The purpose of this article is to contribute to knowledge about workplace-based prevention and rehabilitation programs by investigating effects on outcomes concerning employee health, psychosocial working conditions, sickness absence, sick-cases and rehabilitation indicators in 19 Swedish public human service workplaces including 311 individuals. Interviews with middle managers and an examination of documentation about prevention and rehabilitation interventions at the workplaces made it possible to group the workplaces in two workplace program groups — high versus low quality workplace-based prevention and rehabilitation programs. Statistical methods used were reliability tests, correlation analyses and t tests. Results indicate significant associations between changes in employee-judged stress and psychosocial working conditions, and changes in employee-judged health. The results concerning changes in employees’ health, stress and psychosocial working conditions (after workplace-based programs) showed significant differences between workplaces with high quality workplace-based programs compared with workplaces with low quality workplace-based programs, with the former having more favourable results. The study indicates that workplace-based prevention and rehabilitation programs with a broad change strategy and high levels of management and employee involvement can apply to small public sector workplaces.

This article examines the impact of disability and related variables (age, gender, and education level) on job search behaviours and employment outcomes. Data are from a two-wave study of 681 Australians between the ages of 45 and 65 who were not in paid employment. Regression modelling indicates that disability impedes job search at several stages of the employment process. Although is it unrelated to job search intensity, disability is negatively associated with the probability of engaging in job search, preferred weekly hours of work, and the likelihood of finding work. Gender and age are related to the probability of engaging in job search and gender is also associated with preferred hours to work. These findings indicate that older workers with a disability face multiple disadvantages when seeking employment.

Background: In 2007, the Health and Disability Strategy Group (HDSG) of the TAC and Victorian WorkCover Authority recognised an opportunity to improve scheme outcomes by working more closely with health disciplines. To investigate whether this was feasible, a pilot program was proposed with a select group of physiotherapists. Objectives: To determine whether a network of physiotherapists who were provided with training, monitoring and support could achieve improved outcome in return to work and health outcomes.

Method: In 2008, 92 physiotherapists undertook a select tender process and then completed training in return to work, the HDSG's Clinical Framework and familiarisation of the compensation system for work related and motor accident injuries. The outcomes of this network physiotherapist program were evaluated internally and by three independent research organisations to determine 1) impact on return to work, 2) impact on health outcomes, 3) patient satisfaction and 4) satisfaction of the physiotherapist providing the service. Results: When compared to non-network physiotherapist, the network physiotherapists demonstrated improved return to work for clients, better health outcomes, and greater patient satisfaction. Therapist satisfaction was also higher within the network physiotherapists.

Discussion: This body of work conducted on a pilot group of physiotherapists demonstrates improved outcomes in a number of important domains for the management of worker's and motor accident injuries. It indicates that there is a benefit for schemes in supporting clinical programs. Current evidence suggests that compensable patients have worse health outcomes than their non-compensable counterparts. There is a need to promote programs that are beneficial to patients, compensable schemes and providers. Further investigation is required to demonstrate this benefit on a larger scale.

Conclusions: This study indicates that there may be opportunities to improve health outcomes by investment from compensable bodies in training, support and monitoring of specific health disciplines.

Background: Previous research into the retirement experience tends to focus on the individual experience. This study looks at the role of work and retirement on subjective wellbeing and how corporations must change to engage workers for longer if they themselves are to remain sustainable.

Objectives: The objective of the study was to ascertain the need for creative solutions for older employer engagement.

Method: Using mixed methods Internet-based research methodology, 317 people were recruited with an online survey. Thematic content analysis was utilised to explore trends that emerged from the qualitative analysis.

Findings: The principle finding was that, employers need to rethink how they engage the older worker to ensure that their workforce remains stable.

Discussion: Low levels of life satisfaction were linked with being dissatisfied at work. Being at work also decreased the likelihood of social interaction. In contrast retirement offered freedom from the constraints of work. Employers need to adopt suggested solutions around flexibility, offering choices and a differentiation of the meaning of the “working day” to this cohort if they are to be successful in retaining older workers in employment.

