With adequate time for medical recovery and job accommodation, an injured worker should be able to return to work safely and without fear of reinjury. In their letter to the Premier, the Ontario Network of Injured Workers Groups calls on the Government and the WSIB to engage in a conversation about their mistaken and harmful philosophy (Better at Work) that “immediate” return to work, rather than “early and safe” return to work, is always preferable.
Injured workers, particularly the permanently disabled workers ONIWG represents, want to return to work as soon as they are able. However the emphasis on “immediate” return to work can disrupt the healing process. Rather, each case should be decided according to the individual injured workers’ situation.
The workplace is no rehabilitation centre
The WSIB’s 2005 Best Approaches adjudicative guide, “Recognizing Time to Heal – Assessing Timely and Safe Return to Work”, reflected the balance between timeliness and safety of the return to work. The new doctrine “Better at Work” which replaced it adopts a private insurance inspired approach promoted in the 2006 ACOEM report, claiming injured workers should stay at work because to be off work is harmful to them. Using a reverse logic and unsupported by evidence, the pseudo-science assertion that “time to heal causes harm” is extremely dangerous to injured workers. Early activity is good (medically approved and according to individual circumstances). Staying at work or returning to work immediately requires a different threshold of recovery and is not identical to early mobilization or early physical rehabilitation.
As Ontario research from the 1990s to the present has shown, forcing seriously injured workers back to work is counterproductive (i.e. high risk of re-injury) and does not result in sustainable employment. “Time to heal” should be safeguarded as official policy, consistent with the “early and safe” return to work legislation (Workplace Safety and Insurance Act, s.40) and with research-based evidence… [read ONIWG letter]
(Added note (Aug.1) This response to “Better At Work” has generated much feedback and suggested additional readings on research into “early RTW” (understood as within 3 months of injury, not immediate) – see “Related reading” below)
- Lax, M. 2015. “Not Quite a Win-Win: The Corporate Agenda of the Stay at Work/Return to Work Project.” New Solutions 25(1):4-24 (abstract)
- Purdie, G. 2015 Nov. 20. “Is the Statement that if a Person is Off Work for 70 Days the Chance of Ever Getting Back to Work is 35% Justified?” New Zealand Medical Journal 128: 6729
- Marshall, David. 2014 Jun. 18. “The WSIB: An Historic Transformation.” Liversidge e_Letter
- Etches, J. et al. 2012 Jan. 31. Repeat Workers’ Compensation Claims Toronto: Institute for Work & Health (IWH plenary series)
- Institute for Work & Health. 2009. Red Flags/Green Lights: A Guide to Identifying and Solving Return-to-Work Problems. Toronto: IWH
- Ladou, J. et al. 2007. “American College of Occupational and Environmental Medicine(ACOEM): A professional Association in Service to Industry.” International Journal of Occupational and Environmental Health 13(4): 404-426
- Christian, J. 2007. Introduction to ACOEM’s…Guideline: Preventing Needless Work Disability By Helping People Stay Employed. Wayland, MA: 60 Summits Project Inc.
- MacEachen, E. et al. 2007. “A deliberation on “hurt versus harm” logic in early return to work policy.” Policy and Practice in Health and Safety 5(20: 41-62 [abstract]
- Horppu, R. et al. 2016. “Occupational Physicians’ Reasoning about Recommending Early Return to Work with Work Modifications.” PLoS ONE 11(7) – includes interesting observations on possible harms and when early RTW may be inappropriate
- Clay, F. et al. 2014. “How Well Do We Report on Compensation Systems in Studies of Return to Work: A Systematic Review.” Journal of Occupational Rehabilitation 24:111-124 – authors critique the quality of RTW research, concluding overall reporting needs to be improved if research evidence of RTW is to be used to guide policy and practice