Journal of Occupational Rehabilitation

, Volume 22, Issue 4, pp 478–488 | Cite as

Multi-Faceted Case Management: Reducing Compensation Costs of Musculoskeletal Work Injuries in Australia

  • Ross Anthony Iles
  • M. Wyatt
  • G. Pransky


Objectives This study aimed to determine whether a multi-faceted model of management of work related musculoskeletal disorders reduced compensation claim costs and days of compensation for injured workers. Methods An intervention including early reporting, employee centred case management and removal of barriers to return to work was instituted in 16 selected companies with a combined remuneration over $337 million. Outcomes were evaluated by an administrative dataset from the Victorian WorkCover Authority database. A ‘quasi experimental’ pre–post design was employed with 492 matched companies without the intervention used as a control group and an average of 21 months of post-intervention follow-up. Primary outcomes were average number of days of compensation and average cost of claims. Secondary outcomes were total medical costs and weekly benefits paid. Results Information on 3,312 claims was analysed. In companies where the intervention was introduced the average cost of claims was reduced from $6,019 to $3,913 (estimated difference $2,329, 95 % CI $1,318–$3,340) and the number of days of compensation decreased from 33.5 to 14.1 (HR 0.77, 95 % CI 0.67–0.88). Medical costs and weekly benefits costs were also lower after the intervention (p < 0.05). Reduction in claims costs were noted across industry types, injury location and most employer sizes. Conclusions The model of claims management investigated was effective in reducing the number of days of compensation, total claim costs, total medical costs and the amount paid in weekly benefits. Further research should investigate whether the intervention improves non-financial outcomes in the return to work process.


Occupational health Case management Workers compensation Intervention studies 



This work was supported by Canadian Institutes of Health Research (CIHR) grant(s) FRN: 53909. The authors would like to thank the management and staff of OccCorp Pty Ltd for their assistance in describing the intervention examined in this paper.