Conclusion: The results are significant because governments, both local and federal, are encouraging an ageing workforce to remain in work longer. However employers need to consider how they can create greater autonomy for older people in the workplace to encourage them to want to work longer.

Background: It is widely recognised that the type of injury sustained plays a role in an individual's ability to return to work (RTW). Employers are quick to point out, though, that the injury alone does not always impact an injured/unwell worker's RTW outcome.

Objectives: The objectives of this research were to provide Comcare with greater insights and a better understanding of the factors that influence RTW outcomes for workers in the Australian federal workers’ compensation scheme.

Methods: A total of 47 in-depth interviews were conducted with injured workers from both premium paying and self-insured organisations in four Australian States and Territories. An independent research company conducted the interviews on behalf of Comcare between December 2012 and February 2013. A purposeful sampling approach was employed, however, this was influenced by the willingness of people to participate.

Findings: Personal situation, expectations of the organisation, relationship with the organisation and personality traits were identified as key factors influencing an individual's ability to return to work. The two driving characteristics of ‘personal resilience’ and ‘trust in the employer’ were used to identify four key types of claimants – Strivers, Temporarily Floored, Defensive & Entitled, and Victims.

Discussion: Although individuals were found to have a clear disposition towards one typology over another, it was apparent that they could move between these typologies depending on how their RTW journey was going. For example, a ‘Temporarily Floored’ individual encountering perceived ‘unfair or harsh’ judgement from their employer could develop a ‘Victim’ mindset.

Conclusion: Understanding that core individual dispositions impact a person's readiness, preparedness and confidence to RTW, has provided Comcare with the framework to further explore how we can identify and use these personal characteristics at the beginning of a claim to improve the recovery and RTW outcomes of our claimants.

Background: General Practitioners (GPs) play an important role in worker's treatment and return-to-work (RTW).

Objectives: To establish what factors potentially predict the type of medical certification that GPs provide to injured workers following work-related injury.

Methods: A logistic regression analysis was performed to assess the impact of a number of factors on the likelihood that an injured worker would receive an alternate (ALT) vs. Unfit for work (UFW) duties certificate from their GP. Compensation Research Database, containing claims and medical certification data of Victorian injured workers was accessed for the research purposes.

Results: A total of 119,900 claims were included into this study. The majority of the injured workers were males, mostly age of 45–54 years. Nearly half of the workers with UFW and 36.9% with ALT certificates had musculoskeletal injuries. The regression analysis revealed that older males were less likely to receive ALT as opposed to the younger females (25–34 years old) in most occupations. Living in rural areas was associated with smaller odds of receiving ALT. We also found that seeing a GP who is more experienced with workers’ compensation increased the odds of ALT certificates. However, suffering from mental health issues decreased the odds of receiving the ALT in all workers.

Discussion: To our knowledge this is the first study to describe factors predicting GP medical certification of injured workers. The results clearly indicate that workers with physical injuries, female workers, and workers visiting GPs with a higher injured worker case load in metropolitan area are more likely to receive an ALT certificate.

Conclusions: The findings of this study help to identify groups of injured workers that are less likely to be recommended ALT certificates. It also suggests that certain health service providers and policy makers might require more education on the health benefits of RTW.

In addition to demographics and ongoing changes on structures of families and societies, the way in which persons are interacting with organizations is also changing. These interactions are defining service delivery and also the way in which we are and will be working. The power of digital information foster by cloud, mobility and social media is heavily influencing these changes. Twitter for instance, generates in one day more than 12 terabytes and Facebook more than 15 terabytes, while many organizations in the world are producing and processing petabytes of information.

We are certainly facing a new way of doing things and a new work force generation with different values and certainly different ways of understanding prevention and rehabilitation. Do we need to add new strategies and data analysis to prevent accidents and diseases and to bring people back to work? How much information are we prepared to use to properly combine personal medical findings with socio-environmental variables? Can we see trends in our field or in other sectors that can show us where we might be heading? Where is the future heading?

This presentation is about reflecting on some evidence with the aim of provoking discussions and motivate the participants to jointly keep on finding better ways to cope with the future.

