Workers Compensation Board Research Articles

An analysis of changes in stakeholder accountability among Canadian WCBs: 1998–2008

Abstract: Many essential public services in Canada have been delegated to agencies. The semi‐autonomous nature of these agencies, often operating at arm's‐length from government, leads to difficulties in holding them sufficiently accountable. Of the many public‐sector agencies in Canada, workers' compensation boards (WCBs) are arguably the most autonomous in comparison to other government agencies such as health care and social services. In their article, derived from an earlier background paper written in 1998, Therese Jennissen, Michael Prince and Saul Schwartz (2000) called for increased WCB accountability to elected officials. The aim of the current article is, first, to conduct a document review to determine the extent to which the recommendations made by Jennissen and her colleagues have been adopted at the national level and, secondly, through a case study, to examine the implications of these changes at the Newfoundland Workplace Health, Safety and Compensation Commission, where many of the recommendations have been implemented.

Second WCB Claims: Who Is At Risk?

Many workers with one Workers’ Compensation Board (WCB) claim make further claims. If the characteristics of the job, initial injury or worker were predictive of an early second claim, interventions at the time of return to work after the first claim might be effective in reducing the burden of work-related injury. This report explores the characteristic of those who make a second claim. Records of all Alberta WCB claims from January 1, 1995, to December 31, 2004, for individuals 18 to <66 years old were reviewed. For each individual’s first claim, sex and age of claimant, type of injury, type of accident, occupation, industry, an indicator of company size, and industry claim rate were extracted, as well as the date of any second claim. The likelihood of second claim and mean time to second claim were estimated. Multivariate analyses were performed using Cox regression. 1,047,828 claims were identified from 490,230 individuals. Of these, 49.2% had at least two claims. In the multivariate model a reduced time to second claim was associated with male sex, younger age and some types of injury and accident. Machining trades were at highest risk of early second claim (hazard ratio [HR] 2.54 compared with administration), and of the industry sectors manufacturing was at highest risk (HR 1.37 compared with business, personal and professional services). Some caution is needed in interpreting these data as they may be affected by under-reporting and job changes between claims. Nonetheless, they suggest that there remains room for interventions to reduce the considerable differences in risk of a second claim among workers, jobs and industries.

Second WCB Claims: Who Is At Risk?

Many workers with one Workers' Compensation Board (WCB) claim make further claims. If the characteristics of the job, initial injury or worker were predictive of an early second claim, interventions at the time of return to work after the first claim might be effective in reducing the burden of work-related injury. This report explores the characteristic of those who make a second claim. Records of all Alberta WCB claims from January 1, 1995, to December 31, 2004, for individuals 18 to < 66 years old were reviewed. For each individual's first claim, sex and age of claimant, type of injury, type of accident, occupation, industry, an indicator of company size, and industry claim rate were extracted, as well as the date of any second claim. The likelihood of second claim and mean time to second claim were estimated. Multivariate analyses were performed using Cox regression. 1,047,828 claims were identified from 490,230 individuals. Of these, 49.2% had at least two claims. In the multivariate model a reduced time to second claim was associated with male sex, younger age and some types of injury and accident. Machining trades were at highest risk of early second claim (hazard ratio [HR] 2.54 compared with administration), and of the industry sectors manufacturing was at highest risk (HR 1.37 compared with business, personal and professional services). Some caution is needed in interpreting these data as they may be affected by under-reporting and job changes between claims. Nonetheless, they suggest that there remains room for interventions to reduce the considerable differences in risk of a second claim among workers, jobs and industries.

Data linkage to estimate the extent and distribution of occupational disease: new onset adult asthma in Alberta, Canada

Although occupational asthma is a well recognized and preventable disease, the numbers of cases presenting for compensation may be far lower than the true incidence. Workers' Compensation Board (WCB) claims for any reason 1995-2004 were linked to physician billing data. New onset adult asthma (NOAA) was defined as a billing for asthma (ICD-9 code of 493) in the 12 months prior to a WCB claim without asthma in the previous 3 years. Incidence was calculated by occupation, industry and, in a case-referent analysis, exposures estimated from an asthma specific job exposure matrix. There were 782,908 WCB eligible claims, with an incidence rate for NOAA of 1.6%: 23 occupations and 21 industries had a significantly increased risk. Isocyanates (OR 1.54: 95% CI 1.01-2.36) and exposure to mixed agricultural allergens (OR = 1.59: 95% CI 1.17-2.18) were related to NOAA overall, as were exposures to cleaning chemicals in men (OR = 1.91:95% CI 1.34-2.73). Estimates of the number of cases of occupational asthma suggested a range of 4% to about half for the proportion compensated. Data linkage of administrative records can demonstrate under-reporting of occupational asthma and indicate areas for prevention.

