The Real Reason Some Employees Never Come Back to Work

In workers’ compensation, it’s easy to focus on the medical side of an injury — the X-rays, the surgery, the therapy schedule. We’re trained to ask “What’s the diagnosis?” and “When will they be cleared for work?”

But after years of analyzing claim patterns, one truth stands out: the body isn’t always the problem.

In fact, studies show that 60–80% of lost workdays are medically unnecessary. The injury has healed — but something else is keeping the worker out. That “something else” is at the heart of the biopsychosocial model of injury recovery.

Understanding the Model

The biopsychosocial model expands the traditional biomedical view of an injury. It recognizes that recovery isn’t just about fixing tissue — it’s about helping a person heal in body, mind, and environment.

Let’s break it down:

• Bio (Biological): The physical injury itself — a strained back, a torn ligament, or a shoulder sprain — plus any comorbidities like obesity, smoking, or diabetes that affect healing.

• Psycho (Psychological): The worker’s emotional and mental state — fear, anxiety, frustration, depression, or a sense of hopelessness about recovery.

• Social: The external context — family issues, job satisfaction, financial stress, relationships, and even the culture of the workplace.

When these three dimensions interact, they create the worker’s recovery reality. Two people can have the exact same physical injury, but dramatically different outcomes depending on the psychosocial environment surrounding them.

Two Johns, One Injury — Two Very Different Outcomes

Here is an illustration with a simple story of two employees — both named John — who experience the same shoulder strain.

• John #1 plays softball on weekends, stays active, and enjoys his work. He has a good relationship with his supervisor and coworkers. He reports his injury promptly, follows medical advice, and returns to modified duty within weeks.

• John #2, on the other hand, is struggling. He’s going through a divorce, behind on bills, and feels unappreciated at work. When he gets hurt, the injury becomes one more weight on his shoulders — literally and figuratively. He delays reporting, misses therapy, and questions his doctor’s recommendations. Months later, he’s still out of work, frustrated, and feeling hopeless.

The same injury. The same treatment plan. Two completely different outcomes.

The difference lies not in the biology of the shoulder — but in the psychology and social stress surrounding it.

Why This Matters for Employers

Ignoring the psychosocial dimension of recovery is one of the costliest blind spots in workers’ comp. These unseen barriers — anxiety, isolation, distrust, or life chaos — quietly drive up claim duration and cost.

Here’s why this matters:

1. Psychological barriers multiply medical ones.
   A worker afraid of re-injury will resist therapy, avoid light-duty offers, and fixate on pain.

2. Social stress delays recovery.
   Financial pressure, family conflict, or a hostile work culture can turn a minor injury into a major emotional crisis.

3. Unaddressed stress fuels catastrophic creep.
   The longer an employee is out of work, the more disconnected they feel — and the harder it becomes to bring them back.

Spotting the Warning Signs Early

Recognizing psychosocial risk factors is just as important as identifying physical symptoms. Here’s what employers, supervisors, and claims managers should watch for:

• Negative emotions: Anger, resentment, hopelessness, or excessive fear about returning to work.

• Avoidance behaviors: Missed appointments, delayed reporting, or inconsistent communication.

• Resistance to treatment: Complaints about doctors, denial of progress, or refusal of modified duty.

• Life stressors: Divorce, financial trouble, caregiving burden, or substance abuse.

• Isolation: Lack of coworker contact, disengagement, or silence from the employee.

Each one of these is an early indicator that the injury might be turning into a creeping catastrophic claim — the kind that quietly costs your organization hundreds of thousands of dollars and deeply impacts the worker’s life.

Building a Whole-Worker Recovery System

You can’t eliminate life stress — but you can build systems that account for it.
Here’s how employers can apply the biopsychosocial model in real-world claim management:

1. Train Supervisors to See the Whole Picture

Supervisors are often the first to notice when something’s “off.” Equip them to recognize emotional distress, changes in behavior, and early red flags — not just physical complaints.

2. Communicate With Empathy

A simple, supportive phone call can prevent a claim from derailing. Ask open-ended questions like, “How are you feeling about your recovery?” or “Is there anything making this harder for you?”

3. Use Screening Tools

Validated tools like the REBRO Short Form or PHQ-4 can identify risk factors for delayed recovery within the first 2–4 weeks post-injury. They’re short, free, and proven to predict long-term disability risk.

4. Offer Targeted Support

High-risk cases can benefit from cognitive behavioral therapy (CBT) — a short-term, goal-oriented approach that helps workers cope with stress and get back to work faster.

5. Create a Supportive Culture

Encourage a workplace that values recovery, not blame. Celebrate successful return-to-work stories and emphasize that asking for help is a strength, not a weakness.

The Real Goal: Healing People, Not Just Injuries

When employers embrace the biopsychosocial approach, something powerful happens: recovery becomes human again.

You stop treating a claim number — and start helping a person heal.
That shift changes everything: lower costs, faster recoveries, and stronger trust between employer and employee.

Because in the end, workers’ comp isn’t about fixing shoulders or knees — it’s about restoring lives.
And to do that, you have to see the whole person, not just the injured part.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

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