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Psycho-Social Challenges of Managing Employee Illness: Presenteeism, Absenteeism, and "Monday Effect" Oh My

December 17, 2012 (9 min read)
By John Stahl, Esq.
The concept of “it’s complicated” extends beyond describing a romantic relationship; it also often applies to the relationship between an employee’s illness or injury and that person’s employment.
One concern is lost productivity associated with ill employees coming to work. A related issue is many workers’ compensation claimants requesting benefits for non-compensable harm. These trends have prompted research regarding “presenteeism,” which relates to employees unduly ignoring sicknesses, and the “Monday Effect” that relates to a bothersome pattern regarding workers’ compensation claims.
Social scientists have additionally studied what prompts some employees from malingering by not timely returning to work after recovering from an illness or injury.
Exploring why employees sometimes alter the facts regarding illnesses reveals the presence of psycho-social influences. This term relates to how an individual, a manager, and peers influence how someone responds when becoming impaired.
Overview of Presenteeism
An article entitled “Poor Health but Not Absent: Prevalence, Predictors, and Outcomes of Presenteeism” in the November 2012 edition of the Journal of Occupational and Environmental Medicine provides a good overview of presenteeism. Ivan Robertson, Ph.D., is the lead author.
The article defines “presenteeism” as “being at work but having impaired functioning due to mental or physical symptoms.” A simpler description of that concept is “attending work while ill. A broader view is that presenteeism “include[s] factors such as working elevated hours and ‘putting in face time’ or reduced productivity due to events that distract one from full productivity.”
Robertson and his colleagues cite European research that indicates that as much as one-half “of the total dollars attributed to common health problems faced by [US] employers could be the result of on-the-job productivity losses.” Much of this lost productivity is attributable to presenteeism.
An objective of research of psycho-social factors that prompt sick employees to not miss work is “a model in which workplace factors positively predict ill health, which, in turn predicts higher presenteeism.” These elements include:
  • Job control
  • Relationships with colleagues
  • Job insecurity related to downsizing
  • Employer’s industrial sector
These variables largely reflect the level of confidence that an employee possesses regarding continued employment with a current company. Although the article does not address this, a related need to be considered a “team player” or as “essential” can also cause lost productivity that stems from sacrificing vacations.
The conclusions regarding the role of individual characteristics related to presenteeism are consistent with the findings regarding the general elements described above. This aspect of the study concludes that:
  • 60-percent of the study’s participants recently engaged in presenteeism
  • Women are more likely than men to work when sick
  • Widowed, divorced, and separated employees are more likely than single or married workers to work when sick
  • The rate of presenteeism increases in proportion to length of service
These results provide a good opportunity for a primer on basic employment law. The fact that some characteristics listed above relate to an employee’s gender or marital status does not justify discriminatory employment practices based on those variables.
Legal solutions to presenteeism that the article suggests include establishing the following employment practices:
  • Have health care providers write “fit notes” that indicate the extent to which someone can work
  • Reduce productivity expectations while someone recovers
  • “Develop a better understanding of why the respondent is at work, rather than absent.”
  • Create “a coaching, supportive, and encouraging leadership style [that] may help employees better manage their work demands, thereby improving health and reducing the likelihood of undesirable presenteeism.”
Risk Management Tips for Presenteeism
Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. or suggests these tips for risk management solutions for presenteeism,
  • Employers should offer conference call options, such as providing use of GoToMeeting facilities, so employees who are sick can participate in key meetings by phone.
  • Onsite medical clinics for large employers can help with treatment of early symptoms.
  • Onsite clinics can also provide flu shots and pneumonia vaccines for older workers.
  • Wellness programs can help communicate and promote the need to staying home while ill theme, including a poster program.
“Monday Effect”
Researchers also devote substantial resources to studying the “Monday Effect,” which primarily refers to employees filing a moderately disproportionately large number of workers’ compensation claims on Mondays and when those workers return to work after a holiday weekend. A primary explanation for this phenomenon is claims for non-compensable harm that occurs while engaged in leisure activity or home repairs on Saturdays and Sundays.
