By: Lela Holder RN, BSN, CCM | Director Complex Claims 

In the world of workers’ compensation, it’s easy to fall into a pattern of skepticism. When an injured worker delays their return to work, adjusters and employers may assume the worst: that the worker is dragging out the claim to avoid their job. But what if there’s another explanation? What if the delay is rooted in fear avoidance, not defiance?

What is Fear Avoidance?
Fear avoidance occurs when an injured worker is overly anxious about re-injury or believes their pain is a sign of further damage. This psychological response can significantly delay recovery, creating a cycle of inactivity and worsening symptoms. Unlike defiance, a willful refusal to return to work, fear avoidance is often subconscious and driven by genuine concern.

Example of Fear Avoidance vs. Defiance:

• Fear Avoidance: A warehouse worker with a back injury hesitates to return, expressing fear that lifting even small objects will lead to permanent damage. They attend physical therapy sessions but report ongoing discomfort and reluctance to engage in tasks similar to their pre-injury duties.
• Defiance: An injured worker misses appointments, fails to follow the prescribed treatment plan, and shows no interest in communicating about a return-to-work strategy, often without clear justification.

Signs of Fear Avoidance in an Injured Worker
Adjusters can identify fear avoidance by recognizing these behaviors:

1. Consistent Pain Reporting: The worker describes persistent pain despite medical clearance for light-duty or transitional work.
2. Catastrophic Thinking: They frequently use phrases like, “What if I hurt myself again?” or “I’m afraid this will get worse.”
3. Avoidance of Physical Activity: Hesitation to engage in even mild exercises prescribed by physical therapy.
4. Compliance Without Progress: The worker follows the treatment plan but shows minimal improvement due to fear of pushing their limits.

How to Address Fear Avoidance and Foster Recovery

1. Build Trust Through Communication
   Empathy is key: Create a safe space where the injured worker feels heard and validated. Use open-ended questions like:
   • “What concerns you most about returning to work?”
   • “Is there anything specific about your job duties that makes you uneasy?”
2. Educate the Worker
   • Explain the Healing Process: Share that discomfort is expected during recovery and doesn’t always signal harm. Use examples to clarify, such as, “A little soreness after physical therapy can mean your body is strengthening.”
3. Normalize Their Concerns
   • Address Fear Directly: Ask, “What concerns you most about returning to work?” This helps uncover specific fears, like pain or the potential for re-injury.
   • Reframe the Fear: Remind the worker of their progress, such as, “You’ve made great strides in therapy. That’s a sign your body is recovering well.”
4. Maintain Regular Contact
   • Frequent Check-ins: Schedule regular conversations to monitor their progress, answer questions, and provide guidance.
   • Be Consistent: Familiarity with the adjuster builds trust over time and reassures the injured worker that they’re supported.
5. Promote Positive Recovery Stories
   • Share Examples: Without breaching confidentiality, reference similar cases with successful outcomes: “Many workers in your situation have found that starting light-duty work helps them feel more confident about their recovery.”
6. Avoid Pressure Tactics
   • Stay Supportive, Not Pushy: Instead of saying, “You need to return to work soon,” try, “Let’s figure out a way for you to start feeling more comfortable about returning to work.”
   • Give Them Space to Process: Allow the worker time to consider the following steps without overwhelming them.

Why It Matters

• Misjudging fear avoidance as defiance can strain relationships and prolong claims unnecessarily. By recognizing and addressing the root cause of an injured worker’s hesitation, adjusters can resolve claims more efficiently and promote better recovery outcomes.

Real-World Example
A construction worker with a knee injury was cleared for light-duty tasks but refused to return, citing pain and instability. Initially perceived as defiant, the worker’s hesitance was found to be rooted in fear avoidance. With the help of a physical therapist and a supportive return-to-work plan, they gradually regained confidence and returned to full duty within two months.

By shifting our mindset and addressing fear avoidance with compassion and strategy, we can transform a challenging claim into a success story for the injured worker and the employer. Let’s give workers the benefit of the doubt and empower them to overcome their fears.