The News You Need for Nov. 26
Recognizing the drama triangle at work, nurses push back against workplace attacks, and getting in the know in Iowa. Plus, NCCI looks at some recent cases.
The Drama Triangle in Workers’ Compensation: Recognizing Unproductive Patterns?
Claims adjusters, injured workers, and employers play pivotal roles in the workers’ compensation recovery and claims process. Challenges often arise when interactions fall into what psychologist Stephen Karpman termed the Drama Triangle. This model explains three unproductive roles: Victim, Rescuer, and Persecutor. These roles represent patterns of behavior where problems are magnified, and solutions become secondary. Shifting from these roles to more constructive behaviors is crucial for creating a more supportive and effective workers' compensation experience for everyone involved.?
The Drama Triangle has a significant impact on the claims process. It describes dynamics in which people adopt behaviors that unintentionally reinforce conflict, frustration, and dependency. In the context of workers' compensation, the Drama Triangle can hinder recovery, create misunderstandings, and damage trust between adjusters, employers, and injured workers. Understanding and addressing these dynamics is crucial for a more effective and supportive workers' compensation experience.?
Understanding the Roles in the Drama Triangle?
Victim: This role reflects feelings of powerlessness, frustration, and vulnerability. Injured workers, faced with sudden disruptions in their health, income, and daily life, may understandably fall into the Victim role. They might feel that the system is against them, believe they are misunderstood, or worry that no one truly cares about their well-being. This mindset can hinder their recovery and make it challenging to engage positively with claims adjusters or employers.?
Rescuer: This role often appeals to claims adjusters or employers who genuinely want to help. However, a Rescuer's approach tends to be over-involved, solving problems for the worker rather than with them. While the intent may be supportive, the Rescuer inadvertently reinforces the worker's dependence on external solutions, limiting their sense of control over their recovery. This dynamic can lead to frustration for both parties when expectations are not met.?
Persecutor: In the workers' compensation context, the Prosecutor's role may appear when rules or decisions feel harsh, unsupportive, or punitive to the injured worker. Sometimes, claims adjusters or employers adopt this role unconsciously by focusing too much on compliance or policy enforcement without sufficient empathy. From the worker's perspective, this can feel oppressive, leading to mistrust and resentment, affecting their cooperation and openness throughout the claims process.?
Each role reinforces unproductive dynamics, keeping those involved in a cycle of frustration and misunderstanding. For example, suppose a worker perceives an adjuster as a Persecutor. In that case, they may withdraw or act defensively, which may cause the adjuster to become more rigid or feel frustrated, leading to a downward spiral in communication and trust.?
How the Drama Triangle Impacts Workers' Compensation?
The Drama Triangle is more than just a theoretical model; its dynamics play out in everyday interactions within workers' compensation. When individuals fall into one of these roles, the entire process can become bogged down by unproductive behaviors, misunderstandings, and resistance. This realization should concern us, as it hinders the claims process and delays recovery. It manifests in workers' compensation from communication breakdowns to emotional strain and mistrust delaying recovery and resolution.??
Communication Breakdowns: When roles in the Drama Triangle take over, open and transparent communication suffers. An injured worker who feels like a Victim may withhold important details or fail to ask questions, leading to misunderstandings that delay recovery. Similarly, a Rescuer adjuster may decide for the worker without thorough discussion, assuming they know what is best. These miscommunications can increase frustration and hinder cooperation.?
Emotional Strain and Mistrust: The Drama Triangle often leads to heightened emotions, with each role contributing to feelings of stress, anxiety, or resentment. An injured worker may feel frustrated with the lack of control over their situation. In contrast, the claims adjuster, overwhelmed by the Rescuer's role, may feel pressured to meet unrealistic expectations. Trust erodes when both parties experience emotional strain, making it harder to build a collaborative relationship.?
