Not all of those who fail to return to work are unmotivated or manipulative. So why do not the majority of the return to work?
Assume for a moment that the employer does not have a position available within their physical limitations. Also assume that any replacement job would lack the seniority that they are leaving behind and with that seniority was also their level of income. Then ask yourself `how many of those for whom you have cared have stated that they would not go work for (example) McDonald_s at (minimum wage).
A large number of injured workers fear their own future. They may lack education, training and interest in work other than that which they performed before injury. If it is the common injury scenario, they were performing work with a highly than average probability of injury (Eg. Lifting, pulling, carrying, etc). However, by doing such work, they were making more money than many of their contemporaries. Their income, while likely stretched, enabled them the lifestyle they were living at the time of injury.
Upon injury, there is immediate financial impact and loss of material items (vehicles, etc.) Then within months they are existing on an ever dwindling income base. Concurrently, they see that they will never be fully pain-free.
They then examine _what to do next_ and find that they have no interests, skills or training that would permit alternate work at their pre-morbid income level. They become fearful of their own future, a sense of desperation ensues, and with that comes distortions of both future threats and potential solutions.
They cease to see their futures accurately. They do not clearly perceive their options. But most importantly, they stagnate waiting futilely for _something to happen_ without knowing what that will be or even considering that nothing is likely to happen until they mobilize.
Family and friends either participate in the distorted believes and/or become exasperated and impatient.
What the patient needs at that stage is someone who directs them to look at the reality of their situation, the valid options (and lack thereof) and the compromises that are already built-into their future. The patient must work through the anger and resentment, the shame and guilt and ultimately their own fear of failure. The anger toward others is most often a defense for the close-to-the-surface realization that they had not prepared for such a situation and had left themselves few residual and marketable skills.