Unexpected barriers in return to work: lessons learned from injured worker peer support groups

Some workers who are injured at work have unexpectedly prolonged absences from work. Experiences of workers who constitute a disproportionate cost to the return-to-work system and the systemic and compliance-related barriers they encounter during the process of returning to work are reported. A qualitative interview based study was conducted with 37 members of three injured worker peer support groups in a Canadian province. Four dimensions of peer support were identified: worker experience of being misunderstood by system providers, need for advocates, social support, help with procedural complexities of the workers' compensation, and health care systems. Peer support constitutes a partial return-to-work solution for workers with injuries, but injured workers encounter an uneven playing field. Injured worker peer support group needs and activities show us that sensitivity to structural and social issues may lead to better return-to-work outcomes.     

Factors affecting the organizational responses of employers to workers with injuries

The organizational responses of employers to work-related injuries is one of several significant influences on return-to-work outcomes. Thus, understanding the factors that lead to better or worse organizational responses to work injuries may ultimately help to improve success in this area. The purpose of this study was to systematically explore factors that might influence the organizational responses of employers to injured workers, based on employee perceptions. Cross-sectional survey data were collected from 2,943 subjects with work-related injuries which had occurred less than eight weeks prior to survey completion. Measured variables included pre-injury demographic and job factors, injury circumstances, and a measure of post-injury events that comprised the organizational response. Multivariate linear regression results show that age, gender, job dissatisfaction before injury, prior difficulty performing job tasks, injury severity, back injury and lost time were all associated with negative organizational responses, suggesting potential opportunities for intervention.     

HOW DOES HEALTH INSURANCE AFFECT WORKERS’ COMPENSATION FILING?

About half of injured workers choose not to file workers' compensation claims. This is thought to result from their use of health insurance instead of workers' compensation. However, the data suggest that insured workers are actually less likely to file than their more vulnerable uninsured counterparts. We found that this relationship emerges as the result of employer characteristics and, in particular, that employers who offer health insurance to employees are more likely to have workers who file claims; this is much more important than the insurance status of workers themselves or fixed worker characteristics. ( JEL I1, J3)     

Injured and Silenced: Working with Workers' Compensation Claimants and Their Families

It is not uncommon for rehabilitation and workers' compensation systems to treat the injured worker as either a passive victim or a mischievous malingerer. Much ofthe literatureregardingrehabilitation ofpeople with chronic pain and soft tissue injury speaks of paralysis and powerlessness as if the injured person is a piece offlotsam buffeted about by the socialforces of WorkCare (and other compensation systems), the employer and the medical legal systems. This paper will review the pertinent literature and demonstrate the lack ofobjective supportfor a ‘blame-thevictim’ attitude. The importance of the injured person playing an active role in his/her rehabilitation will be emphasised through a systematic analysis ofthe impact ofthe WorkCare scheme on the injured worker and their treatment. In this light, a systems based approach to therapy with injured workers and their families will be outlined.     

A comparison of self-perceived physical and psycho-social worker profiles of people with direct work injury, chronic low back pain, and cumulative trauma

This study investigated the psycho-social factors among injured workers and the influence of their psycho-social profile on the readiness of return to work. Sixty-four subjects with injuries on the upper limbs or lower limbs, low back pain, or cumulative trauma disorder were recruited. The workers' profiles (self-perceived physical health, mental health, and work readiness) together with the impact and types of work injury on the workers' perceived wellness were measured. The regression model of work readiness was constructed to develop a theoretical background for predicting work readiness based on different factors. The results showed that injured workers with chronic injury such as low back pain or cumulative trauma had poorer self-perception of physical health and psycho-social/mental health compared to those with direct trauma. The regression analysis further affirmed that self-perceived pain and physical functioning were significant factors influencing the readiness for returning to work. Workers with low back pain were found to have lower motivation for returning to work. Other factors such as the non-verbal intelligence of the injured workers, their anxiety level, and the support they received from family members were found to have some indirect impact on their ability to return to work, but this was not statistically proven.     

Improving work programs' delivery of information and service to workers' compensation carriers

This paper presents the results of a telephone survey of workers' compensation carriers, addressing how occupational therapy work programs can best meet these carriers' needs. Fifty percent of the market share of workers' compensation carriers in Michigan participated in the survey. Survey results indicated that workers' compensation carriers found Functional Capacity Evaluations, job analyses, and work hardening to be important work rehabilitation services. A significant portion of the respondents (88%) stated that they recognized the need for clinically successful work rehabilitation programs and indicated that if they had return to work rates for different providers, they would utilize providers that had the most successful outcome data in a specific geographical area. Occupational therapists can use these survey results to improve their services and communication with insurance to ensure that injured workers will continue to have access to the efficacious interventions occupational therapists provide in work rehabilitation.     

