The Internal Drivers of Longtail Claims
John Littleton
Why do some injury claims persist for years, despite medical treatment and support programs? These are known as longtail claims – where return to work and meaningful life engagement are significantly delayed, often indefinitely.
Longtail claims typically involve individuals with chronic physical or psychological pain. While return-to-work rates generally improve over time, they tend to plateau well before reaching 100%. As shown in the data from WorkSafe Australia (see graph below), progress slows after the initial months, and some workers remain out of work years later.
Over my 22 years working with injured workers, I’ve noticed recurring patterns that contribute to longtail claims. I recently tested these observations using basic statistical analysis, and the results confirmed what I had long suspected.
In this first article, I’ll focus on internal psychological drivers – factors I am most interested in and encounter regularly in therapy sessions. These drivers are often invisible but powerful, shaping a person’s experience of pain, motivation and sense of self.
Key Internal Drivers of Longtail Claims
Experiential Avoidance
This refers to a person’s effort to avoid or escape uncomfortable internal experiences like anxiety or fear depressive feelings – even when avoidance makes life more difficult. For example, someone may withdraw from valued everyday activities to avoid stress, but this withdrawal or the behaviours aimed at preventing or suppressing uncomfortable internal experiences can reinforce isolation and make it harder to regain function and reconnect with valued activities.
Safe Miserable Zone
Some workers settle into a space that feels familiar but unfulfilling. They perceive this space as less threatening or more controllable than the uncertainty of change. While they may feel trapped, unhappy, or unfulfilled, leaving this zone means confronting uncertainty – which can feel overwhelming from someone already navigating pain and loss. This perceived safety keeps them for seeking change or growth.
Self-Worth Challenges
Self-worth can be thought of as a combination of the roles we hold in life – such as worker, parent, or partner – how well we believe we perform in each, and how much we value them. Most people rarely reflect on their self-worth until it’s challenged. After an injury, when performance in these roles is suddenly limited, self-worth often takes a significant hit – sometimes without the person even realising it.
Pain-Focused Identity
When someone loses their work identity due to chronic pain, it can leave a significant gap in how they see themselves and how they explain their situation to others. In the absence of a professional role to refer to, the pain itself can become the primary narrative they share. This focus on pain can serve as a defence against feelings of shame or perceived judgment – but over time, it can also reinforce a pain-based identity. As a result, individuals may be seen as stuck, overly focused on their symptoms, or even avoidant, which can further entrench them in the Safe Miserable Zone and make it harder to reconnect with a broader sense of identity and purpose.
Why It Matters
These internal drivers often act simultaneously and in combination with external factors (like employers or insurers), making these claims especially complex. Understanding and addressing them is crucial – not just for claim resolution, but for the individual’s wellbeing and sense of purpose.
In a future article, I’ll unpack the external and systemic drivers of longtail claims – including the role of medical systems, insurance processes, and workplace relationships.
For now, understanding the inner world of a longtail claim is the first step in supporting someone out of it.
