Rob, you’re an expert on worker’s compensation law, policy, and procedures. You have a particular interest in the area of needless disability. Can you define ‘needless disability’?
It’s that disability that occurs that isn’t a necessary component or a follow-on on somebody’s actual physical harm. We know, for instance, that two people with exactly the same injuries may not fare the same. One may recover regularly and go back to work, another may sink into helplessness and victimhood. The system and the way that we treat people are what cause the second case, and that’s ‘needless disability’.
In one of your papers you quote the work of Norman Doidge, who’s done a lot of work on neuroplasticity. How is his work relevant to the topic of ‘needless disability’?
Neuroscience has shown us over the last 10 years or so that the brain actually changes to adapt to experience. What neuroscientists would say is that neurons that fire together wire together. And the way it works is like this. When a person is injured, they experience pain, they experience a loss of control in their lives. They experience some fear. Pretty much everyone has those things. And because they all happen at the same time, the brain changes to form a neural network.
Now, most of the time, if that resolves in a reasonable period of time, nothing happens. But if you start adding economic stress, loss of job identity, negative messages from some of the service providers, psychosocial factors and other things, then what happens is it gets reinforced and a network builds—a neural network that changes the way the brain works and changes the way we think. Over time and repetition, that neural network gets facilitated in just the same way that it becomes automatic for you to sign your name. You don’t have to think about how you are doing it. These associations between thoughts and motions and physical sensations become automatic. And if you trigger one part of the network, you trigger the whole thing. That’s how we learn disability.
Do service providers contribute to the problem? Do they understand that their actions may be causing unintended further harm?
I don’t think that they generally do understand it, with the exception of some exceptional people who have really taken to it. But service providers can do a great deal of unintended damage. When a lawyer says, ‘Oh no, mate, stay at home, it will hurt your case if you go back to work,’ it causes harm by loss of job identity. When a doctor looks at an x-ray and says, ‘Oh, this is a really, really bad fracture,’ then that gets rehearsed in the mind of the person over and over again. It becomes part of the message of harm that’s occurred. When a claims manager refuses to return phone calls or treats every claim as if it’s dodgy, then that has an impact as well. And all those help create a situation where people who are already harmed get further harmed.
If we stop the compensation system from creating further harm, what are the benefits?
All around Australia, professionals tell me that about 20 per cent of the cases cause about 80 per cent of the harm. Well, by the nature of these cases, needless disability is part of that 20 per cent, probably the majority of it. If we were able to, say, cut that in half, then we would have 10 per cent of the cases, but they would only be then causing about 40 per cent of the causes and 40 per cent of the headaches. That means that 40 per cent of the resources that we are currently spending on the system could be redirected to increased benefits, better services for the injured, or lowered premiums.
Does this have any application outside the personal injury sector?
It does. If you think about psychological harm in general in the workplace, this is a way of understanding how it occurs. And a careful analysis of the workplace can help us prevent psychological harm. Similarly, where there’s customer satisfaction issues, that’s all based on the reactions of the customer to a combination of things, and we can control what we present to the customer to prevent that kind of bad association.
So the opportunities to really utilise this new understanding of neuroscience are almost limitless.