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Reversing the trend - improving return to work outcomes in NSW

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1. Introduction

Work is a powerful determinant of health. Research consistently shows that returning to work after illness or injury can deliver many benefits to the worker, their employer and the community. The health benefits of good work mean that staying at work to recover or a timely return to work (RTW) is an important part of rehabilitation and recovery1.

Compensation systems must enable and support a worker to recover at work and stay connected to their workplace. Evidence has consistently shown that encouraging and accommodating people to remain in the workforce and stay active while recovering from illness or injury facilitates shorter recovery times and prevents or reduces disability2.

In NSW, State Insurance Regulatory Authority (SIRA) is responsible for regulating the workers compensation insurance, motor accidents compulsory third party (CTP) insurance and home building compensation schemes. SIRA develops policy and guidance to achieve the primary objective of the compensation schemes including optimum results in terms of the timely, safe and durable RTW for workers following workplace injuries3.

SIRA has identified a trend of deteriorating RTW rates since 2018 and, in 2021, SIRA will develop a system-wide strategy in partnership with stakeholders to reverse the trend and improve RTW outcomes.

This background paper has been prepared to inform this process and SIRA will provide opportunities for formal consultation in 2021.

2. Purpose

The purpose of this paper is to provide a summary of current evidence relating to:

  • factors known to positively influence RTW, and
  • practices most likely to optimise outcomes for workers, employers and the broader community.

The information contained in this paper is designed to inform and facilitate discussion about factors contributing to the declining trend in RTW rates, and opportunities to collaboratively reverse the trend.

For this reason, the paper focuses on current evidence identifying factors for which there is moderate to strong evidence of an influence on RTW with a focus on factors that are readily modifiable with the aim of informing discussion about opportunities to improve RTW outcomes in NSW.

3. Approach and scope

In recent years there has been a substantial amount of research evidence, and several key literature reviews, on factors influencing worker outcomes following injury in the workers compensation context. While the majority of research literature is in the context of workers compensation, it is likely that the same factors also influence RTW for workers in the motor accidents compulsory third party (CTP) insurance scheme following injury. This may be a future focus area for SIRA as the new CTP scheme matures.

After conducting an initial review of available evidence, our approach was to base this paper on the following key evidence sources:

  1. Literature reviews

    Existing recent literature reviews provide a comprehensive review of available evidence on factors influencing RTW5. These reviews were used as a basis for this paper as they:

    • identify and evaluate earlier relevant high quality research focused with RTW as a primary outcome measure
    • utilise a recognised model specific to RTW research and the workers compensation context to information under four key domains (personal, workplace, health care, insurance and compensation)
    • distinguish between non-modifiable and modifiable RTW factors
    • provide a clear indication of the level of evidence5 for each RTW factor
    • propose actions to prompt consideration and inform design of evidence-informed strategies to improve RTW outcomes.
  2. National RTW strategy

    The SafeWork Australia National RTW Strategy 2020-2030 (Strategy) aims to drive and leverage national action with the aim of minimising the impact of work-related injury and illness, and enable a timely, safe and durable RTW6.

    The Strategy includes an overview of available evidence on RTW, and five action areas: supporting workers, building positive workplace culture and leadership, supporting employers, supporting stakeholders, and building and translating evidence.

  3. National RTW survey and associated literature

The National RTW survey is undertaken biennially by the Social Research Centre on behalf of Safe Work Australia. The survey compares the RTW experiences and outcomes of workers across workers compensation jurisdictions. Survey questions and the resulting summary report are grouped under four key domains: personal, workplace, health care and compensation. In addition to the most recent survey summary report7, this paper is based on several key literature sources analysing the 2018 survey results8.

In addition, SIRA conducted literature search for relevant high-quality research between August 2018 to August 2020 where RTW was the primary outcome. A database search of Medline for primary studies yielded three articles that met search criteria.