The needs and experiences of injured workers: a participatory research study

This paper reports on the findings of a participatory research study in which 290 injured workers in Ontario, Canada responded to a survey that was developed and administered by a group of university researchers in partnership with injured worker peer researchers. The objectives of the study were to gain a broad view of the needs and experiences of injured workers and to develop strategies for change. Findings indicated that many injured workers experience undue financial, emotional and physical hardship during the compensation, treatment and rehabilitation process. These hardships are experienced due to perceived lack of respect, insufficient information concerning rights and the return-to-work process, and limited opportunities for input into the medical or rehabilitation process. Recommendations for increasing the power of workers and creating a more supportive climate are included.     

Occupational-psychosocial perceptions influencing return to work and functional performance of injured workers

Much has been done to identify psychosocial factors influencing risk of vocational injury and prolonged disability. The purpose of this paper is to enhance the ability of injured workers to return to their prior worker role through the identification of the influencing psychosocial perceptions. Psychosocial perceptions may assist in the identification of negative or counterproductive factors that hinder the rehabilitative process. Identifying perceptions are individual centered and focused on the views of injured workers as they proceed through the transition in life following injury. Occupational therapists play a key role in the rehabilitative process of injured workers through enhancing the person-job-environment fit [4].     

Physical, social and emotional function after work accidents: a medicolegal perspective

The aim of this study was to analyse social and functional consequences of work accidents in a group of workers' compensation claimants who had been referred from the National Insurance Administration for a medicolegal assessment. The injured workers were evaluated on average 3 years after their accidents. Their medical records were analysed, and each injury was scored according to the Abbreviated Injury Scale (AIS). Participants completed the Short Form Questionnaire (SF-36). Factors relating to outcome on SF-36 were analysed using univariate and multivariate methods. 191 claimants returned the SF-36 (62%), 83% of the respondents had an AIS score of less than two, 33% reported working full time. Compared to population-based norms, the respondents reported significantly reduced health on all eight scales of SF-36. Better health and function was mainly associated with a higher level of education and more serious injuries. The extent of social support in the workplace after the accident was only partly related to outcome. The importance of psychosocial factors when making injury assessments in a medicolegal setting is highlighted.     

Giving hope in brain injury. An exploration of families' experiences with the brainwave organisation and therapy

This exploratory study examined families' experiences during the care of brain‐injured children being treated with therapy from the Brainwave organisation. Families highlighted areas of dissatisfaction with existing services. The friendly and positive attitudes they received from Brainwave staff were an indication of hope for the future. Involvement in their children's care and being valued during decision making were advantages attributed to the Brainwave organisation. The study has produced recommendations for the Brainwave Centre to improve their service delivery as well as important areas within conventional care that could be improved and developed to help families with brain injury. Copyright © 2002 John Wiley & Sons, Ltd.     

Informal waste harvesting in Victoria Falls town, Zimbabwe: Socio-economic benefits

Waste harvesting, which occurs mostly but not exclusively at open waste dumps in Zimbabwe, constitutes one of the most important survival options for the urban poor. This paper analyses and discusses socio-economic benefits of informal waste harvesters in Victoria Falls town. Victoria Falls town has an estimated population of 31,000 and is presently the fastest growing urban centre in Zimbabwe. An estimated 8000 tonnes of solid wastes are generated in the town every month. Questionnaires were administered to informal waste harvesters who recover materials mostly from three large open waste dumps. Thirteen dumpsite harvesters, who were available at the time of the survey and willing to participate, were interviewed during the month of October 2002. The questionnaire solicited for information on the character and dynamics of recuperative activities in the town, socio-economic and demographic characteristics of waste harvesters, type of materials recovered and their uses, and income derived from sale of harvested materials and how it is spent. Additional data were obtained from field observations.The study identified two categories of waste harvesters. The first group specialises in the recovery of foodstuffs mainly for household use. The second group comprises informal waste harvesters who specialise in the recovery of building materials such as bricks and river sand and scrap metal primarily for sale. Data provided by dumpsite waste harvesters interviewed show that the mean monthly income from the sale of harvested materials varied from Z$7500 (for 23.1% of the respondents) to Z$22,500.5 (for 15.3% of the respondents). Using the income they obtain from waste harvesting, most respondents (84.6%) indicated that they can now afford to pay school fees for their children in time while 61.5% stated that after engaging in resource recovery, they moved from informal settlements to Chinotimba where they now stay to a more decent accommodation with electricity, piped water and flush toilets. Prior to engaging in waste recovery, over a half of the informal waste harvesters indicated that were staying in informal settlements. The findings of this study, in particular the income and expenditure data, demonstrate that by engaging in waste harvesting, some of the urban poor are able to eke out living in an urban environment where economic opportunities are very limited. However, the contribution of informal waste harvesting to urban livelihoods in urban areas of Zimbabwe needs further investigation.     

