When you’ve suffered a significant injury that impacts your ability to work or participate in meaningful activities, you may have to file an insurance claim, whether it’s with your employee benefits carrier or your car insurance provider. At first, they seem helpful and encouraging, suggesting you get treatments and see your doctor. But after a while, when you’re still not fully recovered, you may start to dread every call and email from them. They seem condescending, vague, and always need more information.
As a former injury adjuster, I have a solid understanding of what adjusters are probably trying to accomplish. Unfortunately, communication and support can deteriorate the longer a claim stays open. Decisions made by an adjuster can have a significant impact on your recovery, particularly when they’re made unilaterally without your input.
I’ve worked on both sides of the claim, as an adjuster and as a vocational rehab counsellor and kinesiologist. I regularly heard from clients who felt their adjuster was “cutting them off” or not approving additional treatments. These decisions often caused anxiety, fear, and uncertainty, sometimes accompanied by a pain flare-up or physical setback. As you can imagine, one phone call could undermine the progress someone had made over months of focused treatment.
When I was in school to become a clinical counsellor, I wrote a major research paper titled Adjustment, Identity Transition, and Injury Claims: An Integrative Review and Reconceptualized Framework. Here are five things I wish adjusters understood about how the claims process can affect the mental health of someone recovering from an injury and influence their rehabilitation progress.
1. The claim itself can affect your mental health
There’s the estimator, the injury adjuster, your doctor, your employer, the physio clinic…you get the idea. The administrative burden of having to file a claim can feel so overwhelming.
Things you have to remember: Schedule your vehicle to get repaired, send copies of your paystubs to verify your wage-loss claim, play phone-tag with the injury adjuster, book physio and massage appointments…that’s the tip of the iceberg.
The uncertainty: How long will I be off work? Will I make a full recovery? Why am I still in pain? It’s been months!
Research supports what you may already be experiencing: The administrative demands associated with insurance claims can add stress during recovery and negatively impact your mental and physical health. Compensation programs can also make the return-to-work (RTW) process more complicated.
I wish adjusters fully acknowledged all the moving parts and the administrative burden that come with filing an injury claim after an accident. It would be helpful if they simplified the process and explained why certain documentation is necessary.
2. Constantly having your recovery decided for you can take a psychological toll
Many insurance recovery specialists aren’t clinicians. They don’t have medical degrees, they aren’t physiotherapists, and they aren’t experts in psychological trauma related to injuries and accidents. The real kicker is that they may have less medical knowledge than the people treating you, yet still have significant power over decisions that affect your recovery. Make that make sense!
When they call, you may feel pressured to do whatever treatment they suggest. You’re afraid that if you don’t, you’ll be cut off from benefits. Then they want to send you to a specialist for an assessment, and if you don’t attend, your benefits will be affected. You may even feel like you’re being forced to go back to work long before you’re ready.
Studies show that a common complaint from people recovering from an injury who have an open insurance or disability claim is that they feel like they have no control over their recovery.
I wish adjusters understood that losing a sense of control, autonomy, and personal agency during recovery can take an emotional toll. Asking for the injured person’s input and feedback on what seems to be working in their recovery would build trust and give them a greater sense of involvement in decisions about their treatment.
3. Pressure to return to work isn’t always motivating
If you’ve been off work due to your injury, you’re already feeling stressed, and not just financially! Maybe you were in the middle of a major project that had to be reassigned to a colleague. Perhaps your employer is now short-staffed, and all your coworkers are having to cover for you.
Either way, you want to get back to work, but you just aren’t ready to manage a full workday at a stressful or physically demanding job. You fear that if you return to work (RTW), you’ll be in so much pain and discomfort from your injuries, and so fatigued, that you won’t be able to do anything else but rest.
Research suggests that external pressure from a case manager or employer, including being deemed as “job ready,” are associated with failed RTW attempts. Consequently, this has a major impact on your mental health, especially if work is really important to your sense of self.
