Wednesday, December 7, 2011

Who creates disability?

Amid the weekend events, Santa Claus parades and early Christmas shopping, you may have missed the pronouncement of December 3 as the International Day of Persons with Disabilities. This UN designated day was acknowledged and proclaimed in many jurisdictions including BC but received little in the way of coverage. I read a couple of news releases but mainstream media was pretty limited.

Does this lack of coverage surprise me? Not really; but it does disappoint me. One might have expected something more would be said about the advances society has made since the first International Year of Disabled Persons 30 years ago. There has been much to celebrate but there is so much more to accomplish.

In the world of workers’ compensation, we see many injuries that cause work-related disability. Unfortunately, we have little time to focus on what that disability really means to the person (and family) affected or to think about what actually creates the disability.

I know there are very specific legal and policy terms for disability. In our legislation, the Workers Compensation Act speaks about Temporary Total Disability, Temporary Partial Disability, and Permanent Partial Disability; we even have a reference in Section 16 (vocational rehabilitation) to “handicap”. For a moment, however, suspend this legalistic terminology and think about disability in terms of the person in society.

A person with a disability is first and foremost a person. He or she is entitled to respect, dignity and inclusion. In the context of workers’ compensation, work may have caused the injury but the consequence for the person with a disability is really not created by the injury; rather, the degree of disablement is created by our societal response. We--you, me, Cousin Eddy, the worker’s employer and the family next door-- we make up society and we create that societal response.

As the World Health Organization puts it, “… disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives”. I’m not saying there are easy answers here but I am saying that as society becomes more aware, accepting and accommodating of persons with disabilities, the quality of their lives and the richness of our society will grow. From a workers' compensation perspectives, safe and timely return to productive, durable real employment epitomizes inclusion and has the potential to reduce disability.

The International Day of Persons with Disabilities reminds us, the relatively and temporarily able members of society, to champion the elimination of both the proximal and societal causes of disabilities.

Thursday, November 24, 2011

Why should we care about research?

This past week, I was in Boston at two conferences for researchers in workers’ compensation. Some of you might think this can’t possibly be of interest to what you do so before you click off to some other blog, let me assure you that research is important to every workers’ compensation policy analyst, disability management practitioner, and prevention professional.

You make decisions. You give advice and direction. As a professional in any capacity you rely on a body of knowledge — one that is hopefully evidence based and validated by research.

Let me give you an example. In this business, we all know about back injuries. Think about an acute low back claim of less than six weeks. What factors would predict the likelihood and timing of a return-to-work? Depression? Lifestyle? Education? This may be your intuition, and designing your policies or programs around this intuition may seem to be the right thing to do but the research tells a different story. There is strong evidence that none of these factors have any effect on duration on acute back claims.

What factors are predictive of the likelihood and timing of return-to-work? The Manitoba WCB's Workplace Research and Innovation Program wanted to know, and provided a grant to the Institute for Work and Health to conduct a detailed "systematic review" of the literature on this topic. The systematic review found strong evidence for factors such as:

  • The worker's recovery expectations (e.g., their predictions about how likely it is they will return to work and/or how long it will be before they are able to return)

  • The availability of modified work

  • Interactions with healthcare providers

This is powerful information for the design of programs, communication with employers and providing guidance to workers and their healthcare providers. Applied appropriately, the findings can reduce duration and improve outcomes for workers and employers. Without the research papers that were reviewed, without the skill and discipline of other researchers who conducted the review, and without the funding of the Manitoba WCB Research and Innovation Program, these findings would not be available for us.

Another study examined temporary disability duration and the impact of rising unemployment. Looking at the unemployment rates by county in 16 U.S. states, the Workers' Compensation Research Institute study found temporary disability duration, (on WC claims of greater than seven days time loss and at 24 months post injury), rose from 17 to nearly 20 weeks as unemployment rose from 5 percent to 10 percent. This finding makes sense and quantifies the magnitude of the increase. The finding is of critical importance in explaining and quantifying the effect of the economic climate, (as epitomized by rising unemployment rates), in many jurisdictions.

Research has tremendous value. The publication of peer-reviewed research is almost free to the user — but it also has a cost. Funding research, systematic reviews, and knowledge transfer is not cheap. Nor is it trivial to attract and retain academics willing to study, develop their understandings, and devote their careers to workers’ compensation and prevention research. Without many people and agencies willing to sponsor research and researchers, most of us would be “free riders” on the coattails of the few that do.

The research reported on at the conferences I attended is important. Without a sustaining and growing body of research-based knowledge, we not only risk the integrity of our professions but more importantly, we risk doing the wrong thing for those we serve.

Thursday, November 10, 2011

What constitutes an emerging OH&S risk?

Everyone who does environmental scanning in workers’ compensation and prevention gets asked the question, “What constitutes an emerging risk in OH&S?” Over the years, I have created lists of emerging risks based on many sources. Here is how I rationalize what makes the list.
I generally follow the European Risk Observatory’s approach, and consider for inclusion in my list of “emerging OH&S risks" any occupational risk that is both new and increasing. A couple of examples illustrate the sort of reasoning I apply to determining what that means.

“New” means the risk did not exist or was not recognized before. Nano-particles and their application in industry are new risks caused by a new technology and new processes. Workplace bullying and psychological stress are not new but are becoming more widely recognized as OH&S risks, (often newly recognized by legislators, regulators, or the Courts). Cyber-bulling is a relatively new social phenomenon that might fit this category.

The recognition of workplace mental or psychological stress is not really new. However, recognition of it being caused by the expectations for 24/7 connectedness via a smart phone might fit as a new type of workplace or organizational structure that would also fit the definition of “new.”

