2012-02-01 12:00 - Messages
An international perspective
Background: Workers' compensation systems are among the most generous disability insurance systems in North America, although they are also known to be potentially adversarial and may have iatrogenic effects on claimants. This article examines issues to be considered to ensure fair compensation provided in a way that respects the dignity of workers.
Methods: An overview of the literature on characteristics and effects of workers' compensation systems is followed by an analysis based on classic legal methods, including those of comparative law, complemented with interview data to examine three models of disability compensation.
Results: The first part of the article identifies cross cutting issues to be considered in the examination of the equity of compensation systems and the protection of the dignity of claimants. These include three underpinnings of workers' compensation: the links between a “no-fault” system and the adversarial process, the appropriate use of medical and scientific evidence in the determination of compensability and the application of appropriate measures for promoting return to work. The second part looks at accident compensation in New Zealand, where compensation is available regardless of the cause of the accident, and disability insurance in the Netherlands, where compensation is available regardless of the cause of the disability. It then describes a composite of characteristics favorable to equity drawn from the thirteen workers' compensation systems in Canada.
Conclusion: Systems that succeed in reducing opportunities for adversarial interactions and that provide substantive protection could better promote the dignity of claimants.
Source : Lippel K. Am. J. Ind. Med. 2012.
Kosny, A.A, et M.E. Lifshen (2012). A national scan of employment standards, occupational health and safety and workers' compensation resources for new immigrants to Canada. Canadian Journal of Public Health, 103(1) :53-58.
OBJECTIVES: The burden of work injuries in Canada is a serious public health concern. Nearly one million Canadian workers experienced nonfatal injuries that led to time off work in 2005. New employees and recent immigrants are more likely to experience a work-related injury. The purpose of this study was to examine services, programs and resources available to newcomers to Canada that focus on employment standards (ES), occupational health & safety (OHS) and workers' compensation (WC). METHODS: We reviewed resources available through community organizations, employers, settlement groups and unions, as well as provincial and federal prevention agencies and workers' compensation boards. The materials were categorized according to geographical distribution, content, resource type, audience and language. RESULTS: We found a total of 224 resources that met our search criteria. The greatest numbers were found in the provinces of Ontario, British Columbia and Manitoba. Most resources consisted of short factsheets on the topic of ES; WC was the focus of the fewest resources. The most comprehensive resources were teaching materials for ESL/FSL classes and Job Search Workshops. Most resources were specifically produced for newcomers but only available in French/English. Our scan uncovered no information for health care providers, union representatives or safety professionals working with immigrants. Very few resources were aimed at young immigrant workers or employers working with newcomers. CONCLUSIONS: Our research identifies gaps in the provision of health and safety resources for newcomers. Additional research is needed to evaluate the depth and quality of materials and to determine how decisions are made around the inclusion or exclusion of ES, OHS and WC information in language and labour market preparation programs for new immigrants.
OBJECTIVE: To identify risk factors for work retention (a patients' ability to both obtain and retain employment) at 1 year after treatment for a chronic disabling occupational musculoskeletal disorder (CDOMD). DESIGN: Prospective cohort study. SETTING: Consecutive patients undergoing interdisciplinary functional restoration treatment in a regional rehabilitation referral center. PARTICIPANTS: A sample of 1850 consecutive CDOMD patients, who were admitted to and completed a functional restoration program, were subsequently classified as work retention or nonwork retention at a 1-year posttreatment evaluation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measures, including medical evaluations, demographic and occupational data, psychosocial diagnostic evaluation, and validated measures of pain, disability, and depressive symptoms, were obtained at admission to, and discharge from, the program. RESULTS: Using a multivariate logistic regression analysis, the following variables were found to be significant predictors of failure to retain work: older age (odds ratio [OR]=1.84; 95% confidence interval [CI], 1.33-2.54), female sex (OR=1.46; 95% CI, 1.09-1.94), nonworking status at discharge (OR=1.65; 95% CI, 1.11-2.45), extreme disability at admission (OR=1.46; 95% CI, 1.06-2.00), antisocial personality disorder (OR=2.11; 95% CI, 1.09-4.08), receipt of government disability benefits at admission (OR=2.28; 95% CI, 1.06-4.89), and dependence on opiate pain medications (OR=1.43; 95% CI, 1.02-2.00). The final model improved prediction by 75% over assigning all patients to the larger (work retention) group. CONCLUSIONS: This study identified demographic, psychosocial, and occupational factors that were predictive of failure to retain work. These risk factors may be used to individualize treatment plans for CDOMD patients in order to provide optimal functional restoration.