I wish injury recovery specialists understood that pressure to RTW too early can backfire. A failed RTW attempt can be discouraging and make the next attempt more difficult. If they want to avoid this cycle, a more flexible, gradual RTW plan may give someone a better chance of finding a pace that feels safe, manageable, and sustainable.
4. “Non-compliance” doesn’t always mean someone doesn’t want to recover
Let me guess: You’re anxious about why you haven’t recovered yet. You’re starting to feel hopeless because treatments aren’t working. You’re overwhelmed and frustrated with managing all the administrative demands of your insurance claim. You feel like you’ve lost all control in your recovery. You’re feeling down, irritable, and downright helpless.
You start cancelling appointments. You’re in pain, fatigued because your sleep has been awful, and sometimes treatment leaves you feeling worse, not better. You don’t always do the stretches and exercises the physio gave you anymore because they don’t seem to make things feel better anyways. When a new treatment is suggested, it takes you a few weeks to get around to booking the first session.
This doesn’t necessarily mean you don’t want to recover and get out of pain, or that you’re deliberately trying to delay going back to work. The ups and downs of recovering from a traumatic injury can take a psychological toll, which can affect how well you’re able to follow through with treatment.
I wish case managers recognized that what they consider “non-compliance” may reflect unaddressed psychological barriers to recovery. Rather than automatically assuming someone is faking their pain and symptoms or being lazy for secondary gain, it’s worth considering what else might be getting in the way.
5. Your mental health is part of your recovery, not a separate problem
Have you noticed that since your injury, when you’re feeling really stressed, your pain gets worse? Your neck stiffens, you get those really bad headaches, and your lower back has that deep ache that Advil doesn’t even touch. If you notice pain flare-ups when doing certain activities, sitting too long, or lifting something too heavy, there may be more going on than the physical injury alone. Ongoing stress and fear can influence how you experience pain and how you engage in activities.
If you’ve noticed that you startle easily or constantly feel like you’re “on edge” since your injury, it may be worth paying attention to how the psychological effects of the accident are influencing your recovery. When you experience an injury that affects your ability to do the things you normally do, it makes sense that you might become more alert to potential threats or worry about making things worse. When you start anticipating pain or expecting an activity to aggravate your injury, fear and stress can influence how you respond to movement and whether you avoid certain activities. Over time, this can become another obstacle to recovery.
Research suggests that stress associated with the claim process and fear about your recovery, are associated with higher reported pain levels and more avoidance of daily activities. When you’ve suffered a life-altering injury that turns your world upside down, it’s not just the physical recovery that needs attention. When it feels like “one step forward, two steps back,” addressing fear, stress, and the psychological effects may be one useful part of managing your pain and getting back to meaningful activities.
I wish adjusters recognized that someone’s emotional and psychological state can impact pain and functional capacity. Having a more compassionate, trauma-informed approach to communicating would go a long way.
Takeaways
If you’ve been injured and are dealing with this right now, the anger, frustration, emotional exhaustion, and physical pain you’re experiencing can be common responses to the stress and uncertainty of recovery. It doesn’t mean every symptom has the same cause, but it does suggest that the psychological impact of an injury deserves attention alongside the physical recovery.
If you’re a case manager, injury adjuster, or insurance claim agent, your role is difficult. But put yourself in the shoes of the person who has been severely injured in an accident. They are in pain, they may be worried about their safety, and they’re concerned about their ability to return to work. Their life doesn’t go on hold just because they were injured. They still have a long list of responsibilities, and now they’re adding on medical appointments, paperwork, and chasing down the people that are supposed to be helping them.
A little more clarity, consistency, and collaboration can make a real difference in how someone experiences the claims process while they’re trying to recover.
If you’re finding that the stress of your injury or the claims process is starting to affect your mental health, it may be worth considering how counselling could support your recovery. You don’t have to wait until you’re struggling to manage everything before addressing the psychological side of an injury. Learn more about navigating life after injury, explore ICBC counselling and chronic pain counselling, or book a free consultation with Tanis Burnett, MC, RCC.