I am particularly concerned about highlighting those issues where new scientific knowledge allows a long-standing issue or common work practice to be identified as a risk. Historically, asbestos was widely used long after it was known to be carcinogenic. What is the new asbestos? IARC and others have identified shift work that interferes with circadian rhythms as a probable human carcinogen, and an important contributor to other health conditions. To my way of thinking, this should be considered new.

Emerging risks may also be long-standing issues that are seen in a new way, or are rising in society in a way that is increasing the OH&S risk. People have always aged and some people have been overweight or obese, but the aging workforce and the epidemic in obesity should be on the list as emerging OH&S risks. Mumps and Rubella have always been a threat to school staff such as teachers, teaching assistances, and administration but the decline in vaccination levels among school age students may be categorized as an increasing OH&S risk.

None of the above risks would make the list of emerging risks if the risk was not “increasing." Clearly the number of hazards, (like sedentary work, for example), leading to the risk , (obesity), is growing. Nano-particles and processes involving their use make the list because they have moved out of the lab, and are increasing in day-to-day operations in the workplace. The exposure to the hazard, (number of people working shifts that interfere with circadian rhythms), leading to the risk, (cancer), is increasing. In some cases the effect of the hazard on workers' health, (pace of work, mental stress), is getting worse, (more people affected or the magnitude of the effect recognized as more serious).

Creating lists of emerging risks is not an end itself. It is more important that we understand what is going on, apply the precautionary principle, and protect workers by education, design, substitution, work processes, and other strategies.

One of my biggest fears is that future professionals in workers’ compensation OH&S will look back at what we knew today about these emerging risks and ask, “What were they thinking? Why didn’t they recognize the emerging risk?” and more importantly, “Why didn’t they do something?”

Wednesday, October 26, 2011

Why should we care about OH&S for Migrant Workers in China?

Migrant labour, temporary foreign workers and in-country migration of workers are becoming more common to many economies. While the “newness” of a worker to any jobsite increases the risk of injury [see Institute for Work and Health, “Newness” and the risk of occupational injury, Issue Briefings, May 2009], a worker in any of these categories faces greater risk if language, education, training, experience are at the low end of the spectrum.

I was in Chongqing China last week as a technical advisor to a project reducing risks to workers. The Canada-China Migrant Labour Occupational Health and Safety project seeks to increase health and safety among the 1.3 million migrant workers concentrated in the coal mining, construction and textile industries in the Chongqing municipality—an administrative jurisdiction serving a population of about 33 million.

Whatever your political views, the simple reality of China’s modernization coupled with the demographic, economic and environmental realities of a billion-plus people create significant challenges. Whether you are in China, Canada or California, you can’t sustain economic growth in sectors like construction without an adequate, safe and healthy labour force. Increasingly, that labour force demand cannot be met through natural population growth and traditional educational streams. For Canada, this means a growing reliance on temporary foreign workers and immigration to meet labour requirements; for places like Chongqing, it’s a matter of temporarily filling demand through migrant labour.

WorkSafeBC’s contribution of training materials, videos and expertise is making a difference. We produce materials for our multicultural labour force in British Columbia so the marginal cost of sending a Chinese translation of a safety brochure in a pdf file or a subtitled two-minute instructional video clip attached to an email is insignificant. The impact on the lives of migrant workers in China (and elsewhere in the world) can be life changing for the better.

At a symposium I attended in Chongqing, I heard first hand (through an interpreter) from migrant workers how many of the safety precautions, work procedures and protective equipment we take for granted are just being implemented in the project’s demonstration sites. More importantly, I heard these worker representatives—not just officials—speak proudly of their advancements in occupational health and safety.

In one of the most humbling moments, I was told how more than 2 million migrant and resident workers in Chongqing have heard about WorkSafeBC and benefitted directly from the materials we produced. That number is almost equivalent to the total labour force in British Columbia.

What happens in China is no longer something that simply occurs far off on the other side of the world. In a global economy, we are all linked; the health and safety of workers who are part of that world-wide supply chain ought to be a concern for all of us. In Chongqing, we drove in German cars, used Dutch translating devices, and watched American software present Canadian knowledge through Japanese projectors.

In a world where there are growing concerns about an “averaging down” of worker health and safety, WorkSafeBC is proudly playing its part in raising OH&S standards for workers in B.C. and elsewhere in our shrinking and interdependent world.

Saturday, October 8, 2011

Have Occupational Injury Rates Stopped Falling?

For most of the last twenty years, we have seen time-loss injury rates decline across a broad spectrum of industries and in jurisdictions around the world. This has been welcome news on all fronts. The human loss and suffering avoided alone is one thing, and the financial costs are yet another reason for celebrating this remarkable improvement.

On the downside, the rate of decline has slowed and may have actually begun to climb. NCCI reports injury frequency has risen for the first time since 1997. In fact, the decline has been going on for even longer than that. If you discount two minor blips in 1997 and 1994, injury rates have declined for 18 of the last 20 years in the study (1991-2009).

Recent data shows 2010 and 2011 have seen increases in overall injury rates. One interesting point made by the analysis is the impact of the length in hours of the work week. Few systems actually measure hours of exposure to work (Washington State being the only North American workers’ comp system I know of), but the NCCI points out that fewer hours of exposure per week (month, quarter, twelve-month moving average) will likely mean fewer injuries if the denominator is week, month or year. As weekly hours increase, so will injuries.

