Ability to RTW: Is the glass half empty or half full and who is pouring the water?

 We've all heard the phrase "playing the victim" or have heard very different stories of two individuals with the same injury taking very different views on their ability to RTW.  Many employers tend to compare one injured employee to another, stating, "Well Tina had cervical fusion surgery and was back after three months, why is Sam still out after 8 months?"  Aside from physical limitations, we rarely consider the other elements that influence an injured worker's perception about their ability to RTW.

Why do some injured workers maintain a positive "can-do" attitude while others hold the "can't-do" attitude?

The way that we, as a society, as individuals, and as employers or coworkers react to those on disability may have something to do with it.  In a system where there is an increasing amount of fraud and stigma associated with being on workers' compensation or disability pay, individuals can react in one of two ways.  They can attempt to prove that they are not "one of them," that they are able to work with some assistance, able to carry on a fulfilling lifestyle and go to work every day with their pain.  On the other hand, if an injured worker doesn't believe that they are capable of performing work or their pre-injury activities, and they do not return to work they may feel that they have to justify their injury to others, or defend their inability to work -- not in an attempt to stay on disability benefits, but in an attempt at self-defense or self-preservation.  When you combine a strong social stigma with a perceived lack of control over a situation, it is human nature for an individual to look to examples of things they cannot do, or even catastrophize the situation. 

If you pay attention to earnings reports, there is a tendency to look to external factors, particularly those out of our perceived control, when the results are less than favorable.  However, when the results or outcome are desirable or exceed expectations, they are usually attributed to positive internal actions. 
Example:  A property and casualty insurer sustains a high loss ratio and less than favorable operating results.  As a result, the weather may be to blame, investment income is low due to the interest rate environment, or some other external force.  In a year where there are favorable operating results, these results are attributed to strong leadership, quality underwriting or prudent decision-making.  None of these "reasons" are false or unlikely factors, so it is not to say that these companies are lying or shirking responsibility for the results -- it is just how they are presented.  The same goes with injured workers.  In a 2013 study published in the BMC Journal of Musculoskeletal Disorders, the authors found that individuals who were working with back pain were regarded as "heroic."   Those in the non-working sample demonstrated patient identities that "focused on the patient as a helpless victim, anticipating and rebuffing potential accusations of personal responsibility and blame" (Brooks, McCluskey, King & Burton, 2013).

Instead of focusing on the fact that injured workers aren’t working with an injury we should really be asking why?  Is it because their employer doesn’t want them back? Is it because there isn’t modified duty identified at their workplace?  Is it because their doctor communicated poor outcomes and emphasized limitations as opposed to capabilities?  We’re not saying that there aren’t examples of fraud or misrepresentation that occur in the world of disability insurance and workers’ compensation – but consider the repercussions of broad-brush assumptions – are we forcing injured workers to “prove” their disability or defer to a “patient is truly disabled narrative” (Brooks, McCluskey, King & Burton, 2013)?

Source:  Brooks, J. McCluskey, S. King, N., & Burton, K. (2013). Illness perceptions in the context of differing work participation outcomes. BMC Musculoskeletal Disorders, 14(48).