4. What the evidence says

RTW is a complex process in which many factors at the individual, organisational and system levels interact to influence a worker’s recovery, absence from work and the durability of their RTW9. The interplay between these factors accounts for the varying outcomes in people with similar injuries in differing psychological and social circumstances10. It is essential therefore that everyone involved in the RTW process understands the factors likely to result in a positive RTW outcome and commits to aligning their RTW practices accordingly.

A positive RTW outcome is where the impact of injury is effectively minimised, and recovery and capacity for work and life is optimised11. SIRA utilises a wide range of RTW measures (primarily using work status codes) and sources to analyse RTW outcomes including:

  • stay at work rates, and RTW rates at key points (at 4, 13, 26 and 52 weeks)
  • significant RTW and durability of RTW
  • claims experience indicators12.

This paper provides a summary of factors for which there is moderate to strong evidence of an influence on RTW outcomes. The focus is on modifiable factors that could contribute to improved RTW outcomes. Evidence is presented in summary regarding factors influencing RTW under four key domains - personal, workplace, health care, and legislative and insurance – which aligns with the Sherbrooke Model of Work Disability developed specifically for RTW research and practice in the context of Australian workers compensation systems13.

4.1 Personal domain

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

There is moderate to strong evidence for 16 RTW factors relating to the worker, of which five are readily modifiable:

  • self-efficacy – workers with greater belief in their ability to achieve goals have a better RTW
  • recovery expectations – workers with stronger expectations of recovery have better RTW
  • perceived work ability – workers who perceive their ability to function in the workplace as lower have a worse RTW
  • pain catastrophising/fear avoidance – workers who describe pain experience in exaggerated teams, ruminate on or feel helpless or avoid pain related situations have worse RTW outcomes
  • concern about making a claim – greater concern results in worse RTW14.

Potentially modifiable factors with moderate to strong evidence include self-rated health, available social support, injury/symptom severity and the presence of co-morbid conditions.
Non-modifiable factors include older age, prior sickness absence, specific injury types (e.g. mental health), education and income/socioeconomic status. Understanding non-modifiable factors is important for tailoring RTW support for individual workers; however, these factors do not present the same opportunity for scheme-wide improvements in practices and outcomes15.

Based on modifiable factors relating to the worker, it is evident that a worker’s response to injury is a key determinant of their RTW outcome. While compensation schemes are designed to protect and support workers, the experience of injury and making a claim can be confusing and create a sense of lack of control of circumstances16. Equipping and supporting workers to take an active role in their recovery may positively influence a worker’s response to injury.

4.2 Workplace domain

The workplace domain considers the working environment, work relationships, work design and its ergonomic impacts, support systems and how a workplace accommodates RTW17.

Employers are in the unique position of having an opportunity to prepare for and contribute to positive RTW outcomes prior to injury that others in the worker’s support team do not.

The information below focuses on modifiable factors in the workplace domain for which there is moderate to strong evidence of an influence on RTW outcomes.

4.2.1 Culture and systems

Workplace culture consists of the shared and demonstrated values, attitudes and beliefs that form part of the organisations’ written and unwritten rules18. Positive organisational culture is essential to both individual and organisational performance19. The National RTW survey includes questions relating to perceived workplace culture prior to injury such as whether work was valued by others, people were supportive of each other, there was a commitment to each other safety at work, and whether they were satisfied with their job. Across all questions scores were significantly higher for workers who had returned to work with a physical injury, although for workers with psychological injury differences between those who were working and those who were not were less evident20.

A positive workplace culture is characterised by an employer’s commitment to physical and psychological health and safety, positive workplace relationships, and a supportive recovery environment21. Leaders promote the culture of a workplace and set the tone for organisational relationships. These relationships underpinned by organisational systems and processes have a significant influence on RTW outcomes22. A change in workplace culture to focus on recovery at work and embed a ‘culture of care’ necessitates senior management commitment and support23.

