Fear Of Firing: a Predictive Factor in Return to Work

Posted by Jeffrey Jacobs, M.D., M.P.H.

Employees who are afraid they will get fired appear to be less likely than non-fearful employees to return to work after reporting a work-related injury, according to data presented last week at the Workers’ Compensation Research Institute’s Annual Issues and Research Conference in Boston.

In a 15-state study, the institute found 10 to 20 percent of injured employees (median, 14 percent) did not return to work. Injured workers completed a survey in which they were asked: “When you were injured, were you afraid of being fired or laid off?”

Dr.  Bogdan Savych, a public policy analyst, said “fear of firing” was identified as one factor that can be used to predict work-return rates. More specifically, among respondents:

  • Those who strongly agreed with the question were more likely than others to have poor health outcomes.
  • 22 percent of those who strongly agreed failed to return to work, compared to 13 percent who somewhat agreed and 9 percent who disagreed with the question.
  • Those who strongly agreed were about twice as likely as those who somewhat agreed and more than seven times as likely as those who disagreed to obtain legal representation.

Self-Fulfilling Prophecy

In a related presentation, Glenn Pransky, M.D., M.Occ.H., director of the Center for Disability Research at the Liberty Mutual Research Institute for Safety, referred to similar findings from another study. At their initial post-injury treatment encounter, injured workers were asked to predict how soon they would return to work. Among individuals who believed they were “unlikely” to be able to perform their regular job without any restrictions within four weeks, only 40 percent eventually returned to work. Those who predicted they would return to work and full function had a 90 percent return-to-work rate within four weeks.

Dr. Pransky also mentioned a previous study that examined ways supervisors influence health outcomes and return-to-work rates. That study showed negative responses by supervisors upon initially learning of a work injury – such as dismissive remarks or expressions of anger or disbelief – tended to foster negative results. Dr. Pransky stressed that when injured workers feel they are not being treated fairly from the start, they are more apt to experience delayed recovery and seek legal remedies.

Mitigating Fear

These findings serve as a reminder that employers, insurers and medical professionals need to practice their listening skills, use initial encounters as an opportunity to guide injured workers toward reasonable expectations for recovery, and educate them about the treatment and claim process so there are no surprises.

When all parties involved in the care of an injured worker show genuine empathy and a willingness to facilitate the return-to-work process at the earliest stage, they help overcome initial employee resistance and mitigate the fear-of-firing response.

Dr. Jeffrey Jacobs is an Associate Medical Director with WorkCare.

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