The purpose of this research, led by Dr Rebecca Scharfe and funded by Injured Workers Community Legal Clinic, was to describe the experiences and mental health needs of injured and ill Northwestern Ontario workers in the WSIB process, in order to promote system improvements….
Lakehead University. Research brief / November 2021
EXPERIENCES, IMPACTS AND SERVICE NEEDS OF INJURED AND ILL WORKERS IN THE WSIB PROCESS: EVIDENCE FROM THUNDER BAY AND DISTRICT
Ontario’s Workplace Safety and Insurance Board (WSIB) is supposed to help injured and ill workers, but the process may be long, demoralizing, and damaging to workers and families, especially when injuries or illnesses are complex1, 2
Recourse pathways and resources for individuals appealing claims denied by the WSIB are fragmented and scarce, particularly in Northern Ontario. As a result, the risk of workers developing mental health concerns related to the WSIB process itself is high.
Stakeholders such as the WSIB, unions, and healthcare providers need information about:
- How are injured and ill workers are affected by the WSIB claims and appeals processes
- Overall and in unique contexts, such as the rural, remote and Northern communities in the District of Thunder Bay
- The types and extent of mental health services needed to support this vulnerable and highly likely distressed group.
- Strategies for improving systems designed to support injured and ill workers, overall and specifically within in rural, remote and northern contexts
The purpose of this research was to describe the experiences and mental health needs of injured and ill Northwestern Ontario workers in the WSIB process, in order to promote system improvements.
Northwestern Ontario workers and their service providers described their experiences with workplace illnesses and injuries, including:
- Direct physical, psychological, social, recreational, financial, and occupational impacts from the workplace injuries and illnesses themselves
- Additional negative impacts from the worker compensation system itself
- Care and recovery complications due to the unique characteristics of rural, remote and northern contexts.
Implications and conclusions
- Workers and service providers suggested system improvements including:
- Streamlining and explicating WSIB processes
- Increasing WSIB continuity of care
- Improved access to regional support services through arms-length navigators for rural, remote and northern workers.
- Stakeholders such as policymakers, the WSIB and community service providers can use these findings to improve supports for Northwestern Ontario injured workers
- Special considerations are needed to promote equity in rural, remote and northern workers’ timely recovery, improved well-being, and sustained return-to-work.
...you get into the process and if you don’t have any help you are overwhelmed, it is just set up…to make people give up. – Injured Worker
How we Conducted the Research
Between November 2020 and March 2021, Lakehead University researchers recruited injured and ill workers, and social service providers with WSIB experience, from across the City of Thunder Bay and its District communities to participate in the study.
On-line survey: Forty (40) injured and/or ill workers completed an on-line survey about their mental health, social service, and legal system needs while involved with WSIB.
Interviews: An additional 16 injured and ill workers and eight (8) WSIB-experienced community service providers completed interviews addressing similar themes.
Injured and ill workers reported that the WSIB processes had negative impacts on their psychological and physical health, relationships with families and friends, their hobbies, community involvement, financial security, and careers. These
themes were apparent in surveys and in interviews with workers and service providers.
Workers and providers identified nine WSIB process impacts on mental health:
1. Financial anxiety and insecurity
2. Family role instability and conflict
3. Frustration and anger
4. Guilt and shame
5. Helplessness and hopelessness
6. Job insecurity
7. Loss of professional or occupational identity
9. Social isolation
They also identified system factors that affected their experience
Claims – Top Challenges:
- Communication with WSIB (72.5%)
- Paperwork (55%)
- Finances while off work (55%)
- Medical expert assessment (47.5%)
- Going through the process while injured/ ill (45%)
Appeals – Top Challenges:
- Communication with WSIB (77.8%)
- Paperwork (50%)
- Medical expert assessment/consultation (38.9%)
- Going through the process while injured/ ill (72.2%)
Injured and Ill Workers Identified Protective and Risk-Promoting Aspects of the WSIB Process
Worker-identified protective (i.e., positive or experience-enhancing) factors were:
1) Access to adequate services (e.g. psychological),
2) Introduction of a WSIB online portal to coordinate and file claims and appeals, and
3) WSIB transparency (i.e., instances when workers knew exactly what to expect from WSIB and what procedures to follow).