Superfriend, a mental health organisation that partners with superannuation funds and group life insurers, produced guidelines and actions for building thriving workplaces, and publish an annual report on survey results against 40 indicators contributing to worker mental health and business success. A thriving workplace is defined as mentally healthy workplaces where people can do and be their best. These sources provide guidance and resources to assist employers to drive improvements under five key evidence-based domains – leadership, connectedness, policy, capability and culture24.

Good culture promotes good work. ‘Good’ work is engaging and fair, and balances job demands, autonomy and job security. It is characterised by safe and healthy work practices and balances the interests of individuals and employers. It matches the work to the individual, provides clear and realistic performance indicators, and an understanding of how the individual’s role contributes to the shared organisation vision and goals creating purpose and meaning in work. Good RTW outcomes are more likely when individuals understand and are supported to access the benefits of good work25.

In addition to workplace culture, employers have the opportunity to positively influence RTW outcomes prior to injury by developing effective RTW systems. All NSW employers must have a RTW program which outlines the systems and processes an employer will use to manage workers with work-related injuries or illnesses. The workplace RTW program presents an opportunity for an employer to reinforce a positive workplace culture by promoting the health benefits of work, consulting and engaging with their workers and conveying a strong commitment to support them at the first sign of injury26.

An essential component of employer RTW systems includes mechanisms for early reporting of work-related injury enabling provision of early intervention and support. Workers must understand how to report an injury, but as importantly know that they will be supported in making a claim. A longer time between date of injury and making a claim is associated with an increased likelihood of a longer time away from work27. RTW outcomes are improved when a worker has low levels of concern about making a claim and perceive the employer to have provided appropriate pre-claim assistance28. Workers who are not concerned about making a claim are more than three times more likely to RTW29.

Responses from National RTW survey 2018 indicated that one third of NSW workers thought they would be treated differently by people at work if they submitted a claim, nearly a quarter thought their supervisor would doubt their injury and/or that they would get fired, and 15% perceived they were discouraged from making a claim. This reinforces the need for employers to develop a positive culture where workers expect support from management and co-workers enabling early reporting and support.

A positive workplace culture requires a commitment to building capability throughout the organisation to appropriately prepare for, respond to and manage work-related injury30.
In NSW, Category 1 employers must appoint someone with the relevant training, skills and experience as a RTW coordinator, and Category 2 employers should nominate someone to manage workers compensation and recovery at work activities31. Evidence confirms RTW outcomes are improved by having a RTW coordinator manage the RTW process32.

Evidence suggests most workers report their work-related injury to their immediate supervisor, and that a positive response from a worker’s supervisor is associated with a durable RTW33.  Additionally, half of all workers in NSW who needed support to navigate the claim process indicated the main source of support was their employer or colleagues34. This provides strong support for supervisors and workers across the organisation with an understanding of the health benefits of good work, the RTW process and how to access early support35.

SIRA’s Guidelines for Workplace RTW programs help employers understand their workers compensation and RTW obligations, and prepare for and respond to work-related injuries.

4.2.2 Workplace response

Early contact with the worker following injury provides the opportunity to demonstrate genuine concern, understand their situation and circumstances, identify options for appropriate support including recovery at work. Workers have better RTW outcomes when workplaces engage with them early and provide support immediately following notification36. For physical claims, 88% of workers who had early contact from the workplace had returned to work compared to 70% of workers who had no contact. For psychological claims, 77% of workers who had early contact from the workplace had returned to work compared to 53% who had no contact. Early contact by the workplace accounted for a significant improvement in RTW results37.

In the 2018 National RTW survey, just over one third of NSW workers (35%) had not been contacted by someone from their workplace following injury. For workers with a psychological (mental illness) claim 61% had not been contacted38.

Worker perception of whether their experience with their employer was positive during the RTW process is one of the most significant influences on RTW outcomes39. This factor incorporates several elements including the following questions from the National RTW survey:

  • perception of employer support
  • provision of information about rights and responsibilities
  • provision of suitable work
  • being treated fairly during and after the claims process.

