of work. And, and,
you know, beholden to this insurance scheme, whatever that scheme is.
I want to get on with my life and this,
this sense of being stuck. Um, just becomes sort of
overwhelming for people. Uh, and that's, that's really challenging. And
(14:01):
as we know, the longer you're out of work, the
more your mental health is actually going to decline. So
having a period out of the workplace for more than, say,
three months is going to start to really actually impact
you negatively, even if you're doing your best to recover,
taking your medication, seeing your psychologist doing all of those things. Um,
(14:22):
just that lack of structure and routine and a sense
of purpose is really, really challenging.
S3 (14:28):
And, and I think that the disconnection from that community because,
you know, the longer that you're away from people, it
feels like a chasm that just opens up. And it
is a hard, big step to go from this fear
and anxiety and then go, oh, I'll just jump in
and I'll just be at work with people. Why do
(14:49):
you think that insurance thing? Because it's interesting. Because you
have always from a career perspective. Well, in the last
couple of years worked from an insurance perspective. Yeah. I
now have jumped into the provider space. So I've got
a whole new perspective of things that happen. Why do
you think that the perspective of insurers is generally negative,
(15:14):
when what you try and do is help people back
to being feeling supported?
S2 (15:22):
The answer to that, I think, is complex. So there's
a couple of different things that's worth touching on there.
One is capability of the actual individual case manager or
claims assessor. So um, whilst it's not, uh, you know,
the responsibility of the unwell or the injured person on claim.
(15:43):
Often the person that's managing your claim is responsible for
a lot of different people, and they're being pushed in
different directions. From my experience sitting in a claims department,
the role of a case manager or a claims assessor
is hard. In life insurance, they have to calculate complex
financial pieces of information. We work with lots of people
(16:04):
that are self-employed, so it can be quite complicated. They
have to understand literally every single medical medical condition or
pull in support to understand those medical conditions. So what
happens is you become a generalist. You're not a specialist
in any one medical condition because how could you be? Um,
they also have to understand legal frameworks and policies and
(16:27):
how the process works as well. Um, and unfortunately, because
of that spread, it draws lots of different people with
lots of different experience. So then there's a lot of
different capability levels across insurance schemes so people can come
from a call centre background. I've worked with ex-police officers
(16:48):
Ex-lawyers other allied health professionals as well. So these individuals
all have their strengths and weaknesses. Um, so so that's
one thing. The other thing that happens is you get
a lot of staff turnover and burnout in this industry.
So then it's it's unfortunately you're dealing with people who
are always learning. Um, and you don't want to be
(17:09):
the person that's causing that learning to happen. But sometimes
that's the case as as the claimant. So as far
as you know, why insurers see injured workers or unwell
individuals or whatever we want to call them, we call
them in life insurance customers negatively. Um, I would challenge that. Um,
(17:30):
and I would say that because of that lack of capability,
sometimes maybe it feels like that because, um, people have
different strengths and weaknesses. When I moved from occupational rehabilitation
into life insurance, I had that concern. I had a
concern that I was working for the big bad insurance company,
and all I would be doing is working out how
(17:53):
not to pay claims. And I saw my role as
a rehab professional at a life insurer as being the
advocate for the customer. Right now, in the years that
I've worked in insurance, I can tell you 90% of
the time I'm sitting in a room with people working
out how to pay a claim. So often we come
(18:17):
across in life insurance, medical conditions that might not neatly
fit into a box or very subjective symptoms. Or it
might be quite complex what their occupation was. And we're
often working out how how we can support that person,
what that ex-gratia payment might look like or that process. Now,
(18:37):
those conversations that we have in that room sometimes don't
leak out through to that individual customer at the other
end who's receiving that phone call. Hey, your forms are
due on this day. We need this information, otherwise you
won't get paid. Right. So, um, I appreciate that, but
a lot of the time that I'm now spending in
(18:58):
my current job is actually training up claims assessors to
be better in their communication. Um, and I think that's
where that, that potentially that negative perception comes through when
I'm training claims staff and they go, look, you know,
sometimes I'm dealing, I'm speaking to a customer and they're being,
(19:18):
you know, difficult. And I'm putting air quotes there around difficult.
But you know, they're demanding things or they're they're stressed.
I go, yeah, it's a really full on time in
their lives. So it's likely that they're going to be
more anxious and find this process stressful. Right. And the
way I visualize that, I said, it's like you're sitting
(19:39):
there behind the other end of a phone or behind
a computer screen with a big bag of money, and
this person feels like they've got to jump through hoops
to get what they need from you in that moment. Now,
that interaction, unfortunately, just naturally creates conflict. And so it's
about kind of unpacking that. Unfortunately there's also an element
(20:00):
of compassion fatigue. So if you work in a job
where every single day you're speaking to somebody who is very,
very sick, maybe they have cancer, maybe someone in their
family has just died, you know, maybe they've had a
really catastrophic accident. But you're doing that, you know, eight
hours a day, five days a week. Unfortunately, what can
(20:23):
happen is that those case managers start to experience compassion fatigue.
And that's when that lack of empathy drops. One of
the pieces of guidance that I gave to the claim
staff is if you are stopping to care about what
you're doing and how you're supporting your customers, you need
a break. Yeah.
S3 (20:40):
Because when you describe the role, I made a little
mark on my page for every role and three different people,
and that's always been a problem. You know, a finance
person isn't necessarily a wellness person. So if then that
case manager in charge is looking at someone who is
now restructuring and getting their coping mechanisms in place, how
(21:04):
does that then differ from becoming well, and how do
you then become well and then help them either move
forward or how do you help if they have to
move back into that old workplace?