  1. 1.
    Young AE, Wasiak R, Roessler RT, McPherson KM, Anema JR, van Poppel MN. Return-to-work outcomes following work disability: stakeholder motivations, interests and concerns. J Occup Rehabil. 2005;15:543–56.PubMedCrossRefGoogle Scholar
  2. 2.
    Loisel P, Durand M, Berthelette D, Vezina N, Baril R, Gagnon D, et al. Disability prevention: new paradigm for the management of occupational back pain. Dis Manag Health Outcomes. 2001;9:351–60.CrossRefGoogle Scholar
  3. 3.
    Waddell G. The back pain revolution. 2nd ed. Edinburgh: Churchill Livingstone; 2004.Google Scholar
  4. 4.
    WorkSafe. 2006–2007 statistical summary. (2008). Accessed 10 Apr 2008.
  5. 5.
    Bernacki EJ. Factors influencing the costs of workers’ compensation. Clin Occup Environ Med. 2004;4:249–57.CrossRefGoogle Scholar
  6. 6.
    Stephens B, Gross DP. The influence of a continuum of care model on the rehabilitation of compensation claimants with soft tissue disorders. Spine. 2007;32:2898–904.PubMedCrossRefGoogle Scholar
  7. 7.
    Butler RJ, Johnson WG, Gray BP. Timing makes a difference: early nurse case management intervention and low back pain. Prof Case Manag. 2007;12:316–27.PubMedGoogle Scholar
  8. 8.
    Selander J, Marnetoft SU. Case management in vocational rehabilitation: a case study with promising results. Work. 2005;24:297–304.PubMedGoogle Scholar
  9. 9.
    Lambeek LC, Van Mechelen W, Knol DL, Loisel P, Anema JR. Randomized controlled trial of integrated care to reduce disability from chronic low back pain in working and private life. BMJ. 2010;340:c1035.PubMedCrossRefGoogle Scholar
  10. 10.
    Hogelund J, Holm A. Case management interviews and the return to work of disabled employees. J Health Econ. 2006;25:500–19.PubMedCrossRefGoogle Scholar
  11. 11.
    Young AE, Roessler RT, Wasiak R, McPherson KM, van Poppel MN, Anema JR. A developmental conceptualization of return to work. J Occup Rehabil. 2005;15:557–68.PubMedCrossRefGoogle Scholar
  12. 12.
    Elfering A. Work-related outcome assessment instruments. Eur Spine J. 2006;15:S32–43.PubMedCrossRefGoogle Scholar
  13. 13.
    Wasiak R, Young AE, Roessler RT, McPherson KM, van Poppel MN, Anema JR. Measuring return to work. J Occup Rehabil. 2007;17:766–81.PubMedCrossRefGoogle Scholar
  14. 14.
    Waddell G, Burton K, Aylward M. Work and common health problems. J Insur Med. 2007;39:109–20.PubMedGoogle Scholar
  15. 15.
    Costa-Black KM, Loisel P, Anema JR, Pransky G. Back pain and work. Best Pract Res Clin Rheumatol. 2010;24:227–40.PubMedCrossRefGoogle Scholar
  16. 16.
    Loisel P, Buchbinder R, Hazard R, Keller R, Scheel I, van Tulder M, et al. Prevention of work disability due to musculoskeletal disorders: the challenge of implementing evidence. J Occup Rehabil. 2005;15:507–24.PubMedCrossRefGoogle Scholar
  17. 17.
    Occupational Health and Safety Act 2004 (2004).Google Scholar
  18. 18.
    WorkSafe Victoria 2011. (2011). Accessed 6 July 2011.
  19. 19.
    Tabachnick BG, Fidell LS. Using multivariate statistics. 4th ed. Boston: Allyn and Bacon; 2001.Google Scholar
  20. 20.
    Faddy M, Graves N, Pettitt A. Modeling length of stay in hospital and other right skewed data: comparison of phase-type, gamma and log-normal distributions. Value Health. 2009;12:309–14.PubMedCrossRefGoogle Scholar
  21. 21.
    Polar Engineering and Consulting. PASW Statistics 17. 17.0.2 ed2009. (2009).Google Scholar
  22. 22.
    Carroll C, Rick J, Pilgrim H, Cameron J, Hillage J. Workplace involvement improves return to work rates among employees with back pain on long-term sick leave: a systematic review of the effectiveness and cost-effectiveness of interventions. Disabil Rehabil. 2010;32:607–21.PubMedCrossRefGoogle Scholar
  23. 23.
    Williams RM, Westmorland MG, Lin CA, Schmuck G, Creen M. Effectiveness of workplace rehabilitation interventions in the treatment of work-related low back pain: a systematic review. Disabil Rehabil. 2007;29:607–24.PubMedCrossRefGoogle Scholar
  24. 24.
    Frank J, Sinclair S, Hogg-Johnson S, Shannon H, Bombardier C, Beaton D, et al. Preventing disability from work-related low-back pain. New evidence gives new hope—if we can just get all the players onside. CMAJ. 1998;158:1625–31.PubMedGoogle Scholar
  25. 25.
    Federspiel CF, Guy D, Kane D, Spengler D. Expenditures for nonspecific back injuries in the workplace. J Occup Med. 1989;31:919–24.PubMedCrossRefGoogle Scholar
  26. 26.
    Hashemi L, Webster BS, Clancy EA. Trends in disability duration and cost of workers’ compensation low back pain claims (1988–1996). J Occup Environ Med. 1998;40:1110–9.PubMedGoogle Scholar
  27. 27.
    Williams DA, Feuerstein M, Durbin D, Pezzullo J. Health care and indemnity costs across the natural history of disability in occupational low back pain. Spine. 1998;23:2329–36.PubMedCrossRefGoogle Scholar
  28. 28.
    Loisel P, Lemaire J, Poitras S, Durand MJ, Champagne F, Stock S, et al. Cost-benefit and cost-effectiveness analysis of a disability prevention model for back pain management: a six year follow up study. Occup Environ Med. 2002;59:807–15.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of PhysiotherapyLa Trobe UniversityBundoora, MelbourneAustralia
  2. 2.Work Disability CIHR Strategic Training ProgramUniversite de SherbrookeMontrealCanada
  3. 3.Department of Epidemiology and Preventative MedicineMonash UniversityMelbourneAustralia
  4. 4.Liberty Mutual Research Institute for SafetyBostonUSA

Personalised recommendations