“They Have All Been Faithful Workers”: Injured Workers, Truth, and Workers’ Compensation in Ontario, 1970-2008

In interviews with injured workers with serious and/or complex injuries, a clear belief emerged that for them to be successful in their compensation claims they had to persuade a regular array of decision-makers that their injuries resulted from accidents that occurred “in and or out of the course of employment,” that they feel the way they say they are feeling, that they can and cannot do what they say they can and cannot do, and that they are capable of learning what they say they are capable of learning. They must, in short, convince these decision-makers (family doctors, employers, Workers Compensation Board [WCB] doctors, and medical specialists, as well as WCB adjudicators) that their story is the truth. The author’s presence as a researcher added another layer to the discursive process, in that the author, too, became someone injured workers had to inform, and, if necessary, convince about their truths. It was in this sense that the authority for the author’s research into the struggles of injured workers became, in Michael Frisch’s terms, a “shared authority.” The author’s written words about their stories and their struggles were to be used to help the decision-makers, the researchers, and the wider public understand that faithful workers were truthful workers.

Poster 297: How Successful is the Workers Compensation Board in Returning Work-Related Traumatic Amputations to Employment?

Poster 297: How Successful is the Workers Compensation Board in Returning Work-Related Traumatic Amputations to Employment?

Impact of compensation on work outcome of carpal tunnel syndrome

Work-related carpal tunnel syndrome (CTS) is a complex and costly condition. There is some evidence that the employment outcome may be worse in cases of CTS where the condition is being considered for compensation. To examine whether workers' compensation status is an important determinant of outcome of CTS. Cases, with a Workers' Compensation Board (WCB) claim, and referents, in work but without a WCB claim, were identified from the practice of a single specialist physician. Data on history prior to and at the time of diagnosis, and events since diagnosis, were collected from clinical records and by a telephone-administered questionnaire. Prior events, severity, treatment and outcome associated with a WCB claim were assessed by logistic regression. Interviews were successfully completed for 46 cases and 50 referents. In the model adjusted only for age and gender, claimants had a worse outcome in terms of changing job or stopping work with time loss from work due to CTS [odds ratio (OR) 5.1, 95% confidence interval (CI) 1.9-13.3]. The OR was much influenced by the inclusion of treatment in the model (OR = 9.6, 95% CI 1.6-58.6) with WCB cases more likely to have surgical and physiotherapy treatments. Cases with a WCB claim cost more to treat and reported greater loss in income than those not seeking compensation. Although these data are limited, the results are suggestive of poorer outcome among WCB claimants despite greater use of treatment and comparable severity of disease.

Reduced Suffering and Increased Productivity - The Workers' Compensation Model

Workers compensation is an employer-funded indemnity, health and death benefit insurance program that is not subject to the provisions of the Canada Health Act. The workers' compensation board (WCB) fulfills the social contract between employers and employees with respect to work-related injuries and workplace disease. Rising healthcare and indemnity costs, poor access to services and increasing evidence of poor outcomes are the primary reasons WCBs have assumed a greater role in managing the care of injured workers. Through activism in the delivery of health services, WCBs have introduced competition, pay for performance, quality measures and provider accountability into the system. The WCB approach to ensure timely, quality care to injured workers provides a view into the potential application of the principles articulated by the Supreme Court in Chaoulli vs. Quebec, should the public system fail its citizens. Managers of the public healthcare system can learn a useful lesson by understanding WCB methods.

Unsentimental Education: Learning from the Workers' Compensation Boards Experience

Hurley et al. document the rise of care provided by workers' compensation boards (WCBs) in Canada and suggest that they potentially represent the "proverbial canaries in the coal mine) for the publicly funded healthcare system. Given WCBs' potential draw on similar resources and their ability to purchase services through incentive-based funding, some may argue that these systems do indeed challenge our current understanding of equitable access under the public system. Here we suggest, however, that while in some circumstances WCB behaviours and policies can create problems for the universal system, they can also serve as role models in their emphasis on prevention, evidence-based practice and timely service.

