When a “hurt” becomes a “harm” in return to work

In brief

  • The "hurt" versus "harm" concept — that the pain a worker experiences after an injury does not cause harm or inhibit recovery — broadly underlies early return-to-work policy in many jurisdictions. However, there are situations in which it may not apply.
  • Certain positive conditions must be in place for early return to work to be beneficial.

Why was this study done?

In many jurisdictions, early return to work (RTW) after a workplace injury is considered beneficial for the worker. Past research has shown that when workers spend a long time away from work, there is a link to physical and mental health problems. However, this research hasn’t looked at the interactions between work absence and ill health. In this study, researchers explored the experiences, situations and quality of life of workers whose early return to work was not successful.

How was the study done?

This work was part of a larger study on this topic that explored how the system functioned and affected individual workers. For this project, researchers examined the scientific research that might support the notion of “hurt versus harm.” In the context of return to work, this concept assumes that the pain or “hurt” a worker experiences after an injury does not inhibit or “harm” the recovery process. The researchers examined this concept from interviews with 48 injured workers with long-term compensation claims, and 21 service providers for injured workers in Ontario, Canada.

What did the researchers find?

The study showed that “hurts” could become “harms” in the following situations:

  • when workers’ pain was not accommodated
  • when claimants had to wait for medical diagnoses
  • when claimants had to wait for financial benefits
  • when there was poor communication with claims adjudicators
  • when employers handled claims incorrectly.

In these situations, “hurts” were related to workers’ experiences with RTW processes and were linked to “harms” such as stress, poverty and addiction to painkillers.

What are some strengths and weaknesses of the study?

By looking at workers’ and providers’ descriptions of events, researchers identified the sequences by which negative events in the return-to-work process led to harms. That is, the study showed how different kinds of “hurts” could accumulate and lead to “harms.” This study is limited to findings about workers with prolonged and difficult experiences with compensation claims. Findings may not be relevant to the majority of workers whose claims experiences are relatively unproblematic.

Publication Information

Title: 

A deliberation on "hurt versus harm" logic in early-return-to-work policy

Author(s): 

MacEachen E, Ferrier S, Kosny A, Chambers L

Journal: 

Policy and Practice in Health and Safety, 2008: vol. 5, no. 2, pp. 41-62