Current research regarding the Monday Effect regularly cites a 1996 study by David Card, who was a Professor of Economics at Princeton University, and Brian P. McCall, who was an Associate Professor of Industrial Relations at the University of Minnesota. Card and McCall published their findings in an article titled “Is Workers’ Compensation Covering Uninsured Medical Cost? Evidence from the ‘Monday Effect’” in the July 1996 edition of Industrial and Labor Relations Review.
Card and McCall report that “possibly the most striking evidence of fraudulent claim activity in the Workers' Compensation … program arises from the unusual pattern of Monday accident claims. At least as early as 75 years ago, it was observed that accidents are more likely on Mondays than on other weekdays.” They add that “although circumstantial, this evidence is consistent with the view that some workers ‘post-date’ weekend back injuries and strains in order to obtain medical coverage and indemnity benefits through [workers’ compensation] WC.”
The overall conclusion from the 1996 research is that “across all types of weekday injuries, 22.95% occur on a Monday.” This percentage is a little higher than the statistic of 20-percent that is expected based on the reasonable expectation that, over an extended time period, an equal number of compensable injuries occur on each of the five traditional workdays of each week.
Aside from the larger number of workers’ compensation claims on the day of the week from which the Monday Effect obtains its name, other proof that that phenomenon exists includes increases in the number of claims on that day during periods in which the local area experiences particular local weather conditions.
Studies support the theory that a greater tendency to engage in active sports, such as skiing and hiking, when the weather is conducive to pursuing those hobbies result in a corresponding spike in Monday workers’ compensation claims. It is equally likely that increased yard work and snow shoveling during the same periods also contributes to the larger number of claims.
An obvious reason for inaccurately reporting a weekend injury as compensable harm is that workers’ compensation provides more generous benefits, possibly including lost-wages benefits, than a general health insurance policy. Additionally, many employees with workers’ compensation coverage do not have general health insurance.
A less obvious reason, but equally basic, reason for the Monday Effect is that employees can file false claims for non-compensable injuries. A significant amount of workers’ compensation fraud relates to the difficulty of proving the cause of many neck, back, knee, and wrist injuries.
The harm described above often develops over long periods of time, does not always manifest itself immediately, and can be easy to mask. Even someone reporting back pain immediately after trying to lift a heavy box at work does not prove that that activity caused that injury.
A third motive for a plausible false workers’ compensation claim is that an employee who is facing a termination, other individual adverse employment-related action, or a wide-spread lay-off may pre-emptively seek protection in the form of being able to argue that illegal bias based on pursuing workers’ compensation rights prompted the adverse decision. If that assertion succeeds, a worker may avoid an adverse decision that is really based on poor job performance or simple bad luck.
The better news is that the solutions to the Monday Effect are as obvious as the practice that requires these responses. These include:
  • Legislative reform regarding fraudulent claim penalties
  • More vigorous fraud enforcement by insurers
  • Education on purposes of workers’ compensation
  • Improved health insurance, including Obamacare-mandated enhancements
These solutions discourage Monday Effect fraud by increasing the probability of detecting that fraud and the penalty associated that fraud while simultaneously reducing the incentive for that malfeasance through better general health insurance coverage.
Risk Management Tips for Monday Effect
Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. or suggests these tips for risk management solutions for Monday morning reporting of claims.
  • Investigate every claim reported on Monday. Include this in your account instructions. This can include a review of social media sites.
  • Have a physician review all Monday-reported claims; do a special compensability review of all claims filed on Monday.
Absenteeism differs from presenteeism and the Monday Effect in that it involves lost productivity associated with an employee who can work. These workers either fake an illness or injury or malinger regarding a valid impaired condition.
The subjective nature of many ailments hinders efforts to detect absenteeism, but reforms that increase the burden of proof on employees regarding sick leave claims help reduce that fraud.
Other solutions include:
  • “Carrots” that reward good attendance without encouraging presenteeism
  • “Sticks” in the form of strict but reasonable enforcement of sick leave and general employment policies
End of the Day
A positive and supportive employment environment that makes employees feel valued and that keeps them informed of relevant business developments helps create loyalty that reduces illness and injury-related abuses.
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