Delays in Recovery and Resolution: The claims process slows down when adjusters and injured workers are trapped in the Drama Triangle. For example, an injured worker feeling like a Victim may hesitate to fully participate in recovery efforts, believing they are not capable of progressing or that their needs are being ignored. Similarly, a Rescuer adjuster may inadvertently enable dependency by not encouraging the worker to take an active role in their recovery, leading to delays.?
Breaking Out of the Drama Triangle?
Breaking free from the Drama Triangle requires awareness and intentional action. Each party in the workers' compensation process—whether an injured worker, claims adjuster, or employer—can choose to step out of these limiting roles and instead adopt behaviors that encourage empowerment and collaboration.??
Here are some strategies to help shift from the Drama Triangle to more constructive interactions:?
Moving Toward the Empowerment Circle?
The goal of understanding the Drama Triangle is not to assign blame but to provide insight into unproductive dynamics that can hinder recovery. By recognizing these roles, workers’ compensation professionals can take steps toward adopting roles from the Empowerment Circle—Creator, Challenger, and Coach—which we will explore in the following articles. In the Empowerment Circle, all parties are encouraged to take an active, constructive role in achieving positive outcomes.?
When adjusters, employers, and injured workers step out of the Drama Triangle and into the Empowerment Circle, they create a culture of cooperation and support. They foster resilience, accountability, and progress instead of reinforcing dependency, frustration, or resentment. The shift may take time, but with each step, the recovery process becomes less about overcoming obstacles and more about building a path to wellness and stability.?
Nurse’s Union Says Work Environment ‘Unacceptable’ due to Attacks
Burrillville, RI (WorkersCompensation.com) – A nurse’s union is speaking out about the work environment at a state-run facility, after a violent patient repeatedly attacked staff members.
The allegations came after a nurse was allegedly attacked on Nov. 15 at the Eleanor Slater Hospital’s Zambarano campus. The United Nurses and Allied Professionals Local 5019 said its members are “extremely frustrated,” after being attacked, and having had a grievance they filed rejected by the Rhode Island Department of Administration last month.
UNAP president Lynn Blais said the patient was transferred to Zambarano after the state closed another hospital, the Regan Building, a separate division of Eleanor Slater Hospitals, for renovations.
Union officials said after the patient arrived in Burrillville, he started assaulting staff members and hurting himself. In its grievance, the union said the patient acted violently, including throwing feces at a nurse, pulling another nurse’s hair and assaulting two staff members. In one incident, the grievance said, the patient left scratches on a nursing assistant’s arm that drew blood.
Blais said nurses are told to go into the patient’s room prepared to be attacked.
“He bites, he scratches, he hits, he punches,” Blais told WPRI. “No one should have to work under those conditions. To tell your staff that you need to be prepared to be attacked and not put the resources in place to prevent those attacks is unacceptable.”
A spokesman for the R.I. Department of Behavioral Health, Developmental Disabilities and Hospitals, said, “The safety of our patients and staff is the hospital’s utmost priority.”
Edgar said the department has increased the security on the patient’s unit, enhanced staff when working with him and retrained its staff on “safe patient handling.”
“The hospital considers multiple strategies to enhance the safety of its staff on an ongoing basis,” Edgar added.
Blais said the actions weren’t enough. The union said it has filed criminal complaints against the patient.
“Talk doesn’t get us where we need to go,” she said. “We need action.”
The union has also requested the hospital transfer the patient back to the original campus that he came from and even consider discharging him to a homeless shelter. But staff with Eleanor Slater Hospitals said the patients’ medical needs are too much to handle at any other psychiatric hospital in the state.
Blais said the issue is emblematic of the larger issue of violence against healthcare staff at hospitals across the state.
“It happens,” she said. “There’s still a lot of work to be done when it comes to ensuring the safety of all of our health care workers in the state, in every hospital. We face this every single day.”
Across the country, nurses, doctors and other healthcare workers are under attack.
In Georgia, the Richmond County Sheriff’s Office said it has arrested a man for allegedly attacking a nurse at Doctors Hospital in August last week.