Another factor relates to claim behaviour. The report suggests:
•Some insurance experts have suggested that workers, fearful of losing their jobs, may have postponed filing workers compensation claims, but now appear less hesitant to file claims as the economy has shown signs of modest improvement. While the extent to which this phenomenon occurred is unclear, it may have contributed to the observed increase in claim frequency in 2010.

•There is evidence of an influx of small lost-time claims in 2010, which may have been medical-only claims in previous years. A lack of available light duty jobs for injured workers to return to might have contributed.

Are injury rates declining elsewhere? At WorkSafeBC and other Canadian workers’ compensation systems, we have heard reports of the same sort of flattening of the injury rate. This chart shows some selected provinces’ data up to 2009 and the generally falling injury rates. Since then, we have seen a flattening out of the injury frequency and some evidence of an uptick.

Is this something to worry about? I think so. No injury is acceptable and the only acceptable injury rate is zero: that has to remain the target. I believe we are making progress toward that end. I also believe we have harvested much of the proverbial “low hanging fruit.” We have taken a bit of free ride on technology as well, (you get few trips and falls over power cords when you are using cordless devices). New designs and innovations have further reduced injury (as you will see in the Saw Stop video). We are even beginning to use technology to organize important research, and to deliver key messages to where they are needed, when they are needed (see the Joint Prevention of Workplace Violence: Creating an Innovative Web-based Tool report, and Prevention of Violence website).

Yes, we have made progress but fundamental change takes time. The next step towards a zero injury rate means fundamental changes in a societal shift in beliefs and attitudes. Until we in the workers’ compensation industry begin to believe that work-related injuries are not inevitable, we have little hope of achieving that fundamental societal change.

Tuesday, September 27, 2011

What happened at the IAIABC Convention – Part 2

Celebrating the centenary of workers’ compensation in the U.S. was the major theme at IAIABC Convention. The opening session was a specially commissioned play depicting the events running up to the establishment of the first workers’ compensation system in the U.S. In Wisconsin, as elsewhere, the need for greater certainty for workers and employers was high on the list of features both sides wanted.  Just as important was the idea that workers’ compensation would act as a major driver of safety changes. 

It is also important to recognize the context of the times. By 1911, modern workers’ compensation law was already part of the landscape in Germany, so it had a track record that was beneficial to understanding the value proposition of the proposed new legislation. It was also a time of great tension between labour and capital.

As depicted by the play, the new legislation was not universally praised. As with most compromises, there were those who wanted more out of the deal. That tension has always been present, and there are few signs that the future will see that tension disappear. Retiring Executive Director, Greg Krohm, of the IAIABC made this point in his opening remarks. While generally positive about workers’ compensation, Greg believes some workers still fall through the cracks. He also points to broader changes in society that are forcing workers’ compensation systems to adapt. As he put it in his opening remarks, it would be odd if workers’ compensation did not change to adapt to trends such as a declining unionized workforce, aging population, and growing medical costs. On this point, Greg quoted NCCI as saying the “Medical/Indemnity pie” that describes workers’ compensation expenditures now registers more than 60 percent on the medical side. 

Greg’s remarks highlighted a belief that recent changes in workers’ compensation law do not really change anything for the large central population of injured workers. He noted a troubling trend in some states where claims are made that lack any likely work-relatedness, yet are pursued to try and reach a settlement. This drives up costs, and creates an impetus for restrictive legislation for these marginal cases. 

While Greg could see no definite pattern of “take-aways” from labour in recent workers’ compensation reform, Professor John F. Burton had a very different view. He noted that workers’ compensation premium costs are often raised as an issue, and pointed out that in the workers’ compensation context declining premiums may or may not be a good thing. In a bid to drive down premium rates, benefits have been cut in his view. He noted that replacement rates on permanent partial disability claims in several states are well below the 50 percent level in states such as California, Oregon, Washington, and even the host state of Wisconsin (among others). He also pointed to the issue of apportionment [apportioning causation in part to work and in part to other causes] in California, and the rise in large deductible policies as being further changes that undermine the system. 

Apportionment of permanent disability on the basis of causation in California terms, accepts the principle that an injured worker has a right to be compensated for a disability that is work-related, but limits the employer’s obligation to compensate an injured worker for a disability that is not work-related.

[Under California Labor Code Section 4663, “(a) Apportionment of permanent disability shall be based on causation. (b) Any physician who prepares a report addressing the issue of permanent disability due to a claimed industrial injury shall in that report address the issue of causation of the permanent disability.”] 

Professor Burton felt strongly that the apportionment issue was a significant shift from the dictum of “taking the worker as you find him.” Greg felt the shift was less pronounced, and noted the “as the employer finds him” position was more related to Arthur Larson’s influence, which he characterized as “very liberal”, than any fundamental principle of workers’ compensation itself. 

The debate over large deductibles included one point of view that suggested firms with such large deductible policies are really self-insured for part of their loss. Some argued that this provides greater incentives to invest in safety. On the other hand, many administrators pointed out that such policies may result in unintended consequences including under-reporting of injuries [why report if there is no insurance to be paid?]. 

Others suggested greater numbers of large deductible policies make funding of oversight, appeal, inspection and prevention initiatives more difficult. These functions are typically funded through assessments on the premiums paid (large deductibles mean lower premiums paid, therefore, lower assessment income to fund other programs). 

There were many more issues discussed at this event and I will raise some of these in future posts to this blog.

Thursday, September 15, 2011

What happened at the IAIABC’s Convention-Part 1?