Parallel Payers and Preferred Access: How Canada's Workers' Compensation Boards Expedite Care for Injured and Ill Workers

Canada's workers' compensation boards (WCBs) finance healthcare for injured and ill workers in parallel with provincial health insurance plans. Parallel systems of healthcare finance can create preferred access for some. WCBs have in recent years pursued a number of strategies to expedite or improve the quality of care for injured or ill workers, including in-house provision in WCB-owned facilities; contracting with private, for-profit clinics; contracting with publicly funded hospitals and clinics for use of facilities "off-hours"; and supporting specialized clinics within publicly funded hospitals. Many of these strategies incorporate incentive payments to physicians and facilities for treating WCB cases more quickly than patients covered by provincial plans. In this paper we document the development of these strategies and discuss their implications for physicians, patients, government and the provincial public insurance plans.

Access and Quality in Canada's Parallel Public Healthcare Systems: Is the Impact of Workers' Compensation Boards a Net Positive?

Jerry Hurley and his colleagues have done a major service in casting light on a dimension of public healthcare policy in Canada that normally flies under the radar of both public and academic debate. Workers' compensation represents less than 2% of public healthcare expenditures in Canada, and the care provided is concentrated in a few categories such as orthopedics. Nonetheless, the transformation of workers' compensation boards (WCBs) from "silent payers" to increasingly sophisticated and entrepreneurial purchasers of care may have important implications and lessons for the broader healthcare system.

The Physician Perspective

In their paper, Hurley et al. document the development of strategies used by workers' compensation boards (WCBs) to provide enhanced access and medical care to injured workers. They discuss the implications of these strategies for physicians, patients, government and the provincial public insurance plans. My comments on their paper focus primarily on Ontario and the physician sector.

The Data Gap in Canadian Women’S Occupational Health

AbstractInformation on occupational health in Canada is potentially available from a number of databases, including those held by workers compensation boards and Statistics Canada. This paper considers the feasibility of using these sources to analyse women’s occupational health problems. It proceeds by identifying common sources of women’s suffering, using as source material qualitative case studies derived from the academic literature in several disciplines, including sociology, ergonomics, industrial relations and psychology. Three common sources of suffering were identified: ill-defined job requirements, multiple low- level hazards and isolation. Evaluating the capacity of the data sources to reflect these risks reveals that unmined information exists on some points, and that relevant data remain to be gathered.

Healthcare Use of Families of Injured Workers Before and After a Workplace Injury in British Columbia, Canada

To examine the overall healthcare and mental healthcare services use of families of injured workers before and after a workplace injury. We use an administrative database that links individual publicly funded healthcare data and Workers' Compensation Board (WCB) data for the entire population of British Columbia (BC), Canada. The spouses and children of all injured workers who filed a WCB claim in 1994 and missed one or more days of work due to the injury (lost time) were included. We compare their change in use of healthcare services relative to a year before the injury to families of workers who did not require time off for their injuries (no lost time) and families of individuals who were not injured (non-injured comparisons). Differences in healthcare services use among the three groups of spouses were marginal, and differences for increases in mental healthcare services use were non-significant. As well, all three groups of children decreased their use of physician and hospital services and increased their use of mental healthcare services, with very little difference among groups. This was a descriptive study looking at a broad group of injured workers and their families. Even modest increases in healthcare use following a workplace injury have some basis for further study.

Capturing cases in workers' compensation databases: The example of neck pain

There is a need to more accurately enumerate workers with musculoskeletal injuries who make lost-time claims to workers compensation boards. The objective of this study is to develop an approach to more accurately enumerate these workers. Lost-time claims to the Ontario Workplace Safety & Insurance Board (WSIB) were reviewed. Using neck pain as an example, nature of injury and part of body codes were identified to classify cases. Claims of a random sample of 434 claimants were reviewed. The proportion of claimants classified as having neck pain was computed. The proportion of claimants classified with soft-tissue injuries to the neck varied from 0.88 for codes including "neck/cervical region," 0.69 for "back region" to 0.05 for those coded as "shoulder/upper arm." Restricting the enumeration of injuries to specific part of body codes can lead to a gross underestimation of the magnitude of soft-tissue disorders in epidemiological studies using workers' compensation data. The proposed approach leads to more accurate enumeration.

Healthcare use before and after a workplace injury in British Columbia, Canada

Objectives: There is growing evidence that occupational injuries influence workers’ emotional and physical wellbeing, extending healthcare use beyond what is covered by the Workers’ Compensation Board (WCB). Methods: The authors...

A study of factors influencing return to work after wrist or ankle fractures

Factors associated with time to return to work are poorly understood for occupational injuries, other than those to the back. Anonymized data on claims for work-related wrist or ankle fracture between 1/1/1998 and 12/31/2002 were identified in administrative data held by the Workers Compensation Board in Alberta, Canada. Bivariate and Cox regression analyses were used to identify factors associated with return to work. Increased duration of temporary disability (TD) was associated with older age, female gender, work in construction and construction trade services, smaller company size, higher industry claim rates, a fall/jump from a height, ankle fracture, and greater medical aid costs in the 30 days following injury (used as a proxy for severity). Factors associated with longer time off work were largely consistent with those reported following back injury. Median time to return to work was longer following ankle than wrist fracture. Although Workers' Compensation Board (WCB) administrative data provided information that could be used to identify factors affecting return to work, better information on injury severity would considerably enhance their research potential.