Worker perceptions of procedural justice in workers’ compensation claims: Do unions make a difference?

The differences between union and nonunion workers’ perceptions of the fairness of the workers’ compensation claims process are examined. The hypothesis tested is that union members should perceive this process as more fair due to union “voice.” The data were collected in a survey of injured workers in Michigan who had filed a workers’ compensation claim. The empirical results indicate that unions have little impact on the perceived fairness of the claims process and that the main contribution of unions is the provision of a complaint mechanism. From the Bill of Rights to Chief Justice Earl Warren’s recurring inquiry of counsel, “but is it fair?” fair treatment has been treated as a value enforceable by law, standing at the very core of the constitutional, political, and social rights of the individual. —Westin and Feliu (1988, p. 255)     

A controlled case study of supervisor training to optimize response to injury in the food processing industry

The role of supervisors to aid injured workers, access health care, and provide reasonable accommodation may prevent prolonged disability among workers reporting musculoskeletal pain. Although supervisor training has been a common element of broad-based ergonomic interventions to prevent injuries, the impact of supervisor training alone to improve injury response has not been studied. In a controlled design, 11 supervisors in an intervention group and 12 supervisors in a delayed intervention control group from the same plant were provided a 4-hour training workshop. The workshop emphasized communication skills and ergonomic accommodation for workers reporting injuries or health concerns. Workers' compensation claims data in the 7 months before and after the workshop showed a 47% reduction in new claims and an 18% reduction in active lost-time claims versus 27% and 7%, respectively, in the control group. Improving the response of frontline supervisors to employees' work-related health and safety concerns may produce sustainable reductions in injury claims and disability costs.     

A return to work program for injured workers: a reassignment model

The current workers' compensation system does not encourage permanently restricted workers who are disabled due to work related injuries to return to work. Workers are often labeled permanently disabled and are released from their positions with their employers. However, according to the Americans with Disabilities Act of 1990, these individuals may be qualified to return to productive employment. This paper will describe a Reassignment Model for occupational therapy supported by the rehabilitation frame of reference. This Model presents reassignment to a vacant position as a reasonable accommodation to return injured workers to productive employment. A case study will illustrate the successful implementation of the model. The potential benefits of using this Model will be described for clients, society, employers, and the occupational therapy profession.     

Use of functional capacity evaluations in workplaces and the compensation system: a report on workers' and report users' perceptions

Until recently, little was documented about how functional capacity evaluations (FCEs) are used by employers and workers' compensation organizations. Such information was one focus of a comprehensive research study on FCEs carried out in southern Ontario, Canada, which involved representatives from the full range of groups involved in FCEs: referral sources, assessors, return-to-work specialists, third party payers and injured workers [1]. This paper shares findings from a cohort of injured workers undergoing FCEs, and explored how their FCE results were perceived and utilized by those receiving the reports. Based on study findings, we provide recommendations as to how FCEs should be requested, undertaken, reported and particularly applied to reduce work disability among injured workers.     

Will Australian workers' compensation insurance management get better soon?