Source : Brede E, Mayer TG, Gatchel RJ. Arch. Phys. Med. Rehabil. 2012; 93(2): 268-274.
OBJECTIVE: To use a 2-part model to identify biographic, injury, educational, and vocational predictors of postinjury employment and the percentage of time employed after spinal cord injury (SCI) onset. DESIGN: Survey. SETTING: Data were collected at 3 hospitals in the Southeastern and Midwestern United States. PARTICIPANTS: Participants were adults with traumatic SCI of at least 1 year duration, all under 65 years at the time of SCI onset. A total of 1329 observations were used in the analysis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Postinjury employment, defined by whether the individual had ever been employed after SCI and percentage of time employed after SCI onset. RESULTS: Almost 52% of participants worked at some point in time postinjury. Among those who had worked postinjury, the mean portion of time spent working was 0.56. Several factors were significantly related to postinjury employment and portion of time worked postinjury. The probability of postinjury employment increased with successively less severe injury. However, only ambulatory participants were found to have a significantly greater portion of time postinjury among those who became employed. Having obtained either a 4-year or graduate degree after injury was associated with a greater likelihood of postinjury employment. Conversely, among those who worked postinjury, having obtained those degrees prior to injury was associated with a greater portion of time employed. Being white, a man, having completed a 4-year degree or a graduate degree, and having worked in the service industry prior to SCI onset were all associated with a greater portion of time working among those who had worked. CONCLUSIONS: The factors precipitating PE are not identical to those associated with a greater portion of time employed after SCI onset.
Source : Krause JS, Terza JV, Erten M, Focht KL, Dismuke CE. Arch. Phys. Med. Rehabil. 2012; 93(2): 373-375.
A comparative outcome study
The aim of this study was to compare the effectiveness of two individual-level psychotherapy interventions: (a) treatment as usual consisting of cognitive–behavioral therapy (CBT) and (b) work-focused CBT (W-CBT) that integrated work aspects early into the treatment. Both interventions were carried out by psychotherapists with employees on sick leave because of common mental disorders (depression, anxiety, or adjustment disorder). In a quasi-experimental design, 12-month follow-up data of 168 employees were collected. The CBT group consisted of 79 clients, the W-CBT group of 89. Outcome measures were duration until return to work (RTW), mental health problems, and costs to the employer. We found significant effects on duration until RTW in favor of the W-CBT group: full RTW occurred 65 days earlier. Partial RTW occurred 12 days earlier. A significant decrease in mental health problems was equally present in both conditions. The average financial advantage for the employer of an employee in the W-CBT group was estimated at $5,275 U.S. dollars compared with the CBT group. These results show that through focusing more and earlier on work-related aspects and RTW, functional recovery in work can be substantially speeded up within a regular psychotherapeutic setting. This result was achieved without negative side effects on psychological complaints over the course of 1 year. Integrating work-related aspects into CBT is, therefore, a fruitful approach with benefits for employees and employers alike.
Source : Lagerveld, Suzanne E.;Blonk, Roland W. B.;Brenninkmeijer, Veerle;Meij, Leoniek Wijngaards-de;Schaufeli, Wilmar B.
Journal of Occupational Health Psychology, 2012.