The impression that work can be good for a worker's health is a powerful one especially when it is combined with the idea that returning people to work may also have positive benefits for employers and government, physical and vocational rehabilitation and reintegration assumes even greater significance. The Social Security Organization of Malaysia (SOCSO) is a statutory body governing the Employment Accident Insurance Scheme and the Invalidity Pension Scheme. SOCSO covers over 6 million workers and processes over 70,000 new claims annually. SOCSO introduced the RTW Program in 2007 which is a comprehensive multidisciplinary biopsychosocial rehabilitation program for its Insured Persons who are experiencing disability due to accidents in the workplace or those claiming for invalidity. This rehabilitation program is unique as it involves the concept of “disability management” in which each Insured Person who is referred to the program, is assigned to a Disability Case Manager who is actively involved throughout the return to work process. This presentation discusses the justification of introducing the RTW programme in Malaysia, with reference to the underlying rationale, association between work and rehabilitation, evidence to establish a positive relationship between health and work, and the benefits of RTW for employees, employers and SOCSO. Up to date (December 2013), 11,090 workers were motivated to participate in the SOCSO RTW Programme and 7,881 (71%) have returned to gainful employment. This clearly shows the success of the RTW Programme in not only returning a disabled worker to work but to give them their lives back. Due to this success, SOCSO has started to build its National Rehabilitation Centre for the purpose of RTW which will be ready in mid-2014. However, there is still room for improvements which establish the way forward for SOCSO in creating a more disability-management-centric system.

Background: In 2012 I presented a program to the London IFDM entitled “Breaking the Web of Needless Disability”. The model drew heavily from the latest neuroscientific theory, and was quite well received. This program represents further development of the ideas presented in London to encompass “resilience”.

Hypothesis: 1. “Resilience” is a behaviour that is learned and unlearned like any other skill; 2. Understanding how humans think and react in compensation systems will yield valuable insight into the building of resilience to unnecessary disability.

Methods: Extension of existing literature and pilot studies examining the differences between those people who suffer injury and recover as expected and those who suffer the same sort of injury and spiral down into despair and dependency. Principal findings: “Resilience” is a specific behaviour beneficially affecting the sense of loss of control that attends injury. There are four specific “styles” of resilience. Each person uses one or more of these styles to a greater or lesser degree. By use of modified psychological inventory tools, the predominant resilience style of an individual can be ascertained, and approaches that enhance their resilience style can be utilised for either prevention or treatment.

Discussion: “Habits of thought” are established by repetition. For habits of thinking of one's self as able or disabled, the most significant form of repetition is internal dialog. In resilient people, there are four discrete kinds of dialog that are used to overcome a sense of loss of control. By identifying and bolstering those styles of resilience an injured person can become less susceptible to a sense of loss of control that gives rise to unnecessary disability.

Conclusion: The approach is useful in understanding failure to recover as expected, and shows promise for effective individualised treatment for injury management.

In the United States, workers’ compensation law is state-specific, and employee benefits including health care costs are born primarily by the employer. In response to cost increases in medical treatment and absences due to illnesses and injuries occupational or non-occupational, the practice of Disability Management (DM) has continued to evolve. The purpose of Disability Management is to reduce the incidents of employee absences, whether due to illness, injury, or other causes. There is a distinct paucity of meaningful analyses of the history and emerging evidences in the DM field. As a more integrated approach to disability management, both a theoretical understanding and an evidence-based practice is sought by each stakeholder in order to structure the evolution of practice and to document consistent ROI metrics. Theoretical underpinnings, historical evolution of disability and absence management, and specific evidence-based trends emerging in the field form the foundation of these standards. This study is a workplace approach that begins to define standards of practice to integrate disability management, health and wellness, and absence management. The purpose of this study is to collect data to comprehend how employers perceive their own awareness, importance, and feelings of preparedness pertaining to the primary practice domains identified in DM. This data will be obtained through an electronic survey using rating scales with an online questionnaire which will include descriptive and ex post facto design components. The survey items were developed by these authors in collaboration with other colleagues known in the field of Disability Management. Descriptive statistics will be computed for the employer participants characteristics based upon the demographic portion of the online questionnaire. The population of interest in this study is national or international employer(s) that have deployed or interested to develop Disability Management program(s) at their worksite(s). The specific type of employees/partners with these employers include: Occupational Health Practitioners, Department Heads and Supervisors, Human Resources personnel and Risk Management/Safety Personnel. The findings from this study will help identify employer perceptions of recognized DM practice domains, identify potential training needs of employers, and assist in developing standards of practice approach to workplace disability, health/wellness, and absence management, and DM educational standards. In addition, employers will be able identify their position on the continuum of the model disability management that evolves to engage practices integrating health and wellness, absence management, and productivity management. Maturation benchmarks will place the employer in a continuous improvement mode towards a workplace with a healthier workforce in a healthier community. Information will also be beneficial to the literature, and capacity development of students and practitioners in the field of Disability Management.

