Why some injured workers don’t return to work as expected

In brief

  • For workers’ compensation claims that are long-term and costly, researchers identified four contexts in the return-to-work (RTW) process that contributed to problems. These four contexts were in the workplace, health care, vocational retraining and workers’ compensation systems.
  • Researchers proposed the concept of a “toxic dose” resulting from an overload of system problems in all contexts.

Why was this study done?

Most workers who are injured on the job usually return to work following a relatively straightforward path. However, some disability episodes are long term and disproportionately costly. This study sought to understand the systemic, process-related problems affecting injured workers who did not return to work as expected.

How was the study done?

Researchers conducted 69 in-depth interviews with injured workers who had complex and long-term claims, and with service providers such as health-care workers, insurers, legal advisors and workplace personnel. Interview questions focused on participants’ experiences of RTW situations, challenges with return to work, why problems occurred and what could help alleviate them. Workers were also asked about their injuries and their understanding of the workers’ compensation system.

What did the researchers find?

The findings are related to four contexts:

Workplace: The researchers found problems with poorly implemented workplace-based RTW policies. When employers were more focused on business costs than to an injured worker’s recovery needs, they might prompt the worker to return when unwell, or provide poorly integrated modified work. In these situations, co-workers may not be willing or able to do extra work to help the injured worker.

Health care: One key problem was that health-care providers, who were required to complete detailed forms for workers’ compensation, did not always have time for this paperwork. Sometimes forms were delayed or had insufficient detail. Also, physicians sometimes avoided treating injured workers because their recommendations were not always accepted by compensation decision-makers.

Vocational retraining: In Ontario, the labour market re-entry program provides retraining to workers to restore their wage-earning ability. However, worker health problems and educational challenges did not always fit with retraining plans and goals. Also, after completing training, workers were not considered to need benefits, and were expected to compete in the job market, even with chronic pain problems and no experience in their new field.

Workers’ compensation: Researchers found problems in how the workers’ compensation system was set up, in terms of interactions with injured workers. In particular, there were communication barriers related to a lack of face-to-face contact, workers’ compensation letters that could be difficult to understand, and a slow pace to the claims process.

Overall, these problems in specific contexts created the risk of a “toxic dose” for the worker, which hindered the ability to return to work. This occurred when problems happened across the different RTW contexts, and played a role in extending and complicating workers’ compensation claims.

What are some strengths and weaknesses of the study?

Key strengths included the systematic sampling process in which workers were recruited from a range of sources and locations. In addition, a variety of providers were interviewed, and an experienced team gathered and analyzed data. One limitation is that this study was not designed to measure the frequency of problems in RTW contexts.

Publication Information

Title: 

The “toxic dose” of system problems: why some injured workers don’t return to work as expected

Author(s): 

MacEachen E, Kosny A, Ferrier S, Chambers L

Journal: 

Journal of Occupational Rehabilitation, 2010: vol. 20, no. 3, pp. 349-366