A few weeks ago I attended the International Association of Industrial Accident Boards and Commission’s 97th annual convention in Madison, Wisconsin. Wisconsin was the first state to have a constitutional worker's compensation law and that centenary was a central theme of the convention. While other states in the U.S. have some claim to concurrent or even earlier laws, Wisconsin probably wins by virtue of the first fatality claim being paid under legislation declared valid by the state’s Supreme Court.   

As a speaker, I was honoured to receive a commemorative coin specially minted for the centennial. The antique bronze medallion bears the image of the Wisconsin capital building and the state’s motto, “Forward” on one side. On the obverse, a stylized “W” and character illustrate the compromise that was reached a century ago. The presentation case included a card stating I would also receive a printed commemorative volume of the “reflections” on the history and development of workers’ compensation in the U.S., but you can read the content of those reflections online. By the way, the placement of the apostrophe on the coin is correct. Wisconsin’s system is the “worker’s compensation” system; all others in Canada and the U.S. use the plural possessive “workers’ compensation.” (More trivia: another exception to the plural-possessive rule is the title of the legislation in British Columbia, which omits the apostrophe altogether).   [gallery]

The importance of workers’ compensation as social legislation as opposed to pure insurance, was also underscored in part by reference to the 50th anniversary celebrations held in 1961. While in the present environment it may not be possible to garner the same attention, for that anniversary the U.S. Post Office issued a stamp, and President Kennedy gave an address in recognition of the half century milestone.

What was fascinating about the various sessions exploring the development of workers’ compensation in the U.S. was the focus on its nature as a compromise, and its intent as mechanism to improve the health and safety of workers. I was impressed how often the theme of occupational health and safety was presented both in its historical sense and as the present and yet undiscovered land (after all, we have been at it for 100 years and we have yet to achieve safe workplaces free of work-related injury, illness and death). Several presenters made reference to the 1972 Report on National Commission on Workmen’s Compensation. The commission was chaired by John F. Burton, Jr. who was an honoured guest at the convention. It is interesting to note the commission’s view on prevention: 
"We recommend that insurance carriers be required to provide loss prevention services, and that the workmen's compensation agency carefully audit these services. State-operated workmen's compensation funds should provide similar accident prevention services under independent audit procedures where practicable."

A hundred years on, one has to wonder how much of a priority prevention services really are.

On a similar note, OSHA in the U.S. appears to be evaluating if state OSHA programs are living up to their requirements to offer occupational safety and health programs at the state level that are of equivalent effectiveness as those offered by the national agency. The enhanced Federal Annual Monitoring and Evaluation (FAME) reports make interesting reading for any agency that has a prevention mandate. Timeliness of reports, what’s included in databases, and how enforcement is being done are all included. In the ones I’ve read, there are also responses from the state agencies with concrete actions and commitments.   

I’ll have more from this event in a later post.
A few weeks ago I attended the International Association of Industrial Accident Boards and Commission’s 97th annual convention in Madison, Wisconsin. Wisconsin was the first state to have a constitutional worker's compensation law and that centenary was a central theme of the convention. While other states in the U.S. have some claim to concurrent or even earlier laws, Wisconsin probably wins by virtue of the first fatality claim being paid under legislation declared valid by the state’s Supreme Court.   

As a speaker, I was honoured to receive a commemorative coin specially minted for the centennial. The antique bronze medallion bears the image of the Wisconsin capital building and the state’s motto, “Forward” on one side. On the obverse, a stylized “W” and character illustrate the compromise that was reached a century ago. The presentation case included a card stating I would also receive a printed commemorative volume of the “reflections” on the history and development of workers’ compensation in the U.S., but you can read the content of those reflections online. By the way, the placement of the apostrophe on the coin is correct. Wisconsin’s system is the “worker’s compensation” system; all others in Canada and the U.S. use the plural possessive “workers’ compensation.” (More trivia: another exception to the plural-possessive rule is the title of the legislation in British Columbia, which omits the apostrophe altogether). 

The importance of workers’ compensation as social legislation as opposed to pure insurance, was also underscored in part by reference to the 50th anniversary celebrations held in 1961. While in the present environment it may not be possible to garner the same attention, for that anniversary the U.S. Post Office issued a stamp, and President Kennedy gave an address in recognition of the half century milestone.

What was fascinating about the various sessions exploring the development of workers’ compensation in the U.S. was the focus on its nature as a compromise, and its intent as mechanism to improve the health and safety of workers. I was impressed how often the theme of occupational health and safety was presented both in its historical sense and as the present and yet undiscovered land (after all, we have been at it for 100 years and we have yet to achieve safe workplaces free of work-related injury, illness and death). Several presenters made reference to the 1972 Report on National Commission on Workmen’s Compensation. The commission was chaired by John F. Burton, Jr. who was an honoured guest at the convention. It is interesting to note the commission’s view on prevention: 
"We recommend that insurance carriers be required to provide loss prevention services, and that the workmen's compensation agency carefully audit these services. State-operated workmen's compensation funds should provide similar accident prevention services under independent audit procedures where practicable."

A hundred years on, one has to wonder how much of a priority prevention services really are.

On a similar note, OSHA in the U.S. appears to be evaluating if state OSHA programs are living up to their requirements to offer occupational safety and health programs at the state level that are of equivalent effectiveness as those offered by the national agency. The enhanced Federal Annual Monitoring and Evaluation (FAME) reports make interesting reading for any agency that has a prevention mandate. Timeliness of reports, what’s included in databases, and how enforcement is being done are all included. In the ones I’ve read, there are also responses from the state agencies with concrete actions and commitments.   

I’ll have more from this event in a later post.

Thursday, September 8, 2011

What can you learn from an old name tag?