Each year large numbers of persons sustain serious injury as a consequence of criminal behaviours. All Australian jurisdictions provide systems of compensation to those harmed in this way. In many instances assessors of compensation have to consider not simply the appropriate and fair amount of compensation but how a person will be affected by the payment of compensation. Often those applicants apply through their guardians or a public trustee, although many applicants apply in person. This paper examines the use of legislative provisions, rules regulations and practices in the various Australian jurisdictions in relation to how vulnerable criminal injuries applicants may be protected once an award of compensation is made in their favour. Most jurisdictions provide for a mechanism by which compensation awarded may be held in trust in the event that the compensation assessor considers that the applicant may be unable to manage her or his financial affairs and where it would be in the best interests of the applicant. When considering what is in the best interests of the applicant the assessor will have regard to the manner in which the inability to manage financial matters has arisen either as a consequence of the offence the subject of the application, pre-exiting mental health issues, substance addiction and abuse or vulnerability to exploitation by family members or close associates. This paper explores what factors are taken into account by assessors in the absence of and pursuant to legislative directions. It considers how the approach may vary across jurisdictions and creative approaches to protection vulnerable criminally injured persons.

Background: The use of early intervention (EI) strategies following workplace injuries and illnesses have long been espoused by medical specialists, rehabilitation providers, regulators and others to be important in hastening recovery, and shortening the length of absence from work. Little is known, however, about the application, content or effectiveness of EI practices within the Comcare scheme.

Objectives: The aim of this research is to provide a strategic assessment of EI in the Comcare scheme by:

• • investigating what constitutes EI from an employer perspective,

• • determining which agencies/organisations use EI and why, and

• • establishing the impact EI has or could have on the scheme.

Methods: Phase one will consist of in-depth interviews and/or small group discussions with representatives from both premium paying and self-insured organisations. An independent research company will conduct phase one on behalf of Comcare between February and March 2014. A targeted sampling approach has been used to ensure organisations with known greater and lesser experience in the use of EI are included. Phase two will build on phase one, using an online survey to collect information from all premium paying and self-insured organisations in the Comcare Scheme.

Findings: It is anticipated that, within the Comcare scheme, the project will identify: what constitutes EI; what role EI plays or could play; what influences EIs success; and how EI is impacting the type and complexity of claims entering the scheme.

Discussion: This paper will focus on the key findings of the research and the implications they have for policies, practices and service delivery.

Conclusion: Understanding the role of EI in organisations provided Comcare with a framework to better guide and support employers in their response to workplace injuries and illnesses, and improving the outcomes for their people.

Objective: We investigate labour-market earnings of workers’ compensation claimants from three distinctly different workers’ compensation insurance support programs for claimants with permanent impairments. These three programs, which existed in Ontario, Canada in different periods over the last 25 years, are the Permanent Disability (PD) program, the Future Economic Loss (FEL) program, and the Loss of Earnings (LOE) program. The nature of benefit determination and the return to work supports provided by three programs are very different. The focus of the study is on evidence of programmatic impact on labour-market earnings recovery trajectories over nine years post injury.

