Am I being rorted by stress claims?

Hi Aunty B,

I work closely with the CEO of our organisation. We are both very concerned that the organisation seems beset by way too many stress leave claims and that maybe they aren’t all legitimate.

While appreciating that there are legitimate claims, some seem questionable. There’s a long standing department head, fully trained and experienced in recognising and coping with stress and solving workplace problems, who’s been off work for almost 12 months now with “anxiety and depression” without any return to work plan being prepared by the insurer. This person has other family issues that are objectively definitely more stressful than work would ever be.

Then there are three others who just seem to be wanting a holiday at the company’s expense. Their work is relatively evenly paced and the level of accountability isn’t high – it’s their supervisor who is accountable.

The latest “work stress” claim is someone who works in admin with limited defined responsibility. As an ex-admin person, I know that this job isn’t onerous. The employee gets on well with co-workers. Objectively, the problem area seems to be that the spouse is absent a lot for work reasons, there’s a house move afoot and our employee is coping with that and looking after their kids and stretching the budget to pay the additional rent that the house move brought about.

These claims seem like rorting the system rather than legitimate stress-related psychological injury. But the insurance company accepts the claims each and every time and the insurance premium goes up and up. How can the insurance company be persuaded to scrutinise claims more fully before accepting them (and increasing the premium) and what’s the best way of minimising the risks to the employer in this area?

Lyn,
regional NSW

Hi Lyn, I called in Uncle P, legal adviser, to help with this one as there are legal complications.

Here is his response:

“You need to look within your organisation to figure out if there may actually be a problem at senior management level – is the senior management stressing out about their direct reports because of their style, the demands of the business or whatever – don’t just assume it is outside pressures.

“A return to work plan is the employer’s responsibility. Get on to it ASAP; find a good return to work provider and work with them to find a good doctor to look after the company’s interests. Make sure you have input into the return to work plan and actively hold the employee to it.

“If outside pressures are a problem, think about implementing an employee assistance plan. Maybe specific employees could be offered some limited financial counselling at the company’s expense. In regional areas, is drought an issue that may affect the employee?

“When a new claim comes up, make clear to the insurance company what your attitude to it is and press them not to accept the claim without an investigation. Try and get your insurance company to provide you with a dedicated account manager – a lot of problems stem from too many clerks passing the file around at their end.

“Arrange regular medical examinations through the insurance company to assess the employee’s progress. You may also need to consider termination on the basis of incapacity to perform the inherent requirements of the position, but this is an anti-discrimination minefield, so get advice.”

Good luck,

Uncle P.