DOI : 10.1037/a0027049
The Danish national return-to-work (RTW) program aims to improve the management of municipal sickness benefit in Denmark. A study is currently ongoing to evaluate the RTW program. The purpose of this article is to describe the study protocol. The program includes 21 municipalities encompassing approximately 19 500 working-age adults on long-term sickness absence, regardless of reason for sickness absence or employment status. It consists of three core elements: (i) establishment of multidisciplinary RTW teams, (ii) introduction of standardized workability assessments and sickness absence management procedures, and (iii) a comprehensive training course for the RTW teams. The effect evaluation is based on a parallel group randomized trial and a stratified cluster controlled trial and focuses on register-based primary outcomes – duration of sickness absence and RTW – and questionnaire-based secondary outcomes such as health and workability. The process evaluation utilizes questionnaires, interviews, and municipal data. The effect evaluation tests whether participants in the intervention have a (i) shorter duration of full-time sickness absence, (ii) longer time until recurrent long-term sickness absence, (iii) faster full RTW, (iv) more positive development in health, workability, pain, and sleep; it also tests whether the program is cost-effective. The process evaluation investigates: (i) whether the expected target population is reached; (ii) if the program is implemented as intended; (iii) how the beneficiaries, the RTW teams, and the external stakeholders experience the program; and (iv) whether contextual factors influenced the implementation.
Source : Aust B, Helverskov T, Nielsen MBD, Bjorner JB, Rugulies R, Nielsen K, Sørensen OH, Grundtvig G, Andersen MF, Hansen JV, Buchardt HL, Nielsen L, Lund TL, Andersen I, Andersen MH, Clausen AS, Heinesen E, Mortensen OS, Ektor-Andersen J, Ørbæk P, Winzor G, Bültmann U, Poulsen OM. The Danish national return-to-work program – aims, content, and design of the process and effect evaluation. Scand J Work Environ Health. 2012;38(2):120-133
In November 2010, Ontario's Workplace Safety and Insurance Board introduced the new Work Reintegration Program. Many of its features address problems with the old vocational rehabilitation program that were described by Institute for Work & Health research.
By 2009, Ontario's Workplace Safety and Insurance Board (WSIB) was certainly getting the message that its vocational rehabilitation program for injured workers, called Labour Market Re-entry (LMR), was not working as intended. Although bad press and a value-for-money audit drove the point home, evidence from a research project started two years earlier also indicated problems were afoot.
That research was led by Institute for Work & Health (IWH) Scientist Dr. Ellen MacEachen. Although the results of the research are just now being published, they played an important role in shaping the WSIB's new Work Reintegration Program, introduced in November 2010. The program, which integrates return to work and vocational rehabilitation, addresses many of the problems described by MacEachen's research.
Source : http://www.iwh.on.ca/at-work/67/IWH-research-helps-shape-new-work-integration-initiative
Objectives This study aims to identify the hazard functions that describe the occurrence patterns of new and recurrent sick leave (SL) episodes for mental, respiratory, and musculoskeletal diagnoses.
Methods The data come from a cohort of workers in the Hospital das Clínicas da Universidade Federal de Minas Gerais, Brazil, including all employees working ≥20 hours per week, whose first employment relation with the hospital started between 1 January 2000 and 31 December 2007 (N=1579). We created 15 samples corresponding to combinations of diagnoses causing SL and the number of previous episodes already suffered. We fitted Weibull, log-normal, and log-logistic models by resampling and selected the model having the lowest Akaike information criterion in the greatest number of resamples.
Results Differences were observed in the probability distributions associated with the process generating a SL. Diagnosis showed important differences in terms of risk intensity: mental episodes were the least frequent. There were differences in risk intensity and shape of the function over time depending on the episode number, particularly between the first episode and recurrences. In addition, these differences varied by diagnosis.
Conclusions In most of the samples analyzed, we identified a mixture of distributions, implying a need to revise the statistical methods of analysis for SL occurrence with the aim of obtaining consistent estimates of the risk and the associated factors.
Source : http://www.sjweh.fi/show_abstract.php?abstract_id=3276