Methods: The study included claimants sampled from each of the three programs who sustained a permanent impairment from a work injury. Claimants were identified in a Revenue Canada tax file database known as the Longitudinal Administrative Databank (LAD), which is a longitudinal 20% simple random sample of all Canadian tax filers. Each claimant was matched with similar uninjured controls that were also in the LAD, based on sex, age, labour-market earnings amounts and trajectories in the four years prior to injury, and a propensity score. Statistical modeling analysis was undertaken to compare the labour-market earnings trajectories of claimants relative to their matched controls using data on earnings over the nine years post injury. Analyses focused on sub-strata defined by program, sex, age, permanent impairment level, and pre-injury earnings. A key issue of interest was to determine which program of supports resulted in the best labour-market earnings recovery.

Results: Five distinct earnings recovery trajectories were identified. Claimants in various demographic and pre-injury earnings sub-strata from the LOE program cohort had a statistically significant lower probability of the lowest earnings recovery trajectory, and higher probability of the second highest trajectory compared to the PD cohort. Results for the LOE program were similar to the FEL program.

Conclusions: Injured workers from the LOE program appear to fare better than claimants from the PD program and similarly to those from the FEL program in terms of labour-market earnings recovery over the nine years post injury. Across all programs, older claimants fare more poorly, and women fare worse than men in terms of labour-market earnings recovery.

Background: For injured workers facing increased physical requirements the VBG, a German Social Accident Insurance Institution, provides 2 types of outpatient medical treatment for the last phase of rehabilitation. One option is a functionally orientated extended physiotherapy including the opportunity for work-ability testing at the workplace with a gradual increase of workload and working time. Second option is a newly-developed multidisciplinary workplace-related rehabilitation integrating the specific work-relevant functional flows in therapy under the direction of a qualified physician and therapists in rehab facilities.

Objective: To evaluate the effects of workplace-related rehabilitation after foot fractures in outpatient rehab facilities. Methods: Data of all completed cases with severe fractures of the calcaneus or the ankle joint, undergoing workplace-related therapy in 2013 (n = 27), were compared to consecutive data of 27 completed cases undergoing extended physiotherapy.

Findings: Mean age in both groups was 48 years. In the extended physiotherapy group 14 patients additionally received a work-ability testing directly at the workplace. Mean duration from accident to capacity for work was 169.81 days (SD 60.4) for extended physiotherapy and 176.81 days (SD 49.3) for workplace-related rehabilitation. 23 patients with extended physiotherapy and 26 patients with workplace-related rehabilitation maintained work ability 3 months after achieving full capacity for work. Subsequent rehab measures after regaining capacity for work were needed in 6 cases in the extended physiotherapy group and in one case in the workplace-related rehabilitation group.

Discussion: Though no statistically verifiable difference in duration of incapacity for work between both groups was found, the results provide apparently evidence that multidisciplinary workplace-related rehabilitation is more sustainable. It is suggested, that a systematic approach and individually tailored multidisciplinary training of the specific work-relevant movement patterns under constant medical and therapeutic direction lead to more stable rehabilitation results.

Conclusion: Further research is needed to consolidate our empirical findings.

Background: Tackling the rising trend of workers suffering from disability due to injuries and diseases, the Malaysian Social Security Organization (SOCSO) introduced the Return to Work (RTW) Program in January 2007. The Return to Work Program provides systematic disability management for Insured Persons with employment injuries and illnesses using a bio psychosocial and multidisciplinary approach to enable them to return to work in a safe and fast manner. In this process, it is the ultimate goal of the Case Manager to place the Insured Person with injuries or illnesses back to the same employer within the same, similar or a different job. Nevertheless there are a large number of Insured Persons who fail to return to their same employer and would therefore require job placement assistance to be placed within the “different employer hierarchy”. Note: “Different employer hierarchy” refers to participants who failed to return to work with their previous employers requiring job placement assistance to be placed within new employers.

Objective: This study explores factors predicting the likelihood of return to work among Insured Persons requiring job placement assistance. In the process of placing RTW participants among different employers, SOCSO has seen a drastic shift in the reception of employers wanting to employ persons with disabilities since the program was first implemented. While promotional measures and various interventions are carried out to increase number of participating employers, it is also essential that the readiness of the RTW participant themselves to return to work is evaluated at the beginning of the program to ensure that they will be mentally ready to return to work after being successfully rehabilitated.