Overall in NSW, workers agreed their experience with their employer had been positive (more than two-thirds of respondents agreed with each supporting statement). There were however two notable exceptions:

  • for workers with psychological claims the rate of agreement was at least half of the rate for all claims
  • in relation to early workplace reaction to injury and making a claim, nearly one quarter of respondents (21%) reported their supervisor thought they were ‘exaggerating or faking’ their injury, and 14% reported their employer discouraged them from making a claim40

RTW was much higher in workers who reported a positive experience with their employer. More than half of workers with positive employer experiences returned to work within 30 days compared to 32% of workers who reported a negative experience with their employer41.

This information is useful for employers in developing their systems and capability. It provides support for ensuring everyone involved in supporting the worker in the workplace understands the importance of:

  • remaining focused on actions and interactions likely to facilitate achievement of the worker’s goals, and
  • avoiding unnecessary disagreement or disputes, and promptly and fairly addressing the situation if it arises.

4.2.3 RTW planning

There is strong evidence that RTW improves when the process is planned and the actions of the worker, the workplace and external parties are coordinated42. In the early stage of a claim a written RTW plan, increases the likelihood of RTW by 1.7 times. After 30 days a written plan becomes more important increasing the likelihood of RTW by 3.4 times43.

A tailored RTW plan provides the opportunity to:

  • assist a worker to take an active role in the design and implementation of their plan
  • identify worker needs and effective tailored support
  • engage early with the nominated treatment doctor and other health practitioners in design and implementation of the plan
  • establish clear and common recovery goals and agree on the steps or actions required to successfully achieve the goal/s.

In the National RTW survey 2018 more than two-thirds (67.6%) of NSW workers reported having a RTW plan44, however this result confirms there is scope for improvement with the aim of achieving a corresponding improvement in RTW outcomes.

The SIRA document When a worker is injured: a workers compensation guide for employers and Recover at work plan assists employers to understand how to identify suitable work and develop a RTW plan.

4.2.4 Providing suitable work

There is strong evidence that recovery at work and early return to good work can assist recovery and prevent secondary complications associated with time away from the workplace45. Employers are required to offer suitable work where reasonably practicable to support their workers to recover at work46.

In NSW, 41% of workers were able to perform their usual work on their RTW following injury. Almost 43% returned to work on modified or ‘light’ duties, and 16% performed different work on returning to work. Only 32% of workers with a psychological claim were offered suitable work. While 38% of workers were able to resume working their usual hours, 60% of workers returned to work on reduced hours47. Workers from small businesses were less likely to be offered modified duties likely reflecting their lower capacity to accommodate change48.

In total in NSW, 74% of workers agreed their employer ‘made an effort’ to provide suitable work to support their recovery49. While this is a subjective indication and does not offer insight as to why an employer may not have provided suitable work, it may warrant further exploration given one quarter of workers did not agree with the statement.

Some workers will not be able to RTW at their pre-injury workplace because they are unable to manage their pre-injury duties, or their employer is unable to provide reasonable workplace adjustment and/or suitable employment. Workers who are unable to maintain or are not offered suitable work, need to seek new employment with a different employer.

In NSW approved workplace rehabilitation providers provide specialist advice to assist:

  • an employer to identify suitable work and other workplace adjustments to accommodate the specific needs of a worker, based on the principles of good work50
  • a worker obtain work with a new employer including assessment to identify suitable employment options, job seeking assistance, and facilitating access to programs and support designed to secure new employment.

SIRA did not identify any current literature of strong evidence specific to workplace rehabilitation practices. However, as the role of the workplace rehabilitation provider involves supporting the employer, key factors in the workplace domain such as tailored planning would be equally as relevant to providers.  Further research may assist in determining effective workplace rehabilitation assessment and intervention practice, particularly in the context of workers requiring support to transition to new employment.

4.3 Insurance and compensation

This domain includes claims agents, insurers, regulatory authorities and other government and non-government agencies.

There is moderate to strong evidence for two RTW factors considered readily modifiable in the insurance and compensation domain:

  • administrative timeframes, and
  • perceived experience with insurer (and associated involvement of a lawyer).

