How Medical Case Management Addresses Burnout

Burnout is emerging as a major factor in Workers’ Compensation claims. The World Health Organization (WHO) recognizes burnout as an “occupational phenomenon” tied to chronic workplace stress. The CDC reports that nearly half of healthcare professionals experience frequent burnout. For claims professionals and those overseeing medical case management, that recognition matters. Injured workers struggling with burnout are harder to engage, take longer to recover, and often require more costly interventions.

The National Institute for Occupational Safety and Health reports that job stress contributes to higher absenteeism, increased healthcare utilization, and elevated costs for employers. In Workers’ Compensation, that translates directly into longer claim durations and higher costs.

Understanding Burnout in Workers’ Compensation

Although burnout isn’t classified as a medical condition, it has real consequences for how injured employees heal and return to work. The WHO defines burnout as a syndrome linked to chronic workplace stress, characterized by three dimensions:

• Exhaustion
• Cynicism or mental distance from work
• Reduced professional efficacy

In the Workers’ Compensation setting, these symptoms directly influence claims:

• Exhaustion may lead to missed physical therapy appointments or inconsistent medication use.
• Cynicism and disengagement can erode trust in providers, case managers, and adjusters.
• Reduced efficacy can delay readiness to resume job duties, even after physical recovery.

The Workers’ Compensation Research Institute (WCRI) has shown that psychosocial risk factors are among the strongest predictors of delayed recovery and prolonged claims. Burnout squarely fits into this category, adding another barrier to efficient case resolution.

Burnout as a Barrier to Recovery

Healing from an injury is not just about the body. Burnout adds layers of complexity that slow recovery and extend time away from work:

• Delayed care: Workers experiencing burnout may avoid scheduling tests or skip follow-ups.
• Disengagement: Low motivation often translates to inconsistent participation in rehab.
• Psychological stress: Fear of job loss or financial insecurity compounds physical pain and delays recovery.

Example:

Consider a nurse recovering from a back injury. On paper, her prognosis is favorable. Conservative care and light duty should have her back within weeks. But if she’s also struggling with burnout, she may express hopelessness, miss physical therapy sessions, and feel emotionally drained. What should have been a short-term claim can snowball into months of disability and significantly higher indemnity costs.

The American Psychological Association’s 2023 Work in America Survey found that 77% of workers reported work-related stress that affected their physical health, with fatigue and lack of motivation among the most common symptoms. For claims professionals, this underscores how burnout directly impacts functional recovery and claim outcomes.

The Value of Medical Case Management

Medical case managers are often the first to recognize signs of burnout. They interact directly with both injured workers and providers, making them well-positioned to spot red flags early.

Early warning signs include:

• Missed or canceled appointments.
• Expressions of fatigue, hopelessness, or frustration.
• Reluctance to engage in treatment planning.

The value of medical case management in these situations is twofold:

1. Identification — flagging psychosocial risks that could derail recovery.
2. Intervention — connecting workers with behavioral health resources, counseling, or employer accommodations when needed.

These proactive steps not only support worker well-being but also improve claim outcomes. A 2022 National Academies of Sciences report emphasized that integrating behavioral health into occupational care improves recovery times and reduces disability duration. For Workers’ Compensation, this means medical case management plays a crucial role in keeping claims on track and defensible.

Medical Case Management Strategies for Addressing Burnout

Case managers are uniquely positioned to help by integrating clinical awareness with practical interventions:

• Coordinate holistic care: Connect injured workers with behavioral health support, counseling, employee assistance programs, and stress management resources. Early support can prevent problems from escalating.
• Communicate clearly: Set realistic expectations for recovery, treatment steps, and return-to-work planning to reduce anxiety.
• Collaborate with employers: Align return-to-work plans with both physical and mental readiness, using flexible schedules or light-duty assignments as needed.
• Educate workers: Share resources about stress, burnout, and recovery to build trust and engagement.
• Screen early: Leading programs now use psychosocial screening tools early in claims to flag at-risk employees before issues worsen.

These strategies help employees feel supported while improving recovery outcomes and overall claims management efficiency.

Consequences of Ignoring Burnout and Medical Case Management

From a financial perspective, overlooking burnout is costly. Workers struggling with stress and disengagement often take longer to return to work, require more treatment, and are more likely to litigate. The ripple effects on claims are significant:

• Extended disability: The Workers’ Compensation Research Institute (WCRI) has repeatedly found that psychosocial barriers, like stress, fear of reinjury, and lack of engagement, are strongly correlated with longer disability durations.
• Low return-to-work odds: According to the National Council on Compensation Insurance (NCCI), injured employees who remain out of work for more than six months have only about a 50% chance of returning to their jobs. Burnout is frequently a hidden factor behind these long-tail claims.
• Higher legal exposure: The Coalition Against Insurance Fraud (CAIF) emphasizes that unresolved psychosocial issues often escalate into disputes, driving up legal costs and delaying claim closure.

Claims complicated by burnout cost more in medical and indemnity payments. They are also harder to defend, often spiraling into expensive disputes.

Learn how case managers make a difference in recovery. Register for our next medical case management CE.

Check out our sources:

American Psychological Association. Work in America Survey: 2023 Results. American Psychological Association, 2023, www.apa.org.

Centers for Disease Control and Prevention. Burnout and Public Health. U.S. Department of Health & Human Services, 2023, www.cdc.gov.

Coalition Against Insurance Fraud. The Impact of Fraud on Insurance Claims. CAIF, 2023, www.insurancefraud.org.

National Academies of Sciences, Engineering, and Medicine. Integrating Behavioral Health into Occupational Health Care. National Academies Press, 2022.

National Council on Compensation Insurance. Return-to-Work Statistics and Insights. NCCI Holdings, Inc., 2023, www.ncci.com.

National Institute for Occupational Safety and Health. Stress at Work. Centers for Disease Control and Prevention, 2023, www.cdc.gov/niosh.

Workers’ Compensation Research Institute. Predictors of Worker Outcomes. WCRI, 2023, www.wcrinet.org.

World Health Organization. Burn-out an Occupational Phenomenon: International Classification of Diseases. WHO, 2019, www.who.int.