Methods: The logistic regression model was used to find significant variables from a sample size of 798 participants which may be used as indicators on the likelihood of RTW participants under job placement assistance in returning to work. Findings From the results, it was found that there were eight (8) significant variables which includes the clients self-perceived self-esteem, skills, health condition, pain tolerance, independence, self-confidence and career goals. It was also found that gender was a subsequent variable which could also be used as a predicting factor in predicting the likelihood of the participant returning to work.

Discussion: In enhancing the quality and efficiency of providing job placement assistance for participants of SOCSO's Return to Work Program, significant indicators as found in this study can be used as a valuable tool in future where Case Managers may use this indicators to design interventions at the beginning of the programme . For instance, if the client had issues with self-esteem from the beginning of the program with low scores, this may suggest that additional counselling interventions and motivational programs may be required to improve the participant's self-esteem with the objective that he is able to return to work as soon as possible.

Background: This presentation focuses on results from studies concerning workplace health and rehabilitation interventions in one Swedish rural municipality including 19 workplaces with a population of 311 individuals. The municipality has implemented a model for human resource accounting, an extensive leader and co-worker development program and specific workplace based health and rehabilitation measures.

Methods: The studies compare co-workers and leaders self-ratings of health and psychosocial working conditions, and investigate how workplace health and rehabilitation programs affect these ratings by analysing quantitative results before, during and after carried out interventions. Qualitative data collection consisted of semi-structured interviews with middle managers and an examination of documents reviewing content of the interventions that had been carried out.

Findings: Results indicate differences concerning how the leaders and the co-workers judge their health and psychosocial working conditions. When comparing mean changes in scores on indexes by individuals grouped in the high quality workplace-based program group with individuals grouped in the low quality workplace-based program group, there were more positive mean changes for the former group.

Discussion: The findings of differences concerning how public sector leaders and co-workers judge their health and psychosocial working conditions give support for different job characteristics for these two categories of employees. The rather strong relationships in the assumed direction between employees’ assessment of changes in health, and changes concerning stress and psychosocial working conditions that resulted are in line with other research studies. Comparing workplaces grouped as having high quality workplace-based programs with workplaces with low quality workplace-based programs indicates that workplace-based prevention and rehabilitation programs in public human service organizations using a broad change strategy with high levels of participation from both managers and co-workers, and developed leadership behaviour are more effective in improving employee health and psychosocial working conditions.

Background: In the context of demographic change and lack of qualified workers the preservation of the internal labour force gains importance for the companies. At the same time private and public income security organisations are increasingly interested in achieving better return to work out-comes in order to reduce their costs. Research shows that a functioning DM leads to more effective return to work in companies.

Objectives: The interaction between the welfare state, the companies and private insurers is quite different in each county and highly depending and formed by the established welfare state scheme. In the presentation we will describe the interplay between the different stakeholders in DM for the situation in Switzerland and derive specific challenges and opportunities that arise from this set-ting. Methods: The presentation is based on findings from two studies (2008 and 20013) on disability management in private companies in Switzerland relying on qualitative and quantitative data. The results of these studies will be enriched with first findings from an ongoing international study that compares DM programmes in Switzerland, Australia, Canada and China (2013–2015).

Findings: The cooperation between social insurances and the companies could be improved in various ways. Most important is the improvement of informal and institutional communication between the company and the social insurances representatives. But there is also a need to more effective and efficient cooperation in improving rehabilitation processes and the processes of work-place integration. In general the studies show not only that organisational development is needed but also the qualification of DMP’s, as key factors in the processes, need to be improved.

Discussion: We will present findings from a study on DM programmes in private companies from 2008, from a study on DM activities in small and medium sized companies 2013 and first results from an on-going international comparative research project mentioned above. What lessons can be learned from the perspective of the different actors in DM, especially from companies and social security organisations?

Conclusion: Companies, private insurers and social security organizations will gain new insights into challenges and opportunities of DM. The findings will help to enhance collaboration between these different stakeholders and might provide important insight to improve and enhance existing DM programmes.

