Why do some lost-time claims last longer than anyone expected?
In recent years, about 20 per cent of lost-time compensation claims in Ontario are responsible for approximately 80 per cent of benefit expenditures.
Behind these numbers are the actual stories of injured workers. To understand their experiences, Dr. Ellen MacEachen, Dr. Agnieszka Kosny, Sue Ferrier and Lori Chambers from the Institute for Work & Health interviewed 69 injured workers, peer supporters and service providers from across Ontario. Their goal was to identify the factors that led to long-term or prolonged claims.
Many workers we interviewed seemed to be typical workers, but they got what we called a ‘toxic dose’ of more than one problem, says MacEachen, the scientist who headed this study.
If, in addition to an injury, workers had an unsupportive workplace, financial problems and other issues that prolonged their claim, this “toxic dose” could lead to a spiral of negative events that complicated their claim. In many cases, it also had a devastating personal impact.
If workers only had one problem they might have been able to proceed as expected, says MacEachen,
But it’s the confluence of problems that tips things against their favour.
Although the researchers found some common themes that could prolong claims, each worker's situation was unique. If you were older and already had health problems, if you relied on walk-in clinics instead of a family doctor – these were just a few of the factors that could affect your return to work.
However, all workers needed goodwill from their employers. For instance, an employer might arrange modified work, but this would only succeed if the immediate supervisor was on board and the work was appropriate – not a meaningless “make-work” project that created resentment among colleagues, or work that was too difficult.
If workers can’t do the work, they might be reinjured or be in pain, says MacEachen. Indeed, many said they “over-complied.” They knew they shouldn’t be returning to work or that their modified tasks were too difficult. But they feared losing their jobs so they worked anyway, increasing their doses of pain medication to cope.
I’ve seen a lot of guys like that, says Hal*, an injured worker from the study.
...[they] went back to work, doing whatever they were doing, just, popping pills like a son of a gun to keep going, and all they’re doing is killing themselves.
On the other hand, some workers genuinely feared going back to work and may have resisted it, which could be viewed as uncooperative by employers or the compensation system.
Another underlying problem was miscommunication, which MacEachen likened to a game of “broken telephone,” in the problems that occurred when workers, doctors, employers and adjudicators didn't have an effective or coordinated way of communicating.
Says Tracy*, an occupational physician,
...occasionally workers come to us literally with the letter the [compensation] board has sent them and they don’t have a clue what it means. The language is totally inscrutable to them.
Sometimes the way a claim unfolded led to problems, and the lack of income or benefits hit some workers hard.
These unresolved claims can derail everything, says MacEachen.
Many workers had musculoskeletal disorders, which are injuries to muscles, tendons or other soft tissues that are difficult to diagnose. If additional medical reports were needed to verify the claim, this created delays. Or if a worker didn’t report an injury immediately, thinking it would improve, this made it hard to establish the date and the work-relatedness of the injury. Some felt that their situations were not understood because there was no face-to-face contact with adjudicators.
A person is more complex than what’s written on paper, says Anne*, an injured worker peer helper. It was also a challenge for workers to fill out the forms for a compensation claim, and missed deadlines would delay claims. Or they might be denied and have to appeal the claim to provide more evidence.
Delays, denials and miscommunication can worsen an individual’s situation, leading to poverty and poor health, says MacEachen. With no benefits coming in, some workers would drain their own resources or borrow money repeatedly from family and friends. Add the stress of an unsupportive employer, the pain of the injury, the diminishing goodwill from family or friends, and sometimes workers would develop mental health problems such as anxiety. (see Mental health issues and medication use in injured workers)
To help prevent such situations, MacEachen, Kosny and Chambers are developing a new tool to identify “red flags” and “green lights.” Red flags are those toxic situations or roadblocks that could complicate their claim. If a red flag is identified, the idea is that the service provider needs to look into the individual context more to prevent these other issues from overwhelming the situation. Green lights identify helpful practices in the return-to-work process.
MacEachen has also presented her findings to staff at the Workplace Safety and Insurance Board's Return to Work/Labour Market Reentry branch.
* a pseudonym
Source: At Work, Issue 52, Spring 2008: Institute for Work & Health, Toronto