Worker-identified risk (i.e., negative, or experience-detracting) factors specific to WSIB included:
1) Care coordination and treatment planning issues (e.g., accessing and aligning services between providers),
2) Communication challenges (e.g., difficulty getting in touch with WSIB representatives),
3) Paperwork (e.g., total amount, complex nature),
4) Staff turnover and continuity of care (e.g., having to repeat basic injury/illness information to multiple new workers), and
5) Transparency (e.g., uncertainty about process steps and requirements).
Worker-identified broader system risk factors included:
1) Location and ability to access medical experts for assessments, consultation, or services,
2) Employer and union relations (e.g., pressure from employers to return to work, or work in ways negatively impacting recovery, or tensions between unions and employers), and
3) Going through the WSIB process while injured or ill (e.g., because it is complex, requires multiple steps taking away time for rest and recovery)
Rural, Remote and Northern-Specific Concerns
Well-known, regional health services issues affected the workers in this study, including:
- Insufficient numbers of providers to meet the population need
- Low or no access to primary care providers had cascading effects on workers – Primary care providers must assess the need for and initiate referrals to specialists, as well as plan and coordinate assessments and care.
- Communication infrastructure issues, including low or no access to reliable internet or telephone service to enable access to care or efficient coordination of claims and appeals
- Limited access to specialist providers was also problematic, creating:
- Long waitlists for local providers
- Costs, challenging logistics and time for travel to assessments or care
- The COVID-19 pandemic also restricted travel for several
- Cultural impacts of workplace injury, including loss of equipment for local recreational past-times such as boats and snow machines, which serve as transportation and connection to community, when their income was not adequately replaced
A Path Forward: Potential improvements to the WSIB system in Thunder Bay city, District, and overall
- Factors associated with the presence of claim and appeal-related psychological distress are modifiable.6
- Policies that require individuals to sell all of their belongings in order to qualify for benefits are likely to have unintended, negative impacts on the overall recovery of people who become hurt or ill at work.
- Protective aspects of the WSIB process that can be maintained and enhanced for potentially underserved groups include access to adequate support services (mostly psychological or legal) and the new online portal to coordinate file claims and appeals.
- WSIB may be able to further leverage technology to simplify and enhance workers’ experiences
Worker and service provider specific suggestions for improvement to the system that could improve worker well-being included:
- Creating arms-length navigators to help workers understand and move effectively through WSIB processes
- Enhancing WSIB employee compassion
- Increasing continuity of care (e.g., more opportunity to speak with WSIB representatives familiar with workers’ cases)
- Improving access to/knowledge about support services within and outside of WSIB-funded services
- Increasing responsive communication from WSIB, and
- Increasing transparency about WSIB’s role (i.e., insurer only; not advocate) and the claims and appeals processes overall
This research was funded by the Injured Workers Community Legal Clinic (IWC) and conducted Chelsea Noël, BSc, GradDip, Deborah Scharf, PhD, CPsych, Joshua Hawkins, MA, Jessie Lund, MA, Jewel Kozik, BSc, & Anna Péfoyo Koné, PhD, Lakehead
University, Thunder Bay, ON, Canada contact: firstname.lastname@example.org
(Full Research brief with charts available in pdf)
- ONIWG, 2012. Injured workers and poverty survey 2010: A summary. Many losses, much hardship: The impact of work injury. www.injuredworkersonline.org
- Ballantyne, P. J., Casey, R., O’Hagan, F. T., & Vienneau, P. (2016). Poverty status of worker compensation claimants with permanent impairments. Critical Public Health, 26(2), 173–190. https://doi.org/10.1080/09581596.2015.101048.
- Kilgour E, Kosny A, McKenzie D, Collie A. Healing or Harming? Healthcare Provider
Interactions with Injured Workers and Insurers in Workers’ Compensation Systems. J Occup Rehabil. 2015;25(1):220-239. doi:10.1007/s10926-014-9521-x.
- Collie A, Newnam S, Keleher H, et al. Recovery Within Injury Compensation Schemes: A System Mapping Study. J Occup Rehabil. 2019;29(1). doi:10.1007/s10926-018-9764-z.
- Grant GM, O’Donnell ML, Spittal MJ, Creamer M, Studdert DM. Relationship between stressfulness of claiming for injury: Compensation and long-term recovery: A prospective cohort study. JAMA Psychiatry. 2014;71(4):446-453. doi:10.1001/jamapsychiatry.2013.4023
- Collie A, Sheehan L, Lane TJ, Gray S, Grant G. Injured worker experiences of insurance claim processes and return to work: A national, cross-sectional study. BMC Public Health. 2019;19(1):52-63. doi:10.1186/s12889-019-7251-x