Background: Medical treatment under workers’ compensation represents just a miniscule portion (about 1 percent) of total medical costs in the U.S. Furthermore, legislation and rules are determined autonomously by each state.

Objective: To study Workers’ Comp systems in each state and determine what, if any, impact states adopting the use of evidence-based treatment guidelines has had to outcomes within the respective states. Hypothesis: Worker’ comp medical care, and the outcomes of that care in each state, can theoretically represent a microcosm of what could be achieved in an entire country.

Methods: A trend began in 2003, starting with California, for states to consider adopting Evidence-Based Treatment Guidelines EBTGs) as a mechanism to insure timely and quality care for injured workers by following the least invasive, most-effective treatments today's science has to offer. Bi-products to the effective implementation of EBTGs, include earlier return to work, better outcomes resulting in reduced indemnity costs, less friction in the system (providers know what treatments are authorized and will be paid for), fewer episodes of over-utilization of services, and decreased medical costs, benefiting employers, insurers, providers and business. Findings: Outcomes where true EBTG have been implemented: Ohio adopted EBTGs in 2003. A Pilot conducted in 2005 showed a decrease in medical costs by 64%, lost days by 69% and treatment delays by 77%. Texas adopted EBTG in 2006; Total costs have declined by 50%, patients are recovering more quickly, more providers are willing to treat these patients, opioid abuses have declined and many states are looking to adopt this model.

Discussion: Other state outcomes and essential elements needed in an EBTG will be discussed, time permitting.

Conclusion: Outcomes realized through the adoption/implementation of evidence-based treatment guidelines by selected states, need not be isolated to the US or to the “microcosm” of workplace injuries and illnesses. Countries adopting evidence-based treatments guidelines within their healthcare systems can benefit from the same results: more timely and quality care, better outcomes, reduced costs, less disputes, reduced utilization of unnecessary procedures and services.

The injured worker himself is provides the most powerful of all healing and recovery forces, and yet is the most ignored in contemporary disability management practice. The well-meaning attempts to assist the worker return to work by health professionals may actually be prolonging his disability. It's very difficult for most health professionals to step outside the heath professional paradigm and remember that the injured worker is the entity most capable of recovery, and most responsible for it. If the health professional is “ working harder than the injured worker”, the chances of a successful outcome are minimised. Associating with other professionals by way of referrals, team management practices make it even harder to step outside the health professional paradigm of “we know what's best for you.” The advantage of “encouraging”, “allowing”, “permitting” the injured worker to take the lead role in his own recovery is that the worker can resume the central place in his own life and not become beholden to others. Self-determination in recovery is the principal method whereby an injured worker offsets the psycho-social elements of the cause of, and the recovery from, any workplace injury. Psycho-social reasons are the principal reasons why a person becomes injured in the first place and takes longer to recover than he might otherwise do. Without placing the psycho-social element in a place of prominence, much input by Rehabilitation Providers, Physiotherapists, Physicians and other health professionals is not only ineffective, but contributing to the very psycho-social elements which caused the problem in the first place. Allowing the injured worker to take responsibility for his own recovery is vital to this recovery and preventing injury in the future. Health professionals need to be constantly vigilant that their input is contributing to the injured worker helping himself, and not usurping that role.

Research suggests that psychosocial factors predict recovery better than biomedical factors alone in the normal population. However, no studies have been carried out in the disability income insurance setting, where the availability of financial cover is usually perceived as the main detractor of recovery and return to work.

Swiss Re's clinical claims team in collaboration with the Research & Development team, conducted a 3 year prospective study to evaluate the role of psychosocial factors in recovery within a group income protection sample. Predictors of return to work were: beliefs about recovery and work, work ethic, coping, and self-efficacy. Interestingly, medical diagnosis alone and treatment did not predict recovery and return to work in this sample.

Our objective was to conduct research to gain an understanding of psychosocial predictors in the insurance setting, and additionally to develop specific claims management strategies for our claims assessors to manage their claims more effectively through exploring the psychosocial barriers influencing on a claimant's absence, and providing adequate support at the right time, in a cost-effective manner.