Recovery through work measurement framework

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Introduction

The Recovery through work measurement framework (the framework) outlines a multifaceted approach to measure recovery, as it relates to work, for all people injured on the roads or in the workplace.

This includes measuring the journey of people who, after sustaining an injury, stay at work (SAW) to recover, those who leave work and later return to work (RTW) and those that seek new employment opportunities during and/or following their recovery.

The framework reflects the complexity of the recovery process and the many factors that interact to influence a worker’s recovery through work. It includes:

lead indicators (modifiable factors that influence whether work outcomes are achieved)
lag indicators (work outcomes)
technical details used for designing metrics (parameters) of each measure.

The framework prioritises the most important modifiable factors when designing the new measures. These new measures will enable proactive identification and evaluation of:

emerging trends
potential risks and opportunities for improvement across the personal injury schemes
performance of the scheme
performance of the entities SIRA regulates, specifically insurer performance using both lead and lag Recovery through work indicators
matters for regulatory response
the impact of regulatory efforts to improve system outcomes such as the recovery through work strategy

All measures in the framework are based on current evidence of modifiable factors that influence an injured person's recovery at work, including both lead and lag indicators.

This guideline is available to download Recovery through work measurement framework - PDF

Rationale for the recovery at work measurement framework

SIRA’s approach to recovery through work measurement is based on:

recovery through work obligations in NSW personal injury insurance legislation
evidence of modifiable factors that positively influence recovery at work
stakeholder feedback on the issues that most influence recovery through work
Safe Work Australia National Return to Work Strategy 2020-2030 and measurement framework.

Recovery through work is a key object of the Legislation

The objective of the workers compensation system is set out in section 3 of the Workplace Injury Management and Workers Compensation Act 1998. It is “to establish a workplace injury management and workers compensation system with the following objectives:

a) to assist in securing the health, safety and welfare of workers and in particular preventing work-related injury

b) to provide -

prompt treatment of injuries
effective and proactive management of injuries
necessary medical and vocational rehabilitation following injuries, in order to assist injured workers and to promote their return to work as soon as possible
and to promote their return to work as soon as possible

c) to provide injured workers and their dependents with income support during incapacity, payment for permanent impairment or death, and payment for reasonable treatment and other related expenses

d) to be fair, affordable, and financially viable

e) to ensure contributions by employers are commensurate with the risks faced, taking into account strategies and performance in injury prevention, injury management, and return to work

f) to deliver the above objectives efficiently and effectively.”

Similarly, section 1.3, Division 1.1 of the Motor Accident Injuries Act 2017, outlines its objectives in relation to return to work. They are (in part):

a) “to encourage early and appropriate treatment and care to achieve optimum recovery of persons from injuries sustained in motor accidents and to maximise their return to work or other activities

b) that participants in the third-party insurance scheme have shared and integrated roles with the overall aim of benefiting all members of the motoring public by keeping the overall costs of the scheme within reasonable bounds so as to keep premiums affordable and of promoting the recovery and return to work or other activities of those injured in motor accidents.”

Evidence

Return to work outcomes are influenced by many factors. Measuring modifiable factors act as indicators of RTW performance.

The following provides an evidence summary of the modifiable factors that contribute to positive recovery at work outcomes¹.

Coordinated multi-domain intervention

Evidence indicates that there are multiple factors across four key domains - personal, workplace, healthcare, insurance and compensation - that work together to influence RTW outcomes for an individual worker. This is based on the Sherbrooke Model of Work Disability² developed specifically for RTW research and practice in the context of Australian workers compensation systems³.

There is strong evidence that interventions across at least two domains significantly reduce time away from work following an injury⁴. Coordination and collaboration between all stakeholders involved in supporting the worker to recover at work is necessary to align expectations, develop a common goal and plan, and optimise outcomes.

RTW improves when the process is planned and the actions of the worker, the workplace and external parties are coordinated.

Personal domain

The personal domain includes biological, psychological, behavioural and social factors as they relate to the worker.

