Deliberation on 'hurt versus harm' logic in early-return-to-work policy

The practice of 'early return to work' before full recovery is put foward in many countries as a sensible and unproblematic approach to work injuries. However, there has been a limited appraisal of its effectiveness. Questions remain about what counts as 'effective', how early-return-to-work policy is experienced by workers, and the internal logic of this policy. In this paper, we consider these issues as they relate to the dependence of early return to work on the concept of 'hurt versus harm'; that is, the assumption that 'hurt' is pain experienced during recovery and that hurt does not necessarily impede recovery and, indeed, can improve it. Taking the case of workers' compensation policy in Ontario, Canada, we review research and documents that justify and explain the disassociation of hurt from harm in early return to work. We argue that this concept has been applied too broadly: to situations not supported by research evidence. We contrast this with qualitative interview data from a study of return-to-work problems faced by injured workers with long term workers' compensation claims. We find a lack of recognition of the nature of hurts and harms affecting these workers and suggest that a discourse about 'hurt versus harm' affects the handling of workers' compensation claims in a way that can hinder workers' ability to return to sustainable work. We propose that some long term workers' compensation claims may exist, in part, because of a framework for understanding workplace injury which under-recognises the nature, extent and impact of hurts on workers