Twelve new state studies from the Workers Compensation Research Institute (WCRI) aim to help CFOs and other stakeholders identify ways they can improve the treatment and communication an injured worker receives after an injury, leading to better outcomes at lower costs.

The studies, as summarized on the CFO website, are based on interviews with 4,800 injured workers from across 12 states who suffered a workplace injury in 2010 and 2011 and received workers’ compensation income benefits. The 12 states were Arkansas, Connecticut, Indiana, Iowa, Massachusetts, Michigan, Minnesota, North Carolina, Pennsylvania, Tennessee, Virginia, and Wisconsin. The surveys were conducted during February through June in 2013 and 2014 – on average, about three years after these workers sustained their injuries.

The research found that a worker’s fear of being fired after an injury had a large and pervasive effect on costs and worker outcomes, like when the worker returns to work. The fear of being fired may arise out of the relationship between the worker and the supervisor being one of high or low trust. If the relationship is low trust, the worker is more likely to fear firing when injured.

To describe the level of trust or mistrust in the work relationship, workers were asked to agree with the statement “I was concerned that I would be fired or laid off.” Workers were given four possible answers – strongly agree, somewhat agree, somewhat disagree, and strongly disagree. Depending on the state, 18% to 33% of workers strongly agreed that they feared being fired when injured.

Overall, workers who were strongly concerned about being fired after the injury experienced poorer return-to-work outcomes than workers without such concerns. Across all 12 states, 23% of those concerned about being fired reported that they were not working at the time of the interview – double the rate observed for workers without such concerns. The following are other findings from workers who were strongly concerned about being fired.

1) Concerns about being fired were associated with a four-week increase in the average duration of disability.
2) Workers who were strongly concerned about being fired had higher rates of dissatisfaction with care (21% were very dissatisfied with care) when compared with workers who were not concerned about being fired after the injury (9%).
3) Workers concerned about being fired were much more likely to report problems with access to care. Among workers concerned about being fired, 23% reported big problems getting the services they or their provider wanted. The rate was double the 10% among workers not concerned about being fired.
4) Sixteen percent of workers strongly concerned about being fired reported large earnings losses at the time of the interview predominantly due to injury, compared with 3% of workers not concerned about being fired.

Another CWCRI study published several years ago on attorney involvement looked at why injured workers hired attorneys. The character of the employment relationship, for example, was a factor for the 23% who strongly agreed that they hired attorneys because they feared being fired or laid off. Fifteen percent also strongly agreed that they needed attorneys because their employer could perceive their claims as illegitimate.,