Motivational Interviewing in Workers' Compensation Claims

What you’ll find below:

• Overview of Motivational Interviewing
• Why MI Matters for Claims Involving Psychosocial Factors
• The OARS Techniques and Four Processes of MI
• Takeaways for Everyday Claims Conversations

Picture this: a claimant cleared for modified duty two weeks ago still hasn’t returned. The provider notes don’t flag anything new, and the employer confirms the accommodation is available. On the phone, though, the claimant sounds frustrated and keeps repeating that the plan “isn’t going to work.”

It would be easy to log that as resistance and move on. But how a conversation like this is handled can often influence what happens next in the file.

What is Motivational Interviewing?

Motivational interviewing (MI) is a collaborative, person-centered communication style developed to help people work through ambivalence and build their own motivation for change.

Rather than arguing for a specific outcome, the person using MI asks questions and reflects back what they hear, giving the other person space to explain their own reasons for moving forward.

It’s not about persuading or pressuring. People tend to commit more fully to decisions they feel they arrived at themselves.

Why Does Motivational Interviewing Matter in Claims?

Fear of re-injury, low confidence in recovery, or frustration with the process can all affect how a claimant engages with treatment and return-to-work planning. Hesitation can be easy to interpret as noncompliance, but there may be a specific concern underneath it that hasn’t been identified yet.

The evidence for MI is encouraging but still limited. According to the Journal of Occupational Rehabilitation, a randomized trial that added MI to a functional restoration program found a statistically significant increase in return-to-work rates for injured workers with musculoskeletal disorders.

Additionally, a systematic review of the broader literature found only two controlled trials on MI and return-to-work in this population, with conflicting results, and concluded that the evidence base still has a long way to go (Journal of Occupational Rehabilitation).

None of this guarantees a faster return date, but taking the time to understand a claimant’s actual concerns before responding does have some support behind it.

The OARS Techniques

Four communication skills, commonly grouped under the acronym OARS, form the core of how MI is practiced:

• Open-ended questions invite more than a yes-or-no answer. Instead of asking, “Are you planning to return next week?” a claims professional might ask, “What would need to be true for you to feel ready?”
• Affirmations recognize genuine effort: “It sounds like you’ve kept up with appointments even though scheduling has been tough.”
• Reflective listening restates what was said to confirm understanding. If a claimant says, “I’m not coming back Monday. That plan isn’t going to work,” a reflection might be, “It sounds like something about the return date doesn’t feel right to you.”
• Summarizing brings the conversation together at a natural pause point, making sure both people are working from the same understanding before moving on.

The Four Processes

Beyond the individual skills, MI is organized around four broader processes that build on each other:

• Engaging — building enough trust that the claimant feels comfortable talking openly. Spending a few minutes on how someone is actually doing before jumping into the issue at hand can go a long way here.
• Focusing — identifying the one issue that actually needs to be addressed rather than trying to cover everything at once.
• Evoking — asking something like, “What do you think would help right now?” instead of immediately proposing a solution. This gives the claimant a chance to identify their own reasons for moving forward.
• Planning — mapping out next steps once the claimant has expressed some motivation of their own.

Skipping ahead to planning before a claimant feels heard is a common misstep.

What MI Can Look Like in Practice

The difference can be as simple as changing how a response is framed. Instead of telling a claimant what they should do, a claims professional can acknowledge the concern and ask a question that encourages the claimant to explain what’s behind it.

For example, instead of saying, “The provider has recommended this treatment, so it’s important you keep going to your appointments,” an MI-informed response might be, “It sounds like you’re not convinced this next round is going to make much difference. What’s making you feel that way?”

The first response pushes back on the claimant’s position, which can cause someone to dig in further. The second creates space to understand the actual concern, whether it’s a past treatment that didn’t help or fear of more pain. Once that concern is out in the open, it can be addressed directly instead of showing up later as a missed appointment.

Final Thoughts

Motivational interviewing isn’t about manipulating a claimant, diagnosing a condition, or replacing clinical care. If a conversation surfaces a concern that needs clinical attention, the right step is to involve the treating provider rather than keep digging.

For claims professionals, the approach is really about asking before assuming, listening for the reason behind resistance, giving claimants ownership where possible, and avoiding unnecessary confrontation.

No single communication technique will resolve every claim’s psychosocial factors, but giving claimants space to explain what’s actually going on can help support recovery and keep a file moving.

Psychosocial factors were covered in our most recent CE course. Interested in learning more about emerging topics shaping the claims industry? Register for an upcoming CE to explore more timely industry topics.

Sources:

• Aanesen, F., et al. (2021). Motivational Interviewing and Return to Work for People with Musculoskeletal Disorders: A Systematic Mapping Review. Journal of Occupational Rehabilitation, 31(1), 63–71.
• Miller, W. R., & Rollnick, S. (2023). Motivational Interviewing: Helping People Change and Grow (4th ed.). Guilford Press.
• Park, J., et al. (2018). Motivational Interviewing for Workers with Disabling Musculoskeletal Disorders: Results of a Cluster Randomized Control Trial. Journal of Occupational Rehabilitation, 28(2), 252–264.