The relatively low number of modifiable factors may relate to:

  • the limited number of published studies in insurance and compensation domain51
  • several factors may influence a worker’s ‘perceived experience with the insurer’.

4.3.1 Insurer decision making

Prompt claim liability decisions facilitate the early provision of appropriate support and intervention and enable workers and employers to focus on recovery and RTW.

There is strong evidence to confirm timely liability decisions and decisions relating to approval for treatment and services improves RTW outcomes. Excessive delays in claim decision-making has been reported as stressful by claimants, and is associated with greater disability, higher incidence of anxiety and depression, and lower quality of life52. More than 34% of claims take longer than 30 days between incident and insurer liability decision53. This provides a clear opportunity for improving RTW outcomes across the workers compensation scheme.

Effective communication with workers and employers about the claim determination process, timeframes, and basis for decision making is also an important element of the claim determination process. Insurer communication with the worker should aim to provide an experience of trust and support rather than having eligibility questioned54. This approach increases a worker’s perceived fairness associated with the decision making process.

4.3.2 Experience with insurer

The process of making a claim can be complex. In NSW, 40% of workers reported needing support to navigate the claim process55. Insurers have an important role in assisting workers to access workers compensation support, facilitating prompt access to treatment, guiding workers through the claim process, and ensuring they are an active participant in their recovery and RTW.

The quality of a worker’s interactions with the insurer is a key influencer of RTW outcomes.

The RTW rate for workers reporting a positive experience with the insurer case manager was significantly higher (84% for physical claims, 62% for psychological claims) than worker who reported a negative experience (67% for physical claims, 55% for psychological claims)56.

In NSW, 29% of workers reported a ‘difference of opinion’ with the insurer in relation to their claim57. Evidence confirms involvement of a lawyer to assist the worker in the claims process is associated with a negative influence on RTW58.

The National RTW survey includes self-reported measures of worker perceptions of fairness of their claims experience. Interestingly, ratings for interpersonal fairness such as being treated politely with dignity and respect were most positive (mean score of 4.3 out of 5). Ratings for informational fairness (right information at the right time) and procedural fairness (honest and fair decision making) were rated least positively (mean score of 3.7 and 3.8 respectively) 59. This provides opportunities for improvement in practice and outcomes.

Current evidence-informed claims management frameworks promote a tailored, person-centric claims management approach characterised by:

  • a biopsychosocial approach to understand the worker, their circumstances, goals, barriers and strengths
  • the worker having ownership of RTW goals and outcomes and is encouraged and equipped to make informed, evidence-based decisions focused on recovery and RTW
  • claims processes and supports that are tailored to account for identified risks to recovery, are focused on the worker’s experience, goals and outcomes
  • facilitating commencement of support and intervention as soon as practicable
  • expectations that are aligned throughout the process - everyone understands their mutual obligations and role in assisting the worker achieve their goal60.

Safe Work Australia’s Taking action: A best practice framework for the management of psychological claims in the Australian workers compensation sector provides an overview of evidence defining best practice claims management. While the framework was developed with a focus on psychological injuries, the best practice principles can also be applied to the treatment of physical injury claims.

4.4 Healthcare domain

The healthcare domain includes the provision of treatment and rehabilitation to facilitate recovery from injury.

The following modifiable factors have moderate to strong evidence of an influence of RTW in the healthcare domain:

  • Treatment with a focus on RTW improves RTW outcomes
  • Work-focused cognitive behavioural therapy can reduce lost time and costs associated with work disability for workers with a mental health condition, compared with traditional CBT intervention which has no effect on reducing lost time
  • RTW is improved by contact between healthcare provider and the workplace (this correlates with evidence indicated multi-domain interventions positively influence RTW)
  • A higher level of medical intervention is associated with a negative influence on RTW61.

