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Interactions Between Injured Workers and Insurers in Workers’ Compensation Systems: A Systematic Review of Qualitative Research Literature

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Introduction Work-related injury is a major public health problem and a worker’s recovery can be shaped by their interactions with employers, healthcare providers and the workers’ compensation system. Most research on the effects of compensation has concentrated on examining outcomes rather than considering the compensation process itself. There has been little attention paid to the interactions between stakeholders and only recently has the client’s view been considered as worthy of investigation. This systematic review aimed to identify and synthesize findings from peer reviewed qualitative studies that investigated injured workers interactions with insurers in workers’ compensation systems. Method A search of six electronic library databases revealed 1,006 articles. After screening for relevance, 18 articles were read in full and a search of those bibliographies revealed a further nine relevant articles. Quality assessment of the 27 studies resulted in a final 13 articles of medium and high quality being retained for data extraction. Results Included studies focused mainly on experiences of injured workers, many of whom had long term claims. Findings were synthesized using a meta-ethnographic approach. Six themes were identified which characterised the interactions between insurers and injured workers. The majority of interactions were negative and resulted in considerable psychosocial consequences for injured workers. Positive interactions were less frequently reported and included respectful, understanding and supportive communication and efficient service from insurers. Conclusion Findings from this synthesis support the growing consensus that involvement in compensation systems contributes to poorer outcomes for claimants. Interactions between insurers and injured workers were interwoven in cyclical and pathogenic relationships, which influence the development of secondary injury in the form of psychosocial consequences instead of fostering recovery of injured workers. This review suggests that further research is required to investigate positive interactions and identify mechanisms to better support and prevent secondary psychosocial harm to injured workers.

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  1. The version used by MacEachen et al. [21] excluded one question that related specifically to evaluation research and similarly that question was not included in this review.

  2. Reflexivity refers to the comments made by the authors of each article on how the context, selection of participants or data collection process affected the results obtained in their study.


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The project was funded by WorkSafe Victoria, the Transport Accident Commission and Monash University, Victoria, Australia. The authors wish to thank Dr. E MacEachen for the use of quality appraisal and data extraction proforma previously developed for a systematic review of qualitative literature on return to work.

Conflict of interest

The project No FS-M-11-029 was funded by WorkSafe Victoria and the Transport Accident Commission, (TAC) Victoria, Australia. ISCRR is a joint initiative of TAC, WorkSafe Victoria and Monash University.

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Correspondence to Elizabeth Kilgour.

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Quality Assessment Questions

The questions from the Quality Assessment Framework developed by Spencer [22] and modified by MacEachen [21] were reordered to fit the focus of the review. Each question was rated out of five using the suggested underlying quality guidelines. Questions 1 and 2 were regarded as important screening indicators. If reviewers did not score the first two questions at 2 or above, the assessment was not continued as it was evident that the article was not of sufficient relevance to be included in the review.

  1. 1.

    How has knowledge/understanding of interactions between key parties in workers’ compensation systems been extended by the research?

  2. 2.

    Scope for drawing wider inference about interactions between key parties in workers’ compensation systems—how well is this explained?

  3. 3.

    How well does the study address the original aims and purpose?

  4. 4.

    How credible are the findings?

  5. 5.

    How defensible is the research design?

  6. 6.

    How well defended is the sample design/target selection of cases?

  7. 7.

    Sample composition/case inclusion—how well is coverage described?

  8. 8.

    How well was the data collection carried out?

  9. 9.

    How adequately has the research process been documented?

  10. 10.

    How well was the approach to/formulation of the analysis conveyed?

  11. 11.

    Contexts of data sources—how well are they retained/portrayed?

  12. 12.

    How well has diversity of perspective and content been explored?

  13. 13.

    How well has detail, depth and richness of data been conveyed?

  14. 14.

    How clear are the links between data, interpretation and conclusions?

  15. 15.

    How clear and coherent is the reporting?

  16. 16.

    How clear are the assumptions/theoretical perspectives/values that shaped form and output of the study?

  17. 17.

    What evidence is there of attention to ethical issues?

The question excluded in this modified version was “How clear is the basis of evaluative appraisal?” which applies only to evaluation research.

Rating Calculation Guidelines

Each of the quality assessment questions were rated out of 5 and scores were then totalled to achieve the overall rating of the article. An overall score was calculated for the article and levels of quality were assigned as: Very Low (0–15); Low (16–30); Medium (31–55); High (56–70); and Very High (71–85). The questions included in each section, and the possible maximum scores for each section are listed below



Rated score

Maximum score






Design and Sample




Data Collection
















Reflexivity and Neutrality








Total score



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Kilgour, E., Kosny, A., McKenzie, D. et al. Interactions Between Injured Workers and Insurers in Workers’ Compensation Systems: A Systematic Review of Qualitative Research Literature. J Occup Rehabil 25, 160–181 (2015).

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