I was cleaning out a drawer the other day and came across an old name tag. Time has yellowed its face a little and the pin clip has separated from the back, but the old logo and print are still very readable.  

When I started at WorkSafeBC as a vocational rehabilitation consultant (VRC), this was an essential part of my kit. Before lanyards, swipe cards, and security gates became the norm in industry and at WorkSafeBC, this little name tag was something I wore when I went to visit injured workers in hospitals, schools, and jobsites. 

Back then VRCs were expected to make at least two presentations every quarter. I took this requirement as a challenge. I would arrange to speak to employer groups, chambers of commerce, and rotary luncheons (not as easy as it sounds). My presentations focused on rehabilitation and return-to-work outcomes but the questions always strayed into areas of assessments, experience rating, claims policy and prevention/regulation. I usually wore my own name tag to such events. It was my introduction and it drew a little more attention than those sticky “Hello, my name is” labels ubiquitous at such events.    My name tag from the early 1980s

You will note the name tag doesn’t say “Vocational Rehabilitation Consultant.” Even if it did, I am certain every audience I spoke to considered me “that guy from WCB.” I think this reaction was cunningly intentional on the part of the vocational rehabilitation leadership of the day.  I learned very quickly that in order to have credibility with these audiences, I had to live up to that billing — I had to know more about every aspect of our business. 

As anyone who has tried presenting or teaching something knows, the process of preparation and delivery deepens your knowledge. I read and could quote from George Nelson Wright’s Total Rehabilitation — the vocational rehabilitation bible of its day. I prepared examples from my own experience of successful training-on-the-job initiatives. I  also learned to anticipate the questions that would be asked including those outside my own role. 

When I could, I would co-present. I would bring along others to answer the tough questions and I would learn from them. My credibility depended on giving correct answers and on delivering on any commitments for further information I would make; more importantly, that credibility would make a difference in creating return-to-work opportunities and fostering a safety culture that ultimately protects workers.    

Finding that name tag reminded me that regardless of my role, I am the face of WorkSafeBC to every employer, service provider, worker or representative I meet. The lesson, however, is not specific to me. If you work in the world of workers’ compensation, you need to know about primary prevention, walk the talk when it comes to safety, understand how insurance works, and believe in rehabilitation/return-to-work. No one can know all the answers but every time you facilitate an answer from another part of the worker's compensation system and listen to the answer, your understanding and potential to make a difference increases.  

Not a bad reminder from an old name tag.

Wednesday, August 3, 2011

Is the centenary of workers' comp worth celebrating?

Workers’ compensation in its present form is a concept that is about 100 years old in North America.  Germany celebrated the 125th anniversary of its workers’ compensation last year.  Wisconsin and Ohio are celebrating their century of workers’ compensation in 2011.  In Canada, Ontario will reach the 100 year mark in 2014 while WorkSafeBC’s next hundred years will begin on January 1, 2017.

Is there really something to celebrate?  In one sense, celebration is hardly the word one ought to use for a system that exists because of the injury, disease and death imposed on workers as a consequence of their employment.  Those of us working in worker’s compensation, occupational health and safety, and prevention are keenly aware that our careers flow from failures to secure the safety and health of workers.  On the other hand, it is the sincere belief that we can make a difference that draws us to this work.  There is something positive about having that privilege.

Looking at the past 100 years another way, there are clearly some grounds for celebration.  The establishment of workers’ compensation has certainly provided an alternative to fault systems that often involve lengthy legal battles.  Employers today may not fully comprehend the value proposition contained in the historic compromise that is the basis for workers’ compensation.  No CEO, owner or manager alive today can recall the world before worker’s compensation became the exclusive remedy, barring the injured worker from suing his employer or fellow workers for work-related injury.  Aside from the odd case of non-workers taking action against an employer that gets widely reported in the media, workers have no frame of reference for considering the legal costs and delays that are inherent in most suits.

Workers’ compensation systems have other advantages for employers and workers that are worthy of celebration.  The pooling and mutualization of risks and claims costs by sector provides employers with more predictable costs in the form of relatively stable premiums.  The structure and design of experience rating and discount systems such as COR for employer prevention and disability management programs may also provide incentives for employers to invest in safety and disability management/return-to-work programs.  Safer workplaces and safe, durable return to work for workers are worth celebrating.

The exclusive state fund model is also one worth celebrating.  The German DGUV page for their 125th gives a great little history of the evolution of their system.  The Ohio Bureau of Workers’ Compensation flash slide show celebrating its 100 years  is engaging and speaks to the future as well as the past. 

The US Workers’ Compensation Centennial Commission website is another great resource for reflecting on how far workers’ compensation has come.  This distinguished group of business, labour and government leaders  (mostly based in Wisconsin where the centenary celebrations will be held), includes the AFL-CIO, National Association of Manufacturers, former governors and current workers’ compensation administrators.  Sponsors include the AMA, NCCI, ISO and other private insurers, industry services organizations. 

A century of workers’ compensation is worth celebrating.  If workers’ compensation did not exist, I am certain there would be pressure from workers and employers to create it. And despite the wide range of arrangements by which it is achieved, workers’ compensation promises to be a vital and important part of the public policy for many years to come.

Headline news and teachable OH&S moments: can social media play a role?

Workers’ compensation stories rarely make “front page” news or the “top stories” lists on newsfeeds.  Many stories that do attain headline status have a workers’ compensation connection that is often overlooked, missing an important “teachable moment.”