Officials said Trey Jones has been charged with punching a nurse in the mouth on Nov. 11. The attack caused the nurse to black out and left the nurse suffering from a concussion as well as a bleeding mouth. The nurse was hospitalized and given a neck brace for his discomfort.
Jones was charged with battery and possession of drugs. Doctors Hospital said it has a zero tolerance policy in regard to violence toward its staff and is working with law enforcement on the case.
In Townshend, Vt., a California man was arrested after he attacked a nurse.
Police in Townshend said they were called to Grace Cottage Hospital on Nov. 20, after a patient attacked a nurse. The nurse was treated for facial injuries and released.
Vermont State Police said Adam Rauch, 22, of San Diego, had fled the hospital after the attack and damaging property at the hospital. With some help from the public, police said they found Rauch and arrested him. He was charged with assault on a protected professional and unlawful mischief.
And in Staten Island, N.Y., a man was charged with assaulting a nurse at Richmond University Medical Center earlier this month.
Officials said Alexander Lopez, of West Brighton, was charged with third-degree assault and second-degree harassment in connection with a Nov. 5 attack. Officials said Lopez punched a female nurse in the face and pulled her hair with both hands as she was trying to insert an intravenous injection into him.
Violence against healthcare workers in on the rise. Those workers are five times more likely to experience workplace violence, according to the U.S. Bureau of Labor Statistics. Attacks on healthcare workers account for 73 percent of all nonfatal workplace injuries and illnesses due to violence, BLS statistics show.
According to a report from the Emergency Nurses Association released this year, more than half of the emergency nurses (53 percent) surveyed in 2023 said they had been attacked or threatened with violence in the past 30 days.
And a report from Press Ganey found that more than two nurses were assaulted every hour in the second quarter of 2022, or roughly 57 assaults per day; 1,739 assaults per month; and 5,217 assaults per quarter. The report, National Database of Nursing Quality Indicators, found that the highest number of assaults occurred in psychiatric units and emergency departments, and that psychiatric units and rehab units have the largest percentage of assaults resulting in moderate to severe injuries.
What is Iowa’s Willful Injury Defense?
Do You Know the Rule?
Iowa’s workers’ compensation statute does not allow employees, or their surviving family members, to collect benefits when the employee, effectively, knowingly harmed himself. This is the willful-injury defense outlined in Iowa Code section 85.16(1) (2016), and it allows employers and carriers to withhold compensation under certain circumstances.?
When it applies?
The defense applies in three scenarios:?
1. Intent to harm self or another. The injury was caused by the employee’s willful intent to injure himself or herself or to willfully injure another.?
2. Intoxication. The injury was caused by the employee’s intoxication.??
2. A third-party’s willful act. The injury was caused by the willful act of a third party directed against the employee for reasons personal to such employee.?
Suicide
These cases typically involve situations where the employee purportedly committed suicide. Employers will have to look for clear evidence of the employee’s intent to commit suicide, such as a suicide note or verbal expressions of the intent to coworkers.?
Establishing intoxication?
For the intoxication defense to apply, the employer must show all of the following:?
To show that the intoxication was due to alcohol or drugs, employers can look to drug tests indicating that the employee had alcohol or drugs in his blood at the time of, or right after, the injury.??
Establishing a third-party’s willful act?
To establish the defense based on a third-party’s action, the employer will have to show that the injury arose from a personal situation, such as a dispute between the employee and third-party unrelated to the employee’s job.?
Employee’s burden to overcome the defense?
Once the employee shows the above, the onus is on the employee. He or she can move forward with the claim by establishing one of the following:?
NCCI Court Case Update
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Iowa, Entitlement to Death Benefits
On October 30, 2024, the Iowa Court of Appeals, in?Linnhaven Inc. v. Blasdell, affirmed an award of workers compensation (WC) death benefits to the spouse of a totally disabled employee who died from a prescription drug overdose.