Stakeholder Accountability: Workplace Injuries in the UK and Canada

An increasing feature of public services is the plurality of provision, but few studies examine how organizational arrangements affect stakeholder accountability for financial and performance issues. We examine stakeholder accountability for public services under different organizational forms by examining the workplace injuries systems in the UK and Canada (services provided through private insurance, direct government provision and stand-alone agency). The UK system is a largely uncoordinated arrangement of government provision through the Department of Work and Pensions (DWP) and compulsory private insurance. In Canada, the stand-alone Workers Compensation Boards (WCBs) administer a compensation system on a no fault basis and levy a fee from employers. The research study consisted of stakeholder interviews and documentary analysis in Canada and the UK. The primary stakeholders of the DWP industrial injuries benefit system; the commercial companies providing employers' liability schemes and the Canadian WCBs differ markedly. While all three arrangements have primary stakeholders that include (injured) workers and the government either in a regulatory or funding role, the importance of other stakeholders such as employers varies considerably. We found that stand-alone agencies can facilitate stakeholder accountability but 'voluntary' accountability can lead to lax targets. Government provision tends to rely on political accountability but with little consultation with interested parties. Commercial accountability neglects both the wider aspects of public accountability and the non-investor stakeholders. Stakeholder accountability needs to be planned and controlled under the different organizational forms. Where there is a range of provider, accountability for program elements should be established.

Predictors of return to work following traumatic work-related lower extremity amputation

Purpose. To determine factors predictive of return to work (RTW) and days of total disability (TD) in a population of persons working at the time of lower extremity amputation.Method. Retrospective chart and database review.Results. Of 88 valid cases, 48% involved toe amputation, 23% transtibial, 14% partial foot, 14% transfemoral, and 2% high level. Fifty-eight percent of all subjects RTW, 19% were deemed ‘fit for work’, and 23% did not RTW. Days TD ranged from 0 to 1664, with a mean of 366 days. Toe amputation level showed a mean of 127 days of TD. Bivariate analysis showed amputation level, total costs to Workers Compensation Board (WCB), and days TD significantly related to RTW, and rehabilitation costs, vocational rehabilitation, work assessment, age, number of surgical procedures, number of days in acute care, and amputation level significantly related to days TD. In the multivariate model, only amputation level and higher gross annual income showed predictive value for RTW. However older age, more surgical procedures, less days in hospital, and higher amputation levels were all predictive of increased days TD.Conclusion. Toe amputation level had a surprisingly high number of days TD, which may have significant potential economic and disability impact on the workplace. Other factors beyond simply amputation level (such as previous income level) are important considerations for RTW.

The emergence of manganese-related health problems in Quebec: An integrated approach to evaluation, diagnosis, management and control

This paper describes the strategy developed in Quebec to deal with an emerging problem: manganism in welders. Only two cases of manganism had been reported to the Commission de la santé et de la sécurité du travail (CSST, Workers Compensation Board in Quebec) before 2000. In the fall of 2001, the CSST was informed of a possible cluster of manganism and received 20 compensation claims from one plant. Action was rapidly taken to understand and tackle this emerging problem. Under the leadership of the CSST, a coordinating working group implemented medical and environmental subcommittees involving representatives of the different partners of the prevention network. After a literature review to document the health risks associated with manganese and the lack of some important information, a panel of international experts was formed to try to reach agreement on the parameters to consider in the diagnosis and management of manganism. The CSST compensation management policies would be adjusted accordingly. Simultaneously, all the available industrial hygiene data were analyzed to estimate where and at what levels workers were exposed to manganese. To complete these data, the exposure of workers in more than 50 industrial plants was evaluated and existing control measures were documented. All these data have been presented for a revision of the Quebec permissible exposure limit (PEL). In this integrated approach, the next step targets the formation of neurologists and neuropsychologists for a standardized medical evaluation, to complete workplace evaluation in the high risk sectors, inform workers and employers and recommend control measures where required, based on a revised PEL. Many strategies will be used to inform the prevention network (about 1000 people), employers and employees of the risks of overexposure to manganese and of the measures to control exposure in all the plants where workers are susceptible to be exposed to manganese.