The role of the nominated treating doctor in the workers compensation scheme involves assessing and diagnosing, recommending treatment, supporting a worker to recover at work where possible, and contributing to RTW planning in collaboration with the worker and their support team. Nominated treating doctors are well placed to advise and educate workers that, in most cases, recovery at work is in their best interest for their future quality of life and that of their family. Simple messages delivered in the clinical environment can encourage workers to develop evidence-based views of the relationship between health and work62.

Allied health practitioners provide evidence-based treatment with a focus on RTW to optimise worker recovery. The Clinical Framework for the Delivery of Health Services provides best practice treatment principles including sound assessment using a biopsychosocial approach, setting goals relating to function, participation and RTW, and empowering the worker to manage their own injury63.

In NSW, just over half of workers (53%) reported seeing one healthcare provider and most confirmed this was their nominated treating doctor. Only 15% of workers reported seeing more than two healthcare providers64.

Evidence on factors affecting RTW in the healthcare domain is limited and researchers suggest further work is required in this area where RTW is a primary outcome measure. Researchers suggest further work is required to understand factors in the healthcare domains, particularly in the Australian context65.

4.5 Coordinated multi-domain intervention

The information above confirms there are multiple factors across four key domains – personal, workplace, health care, insurance and compensation - that work together to influence RTW outcomes for an individual worker.

There is strong evidence that interventions across at least two domains significantly reduce time away from work following injury66. 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.

A guiding principle in the National RTW Strategy for ensuring a positive RTW outcome is that stakeholders share relevant information and engage in a coordinated and collaborative approach to RTW where the worker’s social and economic wellbeing is the central outcome.

5. Opportunities

Recent literature reviews that form the basis of this paper, and SafeWork Australia’s National RTW Strategy, propose key action areas for improving RTW outcomes in the Australian context.

A summary of proposed action from these sources are provided below with some variation to align common elements.

Literature review - barriers and enablers to RTW 201867

SafeWork Australia’s National RTW Strategy 2020-2030

Worker response to injury

  • Data collection to inform tailored approach based on worker circumstances and psychosocial factors that influence RTW
  • Evidence supports work focused cognitive behavioural therapy

Support workers to be actively involved in their recovery and RTW

  • Build worker understanding of workers compensation and RTW, rights and responsibilities, and health literacy
  • Understand workers’ psychological response to injury to identify ways to support recovery and RTW
  • Promote best-practice tailored, person-centric approaches underpinned by the principles of good work

Employer processes and procedures

  • Changes in workplace behaviour through education, incentives, or enforcing employer obligations regarding RTW procedures

Support employers to build positive workplace culture and leadership

  • Explore causes and impacts of stigma on workers and campaign to shift negative perceptions
  • Promote best practice culture and leadership that drives positive and supportive workplace relationships and behaviours

Workplace support

  • Programs aimed at supervisor education and training,   and developing a positive workplace culture

Help employers effectively support workers

  • Support capability development to enable employers and their staff to effectively support workers and engage with other stakeholders to coordinate and manage RTW
  • Promote best practice approaches in providing suitable duties and other workplace adjustments
  • Promote best practice RTW programs, policies and plans

Insurer case management

  • Develop more efficient decision making and adjudication processes

Enhance the capability of front-line case management staff to interact with workers in positive ways

Help insurers to support workers in their recovery and RTW

  • Explore best practice early intervention and claims management models

Encourage use of best practice tailored, client-centric and coordinated approaches

Co-ordinated, multi-party rehabilitation

  • Workplace-based RTW interventions that incorporate elements of healthcare, workplace modifications, and are tailored to address worker specific barriers

Help stakeholders to support workers in their recovery and RTW

  • Embed the principles of good work in practice
  • Encourage use of best practice tailored, person-centric and coordinated approaches
  • Pursue national data measures that provide insight into the influence of stakeholder interventions and interactions on RTW

Build and translate evidence to drive continual improvement in practice

Table 1 – Evidence informed actions proposed to improve RTW outcomes

SIRA has considered the available evidence, the proposed priorities for national action to improve RTW outcomes (see Table 1), and factors specific to the legislative and environmental context of NSW. The following focus areas to improve RTW outcomes in NSW are proposed:

  • workplace culture
  • early intervention
  • tailored, person-centric planning
  • transition to employment.

