Not every workers’ compensation claim that stalls has a medical explanation. The injury may be healing, treatment may be appropriate, and modified duty may be available, yet appointments are missed, communication declines, or return to work suddenly becomes difficult.
When that happens, the most important question may not be, “What’s wrong with the treatment plan?” but “What else is influencing this recovery?”
Fear of reinjury, anxiety about returning to work, financial pressure, uncertainty, or simply feeling overwhelmed can influence an injured worker’s behavior. What appears to be noncompliance may actually be a warning sign that something beyond the physical injury is interfering with recovery.
Case Study: Looking Beyond “Noncompliance”
Jessie, a 45-year-old hotel housekeeper, injured her dominant right shoulder after tripping over a guest’s luggage. She was diagnosed with a shoulder sprain and strain, authorized for six physical therapy (PT) visits, and released to modified duty. Initially engaged in her recovery, Jessie attended only two PT sessions, did not return to work, and became increasingly difficult to reach. At follow-up, her pain and restricted motion had worsened, raising concern for developing a frozen shoulder. Her temporary total disability (TTD) benefits were discontinued because she had not returned to available work.
On paper, Jessie appeared noncompliant. When case management became involved, however, a different picture emerged.
Jessie had become increasingly anxious about her recovery. Discomfort during PT convinced her that the exercises might be causing further damage, so she began avoiding therapy. She was also apprehensive about returning to the hotel, fearing she might be asked to work beyond her restrictions or jeopardize her job if she refused.
As those concerns grew, Jessie became overwhelmed. Losing her TTD benefits added financial stress, while uncertainty about her recovery left her worried about whether she could continue working as a housekeeper. Rather than communicating those fears, she withdrew—avoiding calls, her employer, and appointments that heightened her anxiety.
The case manager helped Jessie understand the difference between expected rehabilitation discomfort and signs of potential injury and facilitated conversations with her physician and therapist about her concerns. The case manager also worked with the employer to clarify Jessie’s restrictions and modified duties. With clearer expectations, better communication, and her concerns addressed, Jessie resumed therapy and reengaged in return-to-work planning.
Behavior Can Be Information
Jessie’s case illustrates why it is important to look beyond the medical record when recovery stalls. Missed appointments, withdrawal, poor communication, or reluctance to return to work may look like noncompliance. But they can also signal fear of reinjury, anxiety, financial stress, uncertainty, or feeling overwhelmed.
Nurse case managers are uniquely positioned to identify these barriers because they communicate across the claim—with the injured worker, providers, employer, and claims professional. That visibility can help uncover what is actually preventing progress and coordinate the right response before a manageable issue becomes a prolonged claim.
When a claim unexpectedly stalls, perhaps the most valuable question is also the simplest:
What are we not seeing?
At ISYS®, our nurse case managers help claims teams identify barriers early, understand what may be driving delayed progress, and coordinate the right response.
Seeing unexpected delays, changing behavior, or stalled progress on a claim? Submit a referral to ISYS® and let our nurse case management team help identify what may be standing in the way of recovery.
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