Modifiable personal factors known to influence RTW include:

self-efficacy – workers with greater belief in their ability to achieve goals have better RTW
recovery expectations – workers with stronger expectations of recovery have better RTW
perceived work ability – lower perceived work ability is associated with worse RTW outcomes
pain catastrophising – workers who describe a pain experience in exaggerated terms, ruminate on or feel helpless, or avoid situations, have worse RTW outcomes
concern about making a claim – a positive response from a worker’s supervisor is associated with a durable or sustainable RTW³

Worker perception of whether their experience with their employer was positive during the RTW process is one of the most significant influences on RTW outcomes⁵.

Workplace domain

The workplace domain considers the working environment, relationships, design, support systems and how a workplace accommodates RTW.

Modifiable factors in the workplace domain that SIRA will measure include:

provision of early workplace contact and support (positive workplace culture)
timely injury notification
RTW planning
provision of suitable employment to recover at work
RTW programs
promoting the health benefits of good work
setting expectations of recovery amongst staff and injured workers

Early contact with the worker after injury provides the opportunity to demonstrate genuine concern, understand their situation and circumstances, and identify options for appropriate support including recovery at work.

Insurance and compensation domain

This domain includes claims agents, insurers, regulatory authorities and other government and non-government agencies. There is moderate to strong evidence for RTW factors considered readily modifiable in the insurance and compensation system domain including administrative timeframes and perceived insurer experience. The modifiable factors include:

prompt liability decisions and prompt benefit payments (early intervention)
disputation rate
current injury management (recovery) plan (tailored, person centred planning)
perceived injustice
biopsychosocial approach
worker empowerment (ownership)
aligned expectations
positive experience with the insurer^e.

Current evidence-informed claims management frameworks promote a tailored, person-centric claims management approach characterised by a biopsychosocial approach to understand the workers’ circumstances, identify barriers to desired outcomes and provide appropriate support for the worker as well as the worker having ownership of RTW goals and outcomes.

Healthcare domain

The healthcare domain includes the provision of treatment and rehabilitation to facilitate recovery from injury. The following modifiable factors in the healthcare domain have moderate to strong evidence of an influence on RTW:

evidence based medical utilisation (a high level of medical intervention is associated with a negative influence on RTW outcome⁶)
psychological counselling and treatment utilisation
encourage evidence-based views about health and work (simple messages delivered in a clinical environment⁷)
RTW focused treatment
application of the clinical framework (including using the biopsychosocial approach, setting goals and active participation and empowering the worker to manage their own injury)
positive contact between the employer and treatment provider.

Stakeholder consultation

During 2020 SIRA sought stakeholder feedback about measuring RTW via responses to a discussion paper and virtual roundtable sessions.

Outcome measures (lag indicators)

Feedback included consensus as to the merits of measuring work participation using SIRA’s outcome measures (lag indicators) based on ‘work status code’.

Lead indicators

Key factors (lead indicators) identified by stakeholders for influencing RTW outcomes included:

workplace factors - interactions between the worker and employer (particularly with psychological injury claims), availability of suitable work, workplace culture and environment
health and related factors - nominated treating doctors setting expectations of recovery, effective use of workplace rehabilitation and other providers
personal factors - worker’s experience with the claims process, nature of injury and related aspects, worker’s financial background, experience and skills, psychosocial factors and support structures
claims management factors - triaging/risk classification of claims, effective injury/case management, liability acceptance and timeliness of claim decisions, disputes leading to the involvement of lawyers in the claims process.

The consultation findings are closely aligned to the evidence and demonstrate the multifactorial aspects of RTW. RTW cannot be measured using a single measure.

Safe Work Australia’s National RTW Strategy and measurement framework

The Safe Work Australia (SWA) National RTW measurement framework outlines how SWA will measure the success of the National Return to Work Strategy 2020-2030.

SIRA’s measurement framework is aligned with the national framework and the evidence SWA used to develop its framework.