The recent riot in Vancouver that followed the final Stanley Cup game certainly made headlines around the world, but few will hear about the dozens of workers who suffered injuries as a result of that event.  That number may well grow because workers have up to a year to file a claim with WorkSafeBC.  So far, I haven’t read anything in the media regarding the effectiveness of risk assessments employers undertook before or after the riot, and the plans to protect workers from future risks of violence.

The weather in most of North America is another headline story with very little reference to the protection of workers.  Record-breaking heat and humidity are not only uncomfortable, they can be dangerous particularly to workers who have to spend their work hours in that environment.   US Labor Secretary, Hilda Solis, issued a news release on July 20, 2011 to remind employers of their duty to protect workers saying:

 “Employers must take the precautions needed to protect outdoor workers:

§  Have a work site plan to prevent heat-related . . .

§  Provide plenty of water at the job site and remind workers to drink small amounts of water frequently - every 15 minutes.

§  Schedule rest breaks throughout the work shift and provide shaded or air conditioned rest areas near the work site.

§  Let new workers get used to the extreme heat, gradually increasing the work load over a week.

§  When possible, schedule heavy tasks for earlier in the day.

Tell workers what to look for to spot the signs of heat exhaustion or heat stroke in themselves and their co-workers, and make sure they know what to do in an emergency.”

All of this is great advice, but is the story reaching the intended audience?  A simple search on Google News will show more than 10,000 recent stories on the heat wave; only a dozen or so mentioned employers’ responsibilities for their workers.   From a random sampling of stories with some reference to employers’ responsibilities or practical advice for workers, the references were well down in the text and far below the newsfeed summary or Tweet limit of 140 characters. 

Hazard Alerts and other targeted communications have the potential to reach audiences who need the information but these rely heavily on employers and safety officers self-selecting to receive this sort of communication. 

Now that most of us are headline news consumers, even stories that do contain great information may not be reaching the people who need to hear the message and learn from it.  I’m not suggesting we abandon rapid response and “push” feeds of safety and health information related to headline events; these strategies work for the thoughtful reader who clicks beyond the headline.   And there is no doubt in my mind that linking employer responsibilities and safety advice to headline stories is a potentially strong learning opportunity.  I am suggesting that new approaches to disseminating timely safety and health information need to be developed to reach receptive audiences.  In the age of Facebook, Twitter, and LinkedIn, effective use of social media needs to be part of the answer.

Next time you are looking at your newsfeed, Flipboard app or Google News summary, look at some of the local headline stories and ask yourself, as a worker or employer, what would these circumstances mean to my occupational safety and health?  If you find a good story that does use a current headline as a teachable health and safety or workers’ compensation moment,  re-tweet the story or share it with a friend. 

Thursday, July 7, 2011

More about older workers, incentives to work to an older age

My post from April 12 on Canada Pension Plan (CPP) changes generated some discussion.  I received quite a few questions on the likely impact the changes and the apparent rise in the numbers of older workers in the labour force will have on our organization. 

You may recall that CPP retirement benefits have changed.  Up until last year, someone expecting to retire at age 65 with a CPP monthly benefit of $900 could take the pension as early as age 60 but the pension amount would be reduced by 30%.  The same person could also choose to delay taking CPP.  For every month beyond the month that person turned 65, the pension amount would increase to a maximum at age 70 of 30% more than the base amount at age 65.  Starting this year, the penalties for taking CPP early and the incentives for delaying taking a pension are increasing.  By 2016, the “penalty” for taking CPP at age 60 will be 36% while the “bonus” for waiting to age 70 will be  increase to 42% in 2013. 

Not every worker will delay starting their CPP to age 70 but the financial incentives to do so are attractive.  Using that hypothetical case of someone with an eligibility at age 65 of $900, taking the pension early when the changes are fully in effect will reduce the monthly pension at age 60 to just $576 while waiting to age 70 will see the monthly amount rise to $1278.  As long as the worker still has enough income from employment or other sources, the incentive to keep working to age 70 looks pretty attractive. 

After my earlier posting on this, the number one question I was asked was, “Which is the better thing to do, take CPP early or to delay?”  If the answer is clearly in favour of delaying, more workers are likely to continue working past age 65.  As with almost all such questions, the best answer will depend on individual circumstances.  Health, family issues, living costs, financial resource, life expectancy, taxation situation and other effects will certainly come into play.

A BMO Retirement Institute report put it this way:
One can calculate the “break-even” or “cross-over” point at which one choice proves to be more advantageous, in terms of lifetime earnings, than the others. While it is impossible to predict life expectancy, to put it in perspective, individuals whose life expectancy does not exceed age 73 would be better off drawing their CPP at age 60 – notwithstanding the 36 per cent reduction in benefits under the new rules. Conversely, those who live beyond 81 would be better off drawing their pension at age 70 and taking advantage of the 42 per cent increase in benefits. For everyone in between, the best choice is to draw one’s pension starting at age 65.

If life expectancy is age 90, the report calculates that  “. . . the person who began drawing CPP at age 70 will collect about $100,000 more from the CPP than the early retiree who began collecting CPP at age 60.”  For many, this may constitute an attractive incentive to continue in the labour force to age 70.

The next most common question I was asked concerned what is actually happening out there in the labour force: “Are more workers actually working beyond the age of 65?”  To find out the answer to this question, I downloaded data from Statistics Canada based on the Labour Force Survey.  The time series looks only at workers age 65 and older.  I split the workers into full and part-time categories.  I got the following:

[caption id="attachment_232" align="alignnone" width="450" caption="Workers 65 and over by employment type Jan 1996-Jan 2011 Canada"]Workers 65 and older in Labour Force - Canada[/caption]

As you can see, the lines were relatively flat between 1996 and 2001.  Since then, however, we have more than doubled the number of full-time older workers, and tripled the number of older part-time workers.  What’s fascinating to me is that this chart does not reflect the baby-boom generation.  By definition, that generation was born in and after 1946.  Add 65 to 1946 and you get 2011; the first baby-boomers are just turning 65 this year.  Even if the participation rate among the post-65 population were to remain flat, the sheer volume of people entering that category over the next few decades will see this upward trend continue.

