QBE INSURANCE

ISSUES FORUM
MAY 2007

REHABILITATION AND ACTIVE CASE

MANAGEMENT OF MSDS

OVERVIEW
Recent research from the HSE (1) confirms QBE’s long-
held view that the burden of musculoskeletal disorders
(MSDs) to employers is significant, with the highest
cost relating to time lost from work.

It is no coincidence that financial losses associated with

extended lost time often make up the largest
component of high-value personal injury claims,
offering a component of the business case and a
logical rationale for promoting proactive rehabilitation
and absence management.

We acknowledge the vital importance of ensuring early

and appropriate intervention for those who experience
MSDs, particularly where this has the potential to
escalate into extended absence.

In meeting this objective, the role of the case manager

is pivotal in liaising between affected individuals and
the organisation to facilitate a successful return to work
– a point echoed within the HSE report.

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PRO ACTIVE CASE MANAGEMENT
Employers are increasingly recognising the business case for pro-active risk management strategies to protect the
health and wellbeing of their biggest asset – their employees. Those seeking to implement a successful
programme/system of case management need to consider the framework for the successful operation of such a
programme, recognising the need for senior management commitment and liaison between relevant functions
such as HR, H&S and front line management. This also requires defined roles, ownership and competencies
throughout the management tiers.

Active case management is described as the goal–orientated approach to achieving specific work retention and
return to work outcomes, where the case manager facilitates and integrates clinical and occupational management
with the needs of the individual to ensure an appropriate and timely return to work.

An early return to work can be achieved by dispelling

some of the myths surrounding the subject, for example:

■ The employee should be 100% fit before returning

■ Returning to work increases the risk of re-injury

■ It is the healthcare provider’s responsibility, not the

employer’s, to get the employee back to work

■ A returning employee should be given ‘light duties’

■ A GP’s sick note means an employee cannot work

■ Those with pain want to stay off work as long

as possible

■ The employer should not contact an individual

who is absent.

Many of the factors influencing the adoption of cost

effective case management and rehabilitation
approaches rest with employers and their
financiers/commissioners of healthcare. It is often easier
to integrate these practices into large and medium-sized
workplaces, but the same principles apply equally to
small businesses.

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THE ROLE OF THE CASE MANAGER
Key components of successful and cost-effective case It is also apparent that key individuals should have
management include: defined roles and objectives. Consequently, the
employer needs to set out who does what, when and
■ One case manager assigned to each employee why? In brief, this should address:
■ The case manager facilitates sustainable return to
■ Identify the key personnel who will be involved
work by recognising and addressing any personal
and occupational obstacles. In this context, the ■ Clarify their roles and responsibilities
‘independence’ of the case manager to the ■ Communicate clearly with all concerned
organisation and their ability to mediate can be
■ Provide early access to advice for those
advantageous where the employee for example,
that experience MSD’s
‘blames’ their employer for their injury or illness.
■ Ensure appropriate treatment is identified
■ The case manager interfaces with healthcare
and provided
services
■ Assess whether changes to the work-place
■ The case manager monitors all aspects of
are required.
treatment – appropriateness, timeliness,
adherence, outcome and cost If a member of staff is absent from work,
employers should:
■ The case manager liaises directly with the
employer and negotiates transitional work ■ Keep in contact
arrangements, for example, with the line
■ Agree goals for a return-to-work plan
manager or OH Advisor.
■ Address obstacles that may delay the employee’s
The role of the case manager may be taken by an return to work
occupational health professional or the employer. In
simple cases the employer may be able to manage the ■ Ensure that rehabilitation is focussed on work tasks
case effectively, though for more complex cases which
■ Monitor and review the employee’s progress
are typically of longer duration, an experienced injury
case manager may be better suited to assist with the against the return to work plan and make any
employee’s rehabilitation. necessary changes.

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CONCLUSION
QBE has, for many years, championed rehabilitation and absence management. Working alongside our clients and
their Occupational Health providers, we offer a dovetailed Injury Management support service; ensuring early
intervention for injured employees is secured with the express purpose of promoting a timely return to work.

Additionally, we provide access to highly skilled and experienced case managers who can work alongside, and
enhance, our clients’ in-house functions by supporting Occupational Health staff in returning employees to
the workplace.

FURTHER INFORMATION
(1) HSE Research Report 493 (RR493) – ‘The costs and benefits of active case management and rehabilitation
for musculoskeletal disorders’.
This guidance has been incorporated into a model of best practice for use by UK organisations In addition the report
provides employers with guidance on the elements that ought to be included within a policy for managing MSDs
For further information, visit: http://www.hse.gov.uk/RESEARCH/rrhtm/rr493.htm
For further advice or guidance on how we can support your initiatives to improve Rehabilitation, Case
Management or Absence Management, please contact a member of the QBE Rehabilitation or Liability Risk
Management Teams, or other regular QBE contact.

www.QBEeurope.com/lrm

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 Dear reader
Thank you for taking the trouble to read this publication.
QBE Risk Management believe that best practice organisations are those where senior individuals
facilitate and engage in the processes of sensible risk management. We make this document available to
all interest parties in an effort to share knowledge and promote good practise.
Our services are available only to clients insured by QBE in Europe. Our insurance products are sold
through insurance brokers. We cannot offer advisory services to anyone else, however we would be
delighted to hear if you have found this document useful or believe there are risk management issues that
do not receive appropriate attention in the media.
Regards
QBE Risk Management Team
email: RM@uk.qbe.com
www.QBEeurope.com/RM

Disclaimer
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QBE Insurance Group.
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This Forum provides information about the law to help you understand and manage risk within your organisation.
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This Forum does not purport to provide a definitive statement of the law and is not intended to replace, nor may it be
relied upon as a substitute for specific legal or other professional advice.
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