S2 (21:17):
Yeah. So often people want quick solutions, right? So what
we want as as working in a claims department, is
to tick the boxes to pay the customer the money
they need. And, you know, one, two, three, they go
through the process and they go back to work. And
I move on to the next case right now. I
think we can agree that's not the reality. Uh, but
(21:39):
what that forces from a rehab or return to work.
Perspective is wanting very clear black and white. What is
the date? Do you return to work? What is the
job or the duties that you're doing? Um, and what I,
what I would suggest as far as that process to
get well and to recover is, you know, having a
(21:59):
good occupational rehab provider that can actually support that person
in the middle to advocate for them can be really,
really helpful. Um, because it's overwhelming even going back into
the same workplace where, you know, you've worked for a
long time, but you've been out of that work for
six months or 12 months. Often we see or I
(22:19):
see and I would pull up rehab providers on graduated
return to work plans and make sure that the person
was doing meaningful work. Going back in and spending three
weeks catching up on your compliance training, ticking boxes and
watching videos, you know, is that actually good for your
mental health? Do you feel like you're contributing as part
of that return to work process? Um, so yeah, to
(22:42):
answer your question, I think occupational rehab can be really
helpful there. Um, I think just understanding the mindset of
the claims assessor can actually be helpful. Um, you know,
so if I was almost like coaching a person on claim,
I'd say, what do you need to do to satisfy
the requirements of this claim? And can you gather that
(23:03):
information and have your your treaters around you as supports?
And then how can you focus on getting well, and
what are your next steps? And communicating that, you know,
transparently to the insurer? Um, because they want to hear
that you're moving forward, too. And, you know, again, speaking
from the life insurance industry, there are a lot of
different services that we can offer our customers. And it's
(23:26):
not just about return to work. There's a lot of
health and wellbeing offerings now. So even for a mental
health claim, um, you know, you can get exercise physiology
to help you move better and recover. And we know
that exercise is good for mental health. So, you know,
I would very much advocate for people to say, well,
what's included as part of my policy. You know, what
(23:48):
services do you have? You know, I.
S3 (23:50):
Love that you have mentioned that because I think that
there are so many facets to recovery. Mhm. You know,
as a star. But when you mention the compassion fatigue
and case managers, what happens on the side of the insurers.
Because I agree with you 100%. The role of that
claims manager, case manager, whatever title that you know the
various schemes give, it is absolutely critical to the outcome
(24:15):
for someone who has become injured or unwell. If that
is not a good relationship, it falls apart. So if
you now have someone who is very psychologically and physiologically
close to, everything's on edge, right? And it's very easy
to become really reactive to things. And then you have
a case manager who is just as reactive. But the
difference is they haven't put in a claim. So what
(24:37):
happens to support the case managers.
S2 (24:40):
To be honest, I think it's something that the industry
could be doing better. My hope is actually, and this
is a bit left of field, that the technology will
make things easier for claims staff. At the moment they're
having to read a lot of documents. Um, there's a
lot of manual processes, and then there's that human element
of engaging with that unwell person as well. So I
(25:05):
do some of that, that training, um, from a wellbeing perspective. Um,
I do a lot of talk about self-care and, you know,
supporting your own self-care as part of your job. And
that can apply to anyone you know, whether they've been
unwell or off work or not. Um, ultimately, you can't
control that other person if they're not feeling resilient or
(25:28):
they're being short with you on the phone or whatever
it is. Right. Or you can do is have an
awareness of maybe what their day has looked like. maybe
you're the 15th person they've spoke to who has depression
and who's saying they're struggling to get out of bed. Um,
and focus on yourself and your own journey and what
that looks like, rather than getting caught up in the
(25:52):
service that you're receiving and what that looks like.
S3 (25:54):
One of the reasons that I really want to talk
to you is because you had sort of jumped out of,
you know, a structured insurance, and then you were doing
your career in wellbeing. Tell me a little bit about that. Like,
it was the thing that you most wanted to change
by being able to do that.
S4 (26:10):
Mhm.
S2 (26:10):
Yeah. Um so just a little, a little bit of context.
So um, I'd gone through a process of exploration looking
at what that next career move look like for me
and having some sort of I call it career hygiene,
which I think is very valuable and very important. And
I came to the conclusion that the organisation that I
was at didn't have any opportunities that fitted with what
(26:32):
I was passionate about. So there were opportunities, but it
just quite didn't fit. And um, one of the things
that I'd read a lot about that's now come in
place across, I think, most states in Australia, stuff around work,
health and safety legislation around psychosocial risk and looking at
the impact on our mental health of work, the same
(26:53):
way that we look at physical conditions and looking at
ways to better support people in the workplace with their
mental wellbeing, so not their mental health or mental illness,
but just their mental wellbeing at work. And I saw
a real gap around when you've spent a lot of
time working with people who've been unwell and off work
(27:13):
for a really long time, you know, you'd always want
to jump back and go, imagine if I'd met this
person before this had happened. And even if we use
workplace bullying and harassment as an example. Imagine if I'd
worked with this person just as they were experiencing this
toxic workplace. And what could I have done to support
(27:36):
them to not end up being out of work for
two years, which is where I'm talking about finding a
whole different career.
S3 (27:43):
We want to thank Alicia for coming on to the
My Social Support Network podcast today. It's been such an
interesting perspective for me because just seeing it from the
other side, what is it like to be a rehabilitation counselor?
What is it like to experience this world through the
lens of a case manager? And we're really excited because
(28:04):
what we're going to do is we've split this particular
episode in half, and we're going to come back and
talk to Alicia again about burnout. So stay tuned and
get very excited.
S1 (28:14):
While you've been listening, you may have found some of
these concepts challenging, so please reach out to lifeline on
13 1114 Beyondblue on one 302 24636. The 24 hour
mental health access line, which is one 800 015, double one.
Thank you for joining us. And we'll be back next time.
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