In the last survey carried out on European workers 15 years ago, 57% of those questioned said that they felt work had affected their health. In particular, they highlighted musculo-skeletal problems and stress as issues they had faced.

For an employee, work can be a dangerous place – you can become ill or get injured.

For employers, there are also dangers, with a number of non-injury litigation suits being pursued in the US and the UK, as discrimination and other laws make their effect fully felt.

In terms of employment or employers' liabilities, there are two dominant models that have emerged – tortious liability, enshrouded in the UK in common law, and the workers' compensation programmes that developed in the US at the turn of the last century. In effect, these offer no-fault compensation. There are still investigative steps in workers' compensation but there are not the debates over contributory negligence that are seen within the tortious systems.

Between these two models, there are a number of state provision systems. Here, a third model can be considered – sickness absence, dealt with by national health services.

In Hong Kong, for example, the employees' compensation model is favoured. Europe – which at first glance has a common approach to employers' liability issues by way of the Health and Safety at Work Regulations and similar enacted statutes – has systems varying between strict liabilities within tortious systems.

Cash or care?
In all cases, the question is: should the claimant be compensated by cash or by care? Within the UK, there has previously been a keen focus on cash for injury claims. This is encouraged by a number of the new plaintiff practitioners entering the market. Similar practices have existed even within the workers' compensation programme around the globe.

But is this the right answer? There's a growing view that rehabilitation is a better solution. No-one disputes the quality of medical care following an injury, but early intervention is vital, so there can be an evaluation of the case and the right treatment protocol can be adopted. This is generally called triage.

Timely, thorough contacts are a key component of a successful accident management programme. Benefits and damages are payable in many circumstances, but the key to success, for both the employer and employee, is developing a working relationship with a case manager that can lead to setting common goals, with return to active work being the priority.

Whatever system of compensation exists, it's important to ensure that prolonged and unnecessary treatments are avoided by building a trusting and cooperative relationship with the injured employee and the medical provider. The injured worker must understand that the case manager is concerned with their well being and, in this way, medical management and cost containment are both achieved, as well as success for the injured party.

One of the key features we have seen is that there are fewer returns to work in stress cases. Stress management programmes are, in many respects, in their early stages, but the benefit of evaluating the risks of stress, as has been done out for other health and safety issues, must be considerable.

What drives stress is a variety of internal and extraneous factors. Job stresses may impact on an individual's role in the organisation, their relationships at work and career development within the organisational environment.

Stress factors
Difficulty sleeping and concentrating, and loss of appetite are symptoms of stress. Organisational symptoms include high absenteeism and labour turnover, and industrial relationship difficulties.

Most of the examinations of stress that have been carried out to date consider white-collar workers. Our experience is that blue-collar workers are suffering from the same pressures, as businesses restructure or realign. Many blue-collar workers find themselves operating computers and VDU screens as part of their day-to-day handling of goods.

Stress claims have been admitted in the majority of European and Far East countries. While there is no avalanche of claims, there are enough to give concern.

Looking to the future, we anticipate that there will be more back injuries among white-collar workers. Poor workstations and the fact that more people operate computer workstations can inevitably lead to lower back pains and ongoing injuries.

In conclusion, there's an increasing view that compensation by cash does not necessarily always assist the employee. In discrimination cases, it may be the only solution available; in injury cases, however, prompt triage, coupled with rehabilitation to find the right solution, offers the chance to develop customised care and help the employee back to work. That must surely be an aim for all employers.

  • Jonathan Clark is Crawford & Company's director of strategic operations development for the UK, Europe and Africa, and Asia, and Deborah Edwards is an international healthcare specialist.