6. Next steps

The findings from this practice paper will inform SIRA’s future activities to improve RTW. This will include initiatives for injured people, employers, insurers and other stakeholders that are aligned with the Safe Work Australia National RTW Strategy 2020-2030.

SIRA will:

  • Develop priority actions/solutions to address barriers to the implementation of RTW practices known to improve RTW outcomes
  • Seek stakeholder commitment to action aimed at reversing the trend of deteriorating RTW outcomes in NSW.

End notes

  1. Australasian Faculty of Occupational & Environmental Medicine (AFOEM). 2015. Realising the health benefits of work – an evidence update.
  2. van Vilsteren M, van Oostrom SH, de Vet HCW et al. 2015. The Cochrane Collaboration Workplace interventions to prevent work disability in workers on sick leave (Review), and
    AFOEM. 2015. Realising the health benefits of work – an evidence update.
  3. Section 3 and 41 of the Workplace Injury Management and Workers Compensation Act 1998.
  4. 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, and 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 and messages for practitioners. Journal of Occupational Rehabilitation.
  5. ‘Strong’ evidence is defined as at least five studies where the direction of effect on RTW is consistent between all studies. ‘Moderate’ evidence requires at least three included studies where the direction of effect on RTW is consistent, or at least four included studies in which the direction of effect on RTW is consistent in ¾ of studies.
  6. Safe Work Australia. National RTW Strategy 2020-2030.
  7. Safe Work Australia. 2018. National RTW Survey – Summary Report. Canberra.
  8. 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; and Compensation Policy And Return to work Effectiveness (COMPARE) project papers
  9. Safe Work Australia. National RTW Strategy 2020-2030.
  10. 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.
  11. Safe Work Australia. National RTW Strategy 2020-2030.
  12. See SIRA Discussion paper – measuring return to work (RTW) 2019 for more information.
  13. 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.
  14. ibid.
  15. ibid.
  16. Superfriend. Building Thriving Workplaces Guidelines and Actions. Promoting positive mental health and wellbeing and unlocking organisational performance.
  17. Safe Work Australia. 2018. National RTW Survey – Summary Report. Canberra.
  18. Safe Work Australia. National RTW Strategy 2020-2030.
  19. Superfriend. Building Thriving Workplaces Guidelines and Actions. Promoting positive mental health and wellbeing and unlocking organisational performance.
  20. 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.
  21. Global Access Partners. May 2017. Recovery at Work: Engaging Large Employers in Best Practice. 2nd Strategic Roundtable, and  Safe Work Australia. National RTW Strategy 2020-2030.
  22. Safe Work Australia. National RTW Strategy 2020-2030.
  23. Global Access Partners. May 2017. Recovery at Work: Engaging Large Employers in Best Practice. 2nd Strategic Roundtable.
  24. Superfriend. Building Thriving Workplaces Guidelines and Actions. Promoting positive mental health   and wellbeing and unlocking organisational performance, and Superfriend. Indicators of a Thriving Workplace Survey. 2019 National Report.
  25. AFOEM of The Royal Australasian College of Physicians (RACP). 2017. Consensus Statement on the Health Benefits of Good Work and Superfriend. Indicators of a Thriving Workplace Survey. 2019 National Report.
  26. Safe Work Australia. National RTW Strategy 2020-2030, and SIRA. 2020. Guidelines for workplace RTW programs. www.sira.nsw.gov.au
  27. Gray SW, Sheehan LR, Lane TJ, Beck D, Collie A. May 2018. Determining the association between workers compensation claim processing times and duration of compensated time loss. COMPARE project team. Insurance Work and Health Group, Monash University: Melbourne.
  28. 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.
  29. Sheehan LR, Gray SW, Lane TJ, Beck D, Collie A. 2018. Employer Support for Injured Australian Workers: Overview and association with RTW. COMPARE project team. Insurance Work and Health Group. Monash University: Melbourne. Cited in SafeWork Australia. National RTW Strategy 2020-2030.
  30. Safe Work Australia. National RTW Strategy 2020-2030.
  31. A Category 1 employer is an employer who has a basic tariff premium over $50,000 a year, or is self- insured, or is insured by a specialised insurer and has more than 20 employees. A Category 2 employer in an employer who is not a Category 1 employer.
  32. 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 and messages for practitioners. Journal of Occupational Rehabilitation.
  33. Based on Australian Bureau of statistics data cited in Safe Work Australia’s National RTW Strategy 2020-2030.
  34. Safe Work Australia. 2018. National RTW Survey – Summary Report. Canberra.
  35. Safe Work Australia. National RTW Strategy 2020-2030.
  36. ibid.
  37. 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.
  38. SIRA. December 2018. National RTW Survey 2018 - NSW Summary Report (in draft)
  39. 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.
  40. Safe Work Australia. 2018. National RTW Survey – Summary Report. Canberra.
  41. Sheehan LR, Gray SW, Lane TJ, Beck D, Collie A. 2018. Employer Support for Injured Australian Workers: Overview and association with RTW. Insurance Work and Health Group. Monash University: Melbourne.
  42. 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.
  43. Sheehan LR, Gray SW, Lane TJ, Beck D, Collie A. 2018. Employer Support for Injured Australian Workers: Overview and association with RTW. Insurance Work and Health Group. Monash University: Melbourne.
  44. Safe Work Australia. 2018. National RTW Survey – Summary Report. Canberra.
  45. 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 and messages for practitioners. Journal of Occupational Rehabilitation, and AFOEM. November 2015. Realising the health benefits of work – an evidence update.
  46. Section 49 of the 1998 Act.
  47. Safe Work Australia. 2018. National RTW Survey – Summary Report. Canberra.
  48. Safe Work Australia. 2017. Taking action: A best practice framework for the management of psychological claims in the Australian workers’ compensation sector.
  49. Safe Work Australia. 2018. National RTW Survey – Summary Report. Canberra.
  50. Safe Work Australia. National RTW Strategy 2020-2030.
  51. Clay FJ, Berecki-Gisolf J. Collie A. (2014). How well do we report on compensation systems in studies of RTW: a systematic review. J Occup Rehabilitation.
  52. 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 and messages for practitioners. Journal of Occupational Rehabilitation 
    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.