Recovery through work outcome measurement framework

Figure 1 provides a summary of the Recovery through work measurement framework. It includes:

A person’s injury journey – the journey is broken into three phases: prior to injury, early intervention, and ongoing recovery
Lead indicators are linked to the phases in the person’s injury journey. The lead indicators are based on modifiable factors that influence RTW and grouped into relevant domains; personal, workplace, insurance or healthcare domain
In the bottom right-hand corner is a list of the outcome measures (or lag indicators).

Figure 1. Summary of the framework

Indicators of recovery through work

SIRA’s Recovery through work measurement framework reflects the complexity of the recovery process and the many factors that interact to influence a worker’s recovery at work. All measures in the framework are based on the current evidence of modifiable factors that influence an injured person’s recovery at work, including both lead and lag indicators.

Lead Indicators

Evidence indicates that there are multiple factors across four key domains - personal, workplace, healthcare, insurance and compensation - that work together to influence RTW outcomes for an individual worker. These factors form the basis of the lead indicators. Lead indicators are dynamic factors that can inform opportunities for intervention and influence whether recovery and RTW outcomes are achieved. Success in improving leading indicators will contribute to improvements in recovery through work outcomes.

Lag Indicators

Lag indicators are observable factors that change after a variable has been applied. They can be easy to measure but are harder to effect change. Lag indicators (work outcome measures) are derived from claims data and are based on the work status code field.

A visual representation of the lag indicators is presented in the Recovery through work outcome measures cube in Figure 2.

Recover through work outcome measures cube

The cube in Figure 2 contextualises a person’s compensable journey. It includes those who stay at work (SAW) after sustaining an injury, those who leave work initially and later RTW, as well as those who have not returned to work.

Figure 2. Recovery through work cube

Designing measures/indicators

Principles

The following principles are used when designing a measure:

use a suite of measures – there is no single measure of RTW
ensure measures are comparable, practical, and understandable
use evidence-based modifiable factors that influence RTW
use available data and/or data that could be reasonably collected, for example a sample
support regulatory requirements and functions
support achievement of the objectives of the Acts
accommodate and/or reflect changes in the operating environment.

Data and information sources

The recovery through work measures are derived from the following data sources:

customer enquiries - enquiries received by SIRA and IRO call centres
customer complaints - complaints received by SIRA and IRO call centres
disputes data - disputes lodged with the Personal Injury Commission
claims data - claims data submitted to SIRA by workers compensation insurers on a monthly basis and by CTP insurers on a daily basis
stakeholder insights - insights gained from SIRA’s meetings with stakeholders
case reviews/audits - regulatory reviews and audits to understand compliance with the legislation and performance against SIRA’s expectations
surveys - to learn about customers’ experience of the personal injury schemes:
- SWA conducts every two years a national RTW survey of workers with a worker’s compensation claim. The survey uses self-reported measures of RTW through a telephone survey. Approximately 800 workers are sourced from NSW
- SIRA conducts an injured person survey across both schemes and will undertake a survey of employer’s experience of the workers compensation system
evidence reviews - rapid reviews by research partners as a way of synthesising evidence.

Setting the parameters of the measure

Purpose

Clarify the reason for measuring an activity, payment or process and the expected outcome. For example, how effective is the insurer in helping workers return to work after four weeks?

Measurement selection

Determine which suite of measures will provide the best information to address the purpose.

Parameters

For a full description of parameters refer to appendix 1

Consider the parameters for each measure selected, such as:

1. Cohort(s)

Define the group of claims to which the measure will be applied. This usually represents the denominator of the measure.

2. Data currency (reporting period)

Data currency describes the recency of the data.

3. Measurement point/period (reference period)

The measurement period is the point/period at which the metric is being measured.

4. Exposure period

The exposure period is the start and end date of the cohort being measured. The exposure period varies depending on the time series.

5. Time series

The time series selected may be either rolling or fixed.

Rolling RTW calculation

Claims in the rolling cohort will vary at each reporting month for each measure. As the reporting month moves forward by one month, the rolling period drops the claims in its oldest month and adds the claims in the new month.

