10.5 Return to Work
“Our research shows that if you don’t get a worker back within 90 days of their injury, the chances that they ever go back to work drop by 50 per cent,” said David Marshall, president and CEO of Ontario’s Workplace Safety and Insurance Board, in 2015. [1] Marshall’s views are shared by many employers and OHS practitioners who see a return-to-work (RTW) program as a way to reintegrate injured workers into the workplace via practices such as modified work. As an added bonus, RTW programs save employers money on their workers’ compensation premiums.
Organized labour and injured worker advocates have a different view of RTW, with Ontario Federation of Labour president Sid Ryan calling Marshall “the equivalent of the modern day bounty hunter. His job is to disqualify injured workers from receiving their rightful benefits . . . [His] $400,000 [salary] is his bounty for his work over the last year.” Catherine Fenech, of the Ontario Network of Injured Workers Groups, notes “an increase in workers being told the board thinks they can go back to work no matter how badly injured they are.” [2]
The final component of disability management consists of programs designed to assist workers in recovering from temporary impairment (such as injuries and illnesses) that cause disabilities. The most common disability recovery program is sick leave, which is paid leave designed to help workers recover from short-term illness or injury. Sick leave is so widely available because it is sometimes specifically required by employment standards legislation and generally seen as a reasonable accommodation required by human rights legislation.
Most employers are required to enroll their workers in their provincial or territorial workers’ compensation system, which provides wage-loss and other benefits in the event of a work-related injury of illness. Some employers also provide workers with disability insurance purchased from a private insurer. Disability insurance benefits provide wage-loss replacement for workers who require a longer period of time away from work for reasons other than a work-related injury. The specifics of disability insurance vary among workplaces and frequently reimburse only a portion of the wages lost.
Modified work may also be used to help workers to recover from a temporary impairment that causes disability. Work hardening entails providing a worker with the opportunity to gradually return to work (via increasing hours and work demands) in order to build stamina. Employers may also provide coaching or other forms of support to workers who are returning to work. As noted below, the beliefs underlying these return-to-work strategies and their manner of implementation are the subject of some controversy. Box 10.4 discusses the National Institute of Disability Management and Research, which provides research-based evidence for practitioners.
Credentials in disability management and OHS
The National Institute of Disability Management and Research (NIDMAR) provides education, training, and research focused on the implementation of workplace-based reintegration programs based on research evidence. [3] Recently, NIDMAR has partnered with British Columbia’s Pacific Coast University for Workplace Health Sciences to offer programs focusing on disability management and return to work. [4] This partnership builds upon NIDMAR’s existing (and very good) professional certifications in disability management and return to work.
Many professions—including doctors, lawyers and architects—are subject to regulation by their respective provincial and territorial governments. Such regulations are generally managed through government-appointed professional regulatory organizations (PROs), such as a provincial law society or college of physicians and surgeons. PROs generally determine the qualifications required for practice, certify practitioners, and investigate misconduct. While performing a valuable regulatory function, PROs can also limit access to a profession. For example, foreign-trained doctors often complain that accreditation requirements prevent them from practising.
Over time, many otherwise unregulated occupations have developed voluntary associations that often provide professional development opportunities for their members. Some associations have also developed voluntary credentials and certifications. The Certified Human Resource Professional (CHRP) and the Canadian Registered Safety Professional (CRSP) accreditations are two examples. Accreditation is typically awarded based upon a combination of work experience, formal education, completing a certification exam, and paying an annual membership fee. Accreditation may also require ongoing professional development. While these accreditations are not required to gain employment, many employers use these credentials as a screening tool.
Accreditation in unregulated professions likely enhances the knowledge of practitioners. Yet it is useful to consider what other functions accreditation serves. Accreditation gives a small group of actors the power to determine what knowledge, skills, and behaviour are considered necessary and appropriate. Those workers who possess accreditation often have increased legitimacy and standing, even if the knowledge they have been accredited as possessing is contested terrain. The professionalization of safety also has subtle and sometimes negative implications for the effectiveness of the IRS. Finally, meeting the requirements of accreditation can pose an occupational barrier to traditionally disadvantaged workers.
As noted above, return-to-work (RTW) programs are designed to reintegrate injured workers into the workplace via practices such as modified work. This approach stands in contrast to the historical practice of having workers stay off work (most often collecting workers’ compensation wage-loss benefits) until they are fully recovered. By providing injured workers with modified work, employers are able to reduce the cost of injury borne by workers’ compensation claims. In jurisdictions that operate experience-rating programs, reducing workers’ compensation claim costs can result in a reduction in an employer’s workers compensation premiums. In short, RTW programs can save employers money.
When considering the relationship between injury duration and the likelihood of workers returning to work, it is important to be mindful that more seriously injured workers are likely to both require a longer period of recovery and have a lower chance of ever returning to work. [5] This is a very plausible explanation for why workers who are off work longer may also be less likely to return to work.
There is some evidence that workers with back pain recover more quickly when they remain active. On the surface, this correlation might seem to suggest that RTW can, in fact, be rehabilitative. It is not clear, however, to what degree work is analogous to the more generalized term activity. Work differs from other activities (e.g., going for a walk) because it occurs in the context of a power relationship designed to maximize productivity. Consequently, some employers will promise, but not truly provide, suitable modified work. When this occurs, workers face pressure to work in a manner that can be contrary to their medical restrictions, thereby creating the risk of re-injury. [6] More troubling is that there is no evidence to support the notion that activity aids recovery from injuries other than lower back injuries. That is to say, proponents of RTW are not only misstating the benefits of RTW but are also overstating the medical benefits of activity in general.
There are numerous Stakeholders—primarily employers and workers, but also governments, unions, and medical practitioners—involved in disability management and return to work strategies. Each stakeholder brings a unique perspective to the table. It is the job of the employer to ensure the concerns of each stakeholder is taken into account as they seek to manage workplace disabilities and return to work programs, and stakeholders are included in the process.
Return to Work Flowchart from Workplace Safety and Prevention Services
- Brennan, R. (2015, January 31). Meet the man injured Ontario workers ‘love to hate.’ Toronto Star. http://www.thestar.com/news/canada/2015/01/31/meet-the-man-injured-ontario-workers-love-to-hate.html ↵
- Ibid. ↵
- For more information about NIDMAR, see: https://www.nidmar.ca ↵
- For more information about Pacific Coast University, see: http://www.pcu-whs.ca ↵
- MacEachen, E., Ferrier, S., Kosny, A., & Chambers, L. (2007). A deliberation on ‘hurt versus harm’ in early-return-to-work policy. Policy and Practice in Health and Safety, 5(2), 41–62. ↵
- Ibid. ↵
Programs designed to reintegrate injured workers into the workplace via practices such as modified work.
Paid leave designed to help workers recover from short-term illness or injury.
Private insurance benefits providing wage-loss replacement for workers who require a longer period of time away from work than can be accommodated under sick leave provisions and that is required for reasons other than a work-related injury.
Providing a worker with the opportunity to gradually return to work (via increasing hours and work demands) in order to build stamina.