    Gray SW, Sheehan LR, Lane TJ, Beck D, Collie A. May 2018. Determining the association between workers compensation claim processing times and duration of compensated time loss. COMPARE project team. Insurance Work and Health Group, Monash University: Melbourne.
  53. ibid.
  54. Safe Work Australia. 2017. Taking action: A best practice framework for the management of psychological claims in the Australian workers’ compensation sector.
  55. Safe Work Australia. 2018. National RTW Survey – Summary Report. Canberra.
  56. Wyatt, M and Lane, T. RTW: a comparison of psychological claims and physical injury claims - analysis of the RTW Survey results. Commissioned by Safe Work Australia.
  57. Safe Work Australia. 2018. National RTW Survey – Summary Report. Canberra.
  58. 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, and Safe Work Australia. National RTW Strategy 2020-2030
  59. ibid.
  60. Safe Work Australia. National RTW Strategy 2020-2030, and Safe Work Australia. 2017. Taking action: A best practice framework for the management of psychological claims in the Australian workers’ compensation sector.
  61. 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.
  62. 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
  63. Transport Accident Commission (TAC) and WorkSafe Victoria. Clinical Framework for the Delivery of Health Services.
  64. Safe Work Australia. 2018. National RTW Survey – Summary Report. Canberra.
  65. 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.
  66. 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 and messages for practitioners. Journal of Occupational Rehabilitation.
  67. 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.