Fixed RTW calculation

Fixed cohort tracks how the outcomes for the same group of claims change as time passes

The challenge when selecting a time series is managing the compromise between a rapid approach and a reliable approach. The rapid approach (rolling time series) provides visibility of indicative trends as they are emerging, whereas the fixed series approach reduces the volatility and shows average performance over a longer time period.

6. Development period

The development period is the period at the end of the exposure period. It is added for the purpose of recording whether the activity (for example RTW) has occurred for each of the claims in the exposure period.

The development period is equal to the measurement period.

7. Lag period

The lag period refers to the period in which the data is submitted, compared to the period for which the activity occurred.

Recasting is the updating of measurement results for previous months due to late reported information or reported to SIRA during the lag period.

Catalogue of measures

Appendix 2 is a catalogue of recovery through work measures. All the measures (both lead indicators and outcome measures) are based on the factors from the evidence that are modifiable.

Selection of the chosen measure or package of measures from this catalogue are made based on how the measures are intended to be used, that is the purpose.

Application

These new measures will enable SIRA to proactively identify:

emerging trends, and potential risks and opportunities for improvement across the personal injury schemes, leading to regulatory action
the impact of regulatory efforts to improve system outcomes
performance of the scheme and the entities SIRA regulates, specifically insurer performance.

As data sources expand (such as injured person and employer survey data) more and more metrics will be available for these regulatory activities.

Application to performance

Existing SIRA external reports and insurer performance dashboards will progressively be updated with the new lag indicators (outcome-based measures) including:

Stay at work rates
Return to work rates
Working rates, and
Average days off work (WC only).

The following lead indicators are a priority and will be included in insurer comparative reports and supervision dashboards in the future:

Timeliness of injury notification/lodgement (claim data)
Insurer decision times (claim data)
Disputation rates (claims, PIC data)
Current Injury Management Plan (IMP)/ Recovery plan (claim data)
Timeliness of statutory benefit payment (claim data)
Positive experience with the insurer (SIRA survey data)
Perceived injustice (SIRA survey data).

The information gained from these new lead and lag recovery through work metrics allows for stronger supervision conversations and performance improvement activity.

Glossary

Appendices

1. SIRA 2020, Reversing the Trend- Improving RTW outcomes in NSW, retrieved May 2021

2. Loisel P, Durand MJ, Berthelette D, Vezina N, Baril R, Gagnon D, Lariviere C, Tremblay C. Disability prevention—new paradigm for the management of occupational back pain. Dis Manage Health Outcomes 2001; 9: 351–360

3. Collie, A., Lane, T., Di Donato, M., and Iles, R. August 2018. Barriers and enablers to RTW: literature review. Insurance Work and Health Group, Monash University: Melbourne Australia

4. Cullen K.L., Irvin E., Collie A., et al. Feb 2017. Effectiveness of workplace interventions in RTW for musculoskeletal, pain-related and mental health conditions: an update of the evidence. Journal of Occupational Rehabilitation

5. Wyatt, M. and Lane, T. 2017. RTW: a comparison of psychological claims and physical injury claims - analysis of the RTW Survey results. Commissioned by Safe Work Australia

6. Collie, A., Lane, T., Di Donato, M. and Iles, R. August 2018. Barriers and enablers to RTW: literature review. Insurance Work and Health Group, Monash University: Melbourne, Australia

7. Royal Australasian College of Physicians (RACP). The role of General Practitioners. retrieved September 2020 from: https://www.racp.edu.au/advocacy/division-faculty-and-chapter-priorities/faculty-of-occupational-environmental-medicine/health-benefits-of-good-work

8. SuperFriend, (undated) Action Area 1: Management Practices for Psychological Claims , retrieved May 2021

9. SIRA Claims management guide, https://www.sira.nsw.gov.au/workers-compensation-claims-guide/understanding-the-claims-journey/recovery-at-work/injury-management-plans, retrieved May 2021

10. Section 42 of the 1998 Workplace Injury Management and Workers Compensation Act, retrieved May 2021

This guideline is available to download Recovery at work measurement framework - PDF

Updated 4 March 2025