Finally, I was asked, “What are the implications for prevention and compensation?”  I think it is pretty clear we are going to see an increased number and proportion of older workers in the labour force.  Older workers are more vulnerable to a somewhat different array of work-related injuries than their younger counterparts.  The severity of injuries among older workers is often elevated, because of other conditions like diabetes and obesity that complicate treatment and prolong recovery.  A recent presentation by NCCI provided the top ten diagnosis codes, amongst younger and older workers with lost-time claims paid for temporary benefits closed within 24 months of the date of injury, for accident year 1996-2007 for NCCI states.  The nature of these injuries is indicative of the vulnerabilities as we age, and provide some indication of where prevention efforts should be directed.

Ages 20—34Ages 45—64
 1.       Sprain Lumbar Region2.       Lower Leg Injury, not otherwise specified

3.       Sprain of Ankle, not otherwise specified

4.       Unilateral Inguinal Hernia

5.       Cervicalgia

6.       Lumbar Disc Displacement

7.       Carpal Tunnel Syndrome

8.       Lumbago

9.       Sprain Lumbosacral

10.   Sprain of Neck
 1.       Sprain Rotator Cuff 2.       Unilateral Inguinal Hernia

3.       Carpal Tunnel Syndrome

4.       Tear Medial Cartilage/Meniscus of Knee

5.       Lower Leg Injury, not otherwise specified

6.       Sprain Lumbar Region

7.       Cervicalgia

8.       Rotator Cuff Syndrome, unspecified

9.       Lumbar Disc Displacement

10.   Lumbosacral Neuritis, not otherwise specified

While the largest proportion of injured workers will continue to be in their thirties and forties, the combination of fewer younger worker injuries and increasing numbers of older worker injuries will result in an overall increase in complexity, and upward pressure on duration and medical costs. 

If "70 is the new 65," awareness and sensitivity to the vulnerabilities of older workers will have to increase. 

Thursday, June 2, 2011

What were the hightlights from the Six Steps to Success Conference?

Last week I spoke at the Six Steps to Success conference in Whitehorse, Yukon. My contribution to the program was to bring the 300 member audience (from Canada, the U.S. and as far away as New Zealand), up to date with the demographic changes now underway that will change and shape the labour force for the next few decades. I highlighted why skill shortages are a growing concern, and the business case for making workplaces more accommodating to age-related conditions, acquired impairments, and an increasingly diverse workforce.

The lineup of other speakers was like a who’s who of the disability management and return to work experts, advocates, and role models from across North America. There is no way I can cover all the speakers and their messages but here are a few of the highlights.

Most readers will be familiar with Richard Pimentel either from his many speaking engagements or the movie about his life, Music Within. This retelling of his life story and his life’s work was entertaining, humorous, and poignant. His personal experience of being told that his brain injury and hearing impairment would make it impossible for him to go to college and his adventures with his friend, Art Honneyman, took the audience through a range of emotions and to resolve to see the person, not the disability.

John Kemp’s talk was just as engaging. I had read about him but this was the first time I had the opportunity to hear him. He was immensely entertaining and engaging. He co-founded American Association of People with Disabilities (AAPD) and continues to be actively involved in that organization.

I’ve heard Gary Karp before but this session allowed the audience to view disability through his real life experience. His four books will be of interest to those with and without disabilities. He literally shows the audience what it means to “juggle” personal and societal issues of access, accommodation, and acceptance of people with disabilities as just people.

Each of the above speaks with authority from either a congenital or acquired disability. Others, such as Denise Bissonnette, spoke directly to those of us who work with and for people with disabilities. Poet, author, and an expert practitioner of true “job development,” her keynote address and workshop gave a practical yet novel point of view on identifying the unique genius and gifts of every client, and turning that into an advantage for employers. For those of us with a vocational rehabilitation background, her talk really resonated.

Speakers that will be familiar to those working in the workers’ compensation community in B.C. included Wolfgang Zimmerman, Blake Williams, and Winston Leckie. The Workers’ Compensation Board of the Yukon’s CEO, Valerie Royle, was not only a sponsor and a speaker, she and her band opened for Susan Aglukark. Susan made reference to the healing that is continuing in the aboriginal community through the Truth and Reconciliation Commission. The health outcomes of those who suffered in the residential school programs will continue to reverberate as disabilities for years to come.

A real surprise for me was the talk by Deb Russell. She is a Corporate Manager for Walgreen Co., the big U.S. drugstore chain. She told the story of a Walgreen’s vice-president who, because of his familiarity with the challenges of employment for his own child with autism spectrum disorder, spurred an outreach program to actively recruit, train, and retain people with disabilities. The idea was not to save money, get a competitive advantage, or gain good press. Instead, this was a fundamental commitment by the organization’s leadership to be proactive. Deb was hired to lead the initiative. She provided a DVD full of video and document clips that spoke to the success of the program.

Most interesting to me were Deb’s first-hand experiences of addressing the apprehensions of managers, staff and even the advocate community when dealing with the challenges of persons with epilepsy, autism, hearing loss, mobility, cognition, etc. She related these experiences in the real and practical terms of the workplace. She noted that none of the fears anticipated by the managers have happened in over five years of the program. Her willingness to share these practical experiences disarmed every objection I have ever heard on why firms can’t accommodate workers with particular disabilities. All of this has been accomplished without violating privacy concerns, lowering job standards or incurring large costs. Even the safety record shows workers with identified disabilities have no more time-loss injuries than their able-bodied counterparts; in fact, average time loss injuries are of shorter duration. This is a great example of corporate citizenship both in the practice and the sharing.

This was a great conference and the promised availability of presentations will be a great resource for participants, and ultimately for our communities.

Tuesday, May 17, 2011

What does discriminatory action in worker's compensation look like?

I was asked in a meeting last week to give an example of a “discriminatory action” case under the Workers Compensation Act. In the discussion that followed, I realized there was considerable confusion over what that meant.

The word “discrimination” captures the concept of being treated unfairly, or differently, relative to others. The term “discrimination” has a specific meaning in the B.C. Human Rights Code, which prohibits “discrimination” on the basis of race, colour, ancestry, place of origin, religion, marital status, family status, physical or mental disability, sex, sexual orientation, or age. “Discriminatory action” under the Workers Compensation Act involves an employer’s retaliatory action against a worker for reason that the worker raised health or safety concerns and is regulated by the WorkSafeBC.

WorkSafeBC receives over two hundred discriminatory action complaints a year. Consider the following cases:

  • A young worker burns her forearm operating a deep fryer in a local kitchen. There are no first aid supplies in the area so she leaves to get medical attention at the local emergency. She gets the treatment she needs and returns to work. She complains to her boss about the lack of first aid supplies. The next week, she finds her shifts have been cut, while everyone else’s shifts remain about the same.

  • A worker has a job delivering and installing appliances. The employer requires home delivery staff to don disposable paper slippers when entering customer’s homes. The work says he is willing to put disposable booties over his work shoes, but refuses to remove his steel toed shoes for safety reasons. The employer insists on his workers removing their shoes when delivering and installing appliances and tells the worker he either complies or he will be fired. The worker refuses and his employment is terminated.

  • A worker is directed by his lead hand to operate a particular piece of equipment. The worker refuses because he has not been trained on how to safely use the equipment in question. The worker, having refused the work, is sent home without pay for the rest of the day.

Making a claim is relatively straight forward. A worker may establish a “basic case” of discriminatory action by providing evidence the employer engaged in “discriminatory action” and the worker engaged in activities under section 151 of the Act, of which the employer was made aware, and there is a connection between the two such that the employer’s actions were in retaliation for the worker’s actions.

Assuming the complaint is within the Board’s authority to address, and that the worker’s evidence on its own establishes a basic case of discriminatory action, a WorkSafeBC prevention officer will contact the employer and share the concern.

In some cases, the prevention officer is able to settle the matter directly between the worker and the employer. In others, the prevention officer will complete an investigation and forward it to the Compliance Section at WorkSafeBC where investigations legal officers will generally first refer the complaint to mediation. If not settled at mediation, the investigations legal officers will then adjudicate the complaint after offering the parties an opportunity to provide submissions and further evidence.

Both the worker and the employer may appeal the decision of the investigations legal officer to the Worker’s Compensation Appeal Tribunal (WCAT).

Claims of employer retaliation against workers for raising health or safety issues may not have a high public profile but they are important. Too often cases like these go unreported. Not only is the employer’s retaliation illegal, it hurts more than the worker. Other workers who observe such actions may be dissuaded from raising similar concerns. Even more critically, the health or safety issues may not be raised or corrected putting workers and other persons in the workplace at greater risk of injury, disease or even death.

For more information on this aspect of worker’s compensation, take a look at the resources on the WorkSafeBC website page on Discrimination Complaints.

Friday, April 15, 2011

Will changes to CPP alter retirement and working patterns?

Canada’s social security program, the Canada Pension Plan (CPP) is changing. The changes could alter the retirement plans of those nearing retirement age and this may have consequences on the number of older Canadians who chose to continue to work past “normal retirement age”. Because some workers’ compensation systems use planned retirement ages for the determination of benefits and because the health and safety issues of older workers are complex, these changes may have important implications.

What are the changes? There are several but I want to focus on (a) changes regarding the penalties, and (b) incentives regarding the start of retirement benefits.

Prior to 2011, CPP retirement pensions were reduced by 0.5% per month for each month before age 65 that a contributor started to receive the CPP retirement benefit. For each month beyond the age of 65 that a contributor to the plan delayed the start of retirement benefits, a 0.5% increase per month was applied to the base retirement pension amount payable at age 65. So, prior to 2011 and using CPP at age 65 as the comparison, your CPP amount would be 30% lower if you started your CPP at age 60 or 30% higher if you delayed the start of your CPP to age 70.

Beginning in 2011, there are some increased incentives for delaying retirement beyond 65, and, beginning in 2012, there are some larger penalties for starting CPP retirement pensions under 65. The reductions and increases are being phased in but by 2016 that phase-in process will be complete. Here are the tables summarizing the changes:
• percentage reduction in monthly CPP commenced under 65:
Year % (monthly reduction)
2012 0.52
2013 0.54
2014 0.56
2015 0.58
2016 0.60

• percentage increase in monthly CPP commenced over 65:
Year % (monthly increase)
2011 0.57
2012 0.64
2013 0.70

By 2013, there will be a 42% advantage to starting CPP at age 70, and by 2016 a 36% disadvantage to commencing CPP retirement benefits at age 60 when compared to the benefit payable at age