A study of Australian experience in the state of New South Wales (NSW) suggests that private sector underwriting of workers' compensation insurance risk plus insurer competition on premium price may put downward pressure on benefits for injured workers, inhibit rehabilitation, and cause related cost increases for taxpayers and employers. Insurer underwriting also increases workers' compensation administrative costs and means an unnecessary loss of investment income for government and industry. An emerging and better alternative for the Australian community is for government and industry to underwrite a national workers' compensation scheme and to fix premium and benefit requirements which are competitively administered by insurers. In such a regulatory environment insurer inability to compete on premium price should promote competition to provide effective services to help employers prevent injury, assist rehabilitation and contain cost. National standards are necessary to enable widespread dissemination of comparable, reliable information on the outcome of health, rehabilitation, dispute resolution and return to work services. This is required to assess the competitive performance of service providers in order to ensure effective operation of the market to achieve scheme objectives. Holistic, multi-skilled and objective rehabilitation professionals are needed who can clearly demonstrate the effectiveness of their actions in assisting injury prevention, worker rehabilitation, and safe return to work across a range of industry contexts.     

Working mothers,injury and embodied care work

In this article, we examine how mothers respond when injury interrupts maternal care, using the lens of embodied care, which we conceptualize as a form of ‘body work’. We draw on findings from a qualitative research project with two organizations in Australia that help people with injuries to return to work, examining the experiences of workers who are also mothers of dependent children. Mothers' inability to care for children during periods of injury was a significant concern for our interviewees; constraints on physical labour and physical affection were particularly troubling, indicating the importance of embodied maternal caregiving to maternal roles. Yet, while these mothers inhabited the spheres of paid work and unpaid care work simultaneously, service providers did not consider embodied care work or its relevance to injured women's ongoing needs for support. While our findings reflect the experiences of injured women, they also suggest the need for a materialist analysis of the ways that both paid work and care activities are deeply enmeshed in and through the bodies of those doing the work. Employers and service organizations still fail to recognize maternal ‘body work’, and this may be typical of social attitudes more widely.     

Work injury rehabilitation in Guangzhou: 380 case cohort study

Work injury rehabilitation is a new concept in Mainland China. In 2001, the first work injury rehabilitation centre was established in Guangzhou under the management of the Guanghzhou Bureau of Labour and Security. This paper reviews the profile of a cohort of workers with injuries who received rehabilitation services at this centre. The changes in the physical capacity, daily function, and quality of life of the workers with injuries before and after the treatment services were also reviewed. A total of 380 were extracted from the database which occupied 79% of the total patient population admitted to the centre between 2003 to 2004. The assessment results suggested that workers with injuries showed increases in physical capacity in terms of the range of motion, muscle strength and walking tolerance. The daily functioning by using Barthel Index was also improved. Quality of life assessed with the WHOQOL also demonstrated an increase in the physical and psychological domains. Work injury rehabilitation in Guangzhou is at its infancy stage. The cooperation between the rehabilitation centre, employers and workers is of the utmost importance for a successful return to work outcome. The workers' compensation and rehabilitation policy also dictates the future of success of the rehabilitation services.     

Job matching and return to work: Occupational rehabilitation as the link

Return to work after injury or illness is important for the worker and the employer. Medical providers manage and treat the worker with the illness or injury. Except in cases of focused specialists, the medical professional's role is to take care of a patient, rather than empower a worker. As much as there is promotion of the workers compensation health care system to be similar to sports medicine, there are significant dissimilarities. One major barrier is that the medical caregivers do not know the demands of jobs as they would know the details of sports. Thus, there is a gap in returning a worker to function as the medical professional cannot accurately match the worker to specific jobs. A new model of job function matching, based on research and skills of occupational rehabilitation professionals, is proposed to bridge the gap between the medical community, the employers and the workers.     

Cost-effectiveness of a prework screening program for the University of Illinois at Chicago physical plant

A post-offer screening program jointly developed by the Occupational and Physical Therapy Departments (University of Illinois at Chicago) was first implemented in March 1998. A total of 712 screens were completed from 3-01-98 through 2-28-01. A quasi-experimental design was utilized to analyze changes in Workers' Compensation costs between the three-year period prior to, and the three-year period following program inception. Additionally, injury rates and mean cost per injury were compared between injuries sustained between 3-98 and 3-01 which were incurred by workers who had passed screening and those that had not been screened. Finally, the tabulated cost per screen and reduction in Workers' Compensation costs allowed derivation of a dollar spent/ dollar saved ratio. Dramatic declines in number of injuries, total costs and mean cost per case occurred in the three-year period following program inception. Mean cost per case also dramatically declined comparing injured workers who had passed screening versus those who had never been screened. Cost savings were over US dollars 18 per dollar spent on the program. While a number of mitigating variables may have accounted for some of the profound effects noted, decrease in average cost per case (indicating possible reduction in severity of injury) was consistent with existing literature.