An employee who developed depression after suffering a compensable workplace injury died from a prescription drug overdose. The employee's spouse filed a claim for WC death benefits. The employer denied liability, asserting that the employee died by suicide, which pursuant to Iowa statute 85.16, bars recovery of WC benefits for willfully self-inflicted injuries. The Workers' Compensation Commissioner (WCC) concluded that although there was some evidence that could have pointed to a suicide, other evidence supported a finding of an accidental overdose.
On appeal, the court of appeals explained that the WCC is vested with discretion to make factual determinations in cases such as this. Moreover, the court noted, the WCC's determinations must be accepted when supported by substantial evidence, regardless of whether other evidence in the record makes it possible to arrive at the opposite result. In this case, the court concluded that the WCC's finding that the employee's death was caused by an accidental overdose was supported by substantial evidence and upheld the award of death benefits.
Kentucky, COVID-19 Compensability
On November 8, 2024, the Court of Appeals of Kentucky, in?Norton Healthcare v. Murphy, held that a nurse was not entitled to workers compensation (WC) benefits as she failed to meet her burden of proof that her contraction of COVID-19 was work related.
In this case, a nurse filed an?injury claim?seeking WC benefits for her alleged contraction of COVID-19 at work. The administrative law judge (ALJ) concluded that the nurse failed to present clear evidence of actual exposure at work. The Workers' Compensation Board reversed the ALJ's determination concluding that, as an?occupational disease?claim, the employee only had to show that the workplace conditions "could have caused" the disease.
On appeal, the court of appeals disagreed with the Board's finding, reasoning that the Board had applied the?occupational disease?standard to an?injury claim?based upon exposure to a communicable disease. The court noted that, according to Kentucky statute 342.0011, communicable diseases can be compensable as injuries when the claimant establishes that the risk of contracting the disease is increased by the nature of the employment. Turning to the facts of the case, the court found that while there was some evidence of potential exposure at work, the nurse failed to present any clear evidence of actual work exposure. Moreover, the court added, the record contained substantial evidence that the nurse could have contracted the illness while engaging in activities outside of work.
With this decision, the court reversed the Workers' Compensation Board's findings, concluding that the ALJ applied the correct standard as to the question of whether the nurse was actually exposed to COVID-19 during the course and scope of employment.
Maine, Accrual of Interest on Benefits
On November 5, 2024, the Supreme Judicial Court of Maine, in?Michaud v. Caribou Ford-Mercury, Inc., considered for the first time when specific loss benefits for the loss of an eye become due to a claimant.
In 2014, a claimant suffered a traumatic injury to the left eye, which immediately resulted in a loss of more than 80% of vision in that eye. In 2021, the claimant petitioned for specific loss benefits, which are designed to compensate injured employees for the actual loss of a body part. A physician determined that the claimant was at maximum medical improvement (MMI) and that at that point in time, the claimant had a 94% loss of vision in the affected eye.
The court determined that per Maine statute 212, the claimant was entitled to specific loss benefits as he had sustained 80% loss of vision. Turning to the issue of when the benefits became due, the court reasoned that even though the determination of when benefits become due cannot be made until after MMI has been reached, the date that specific-loss benefits become due is retrospective, potentially to the date of injury. The analysis would require looking backward to determine when the eye injury damaged the employee's vision to the threshold of 80% vision loss, whether treatment later restored the employee's vision, and the extent of any restoration.
Based on the facts of this case, the court concluded that the employee suffered actual loss of his left eye on the date of his injury and there was never an assessment that his vision loss was restored to a point below the 80% threshold after that. Therefore, the court held, the employee became entitled to specific-loss benefits on the date of his injury and the employer owed interest on the award accruing from that date.
For more information on other cases monitored by NCCI's Legal Division, visit previous Court Case Updates and?Court Case Insights?under the?Legal section?of?INSIGHTS?on?ncci.com.
CRRN, PACU - BSN, RN, multi state. Rehabilitation, cardiac and wound care.
3 个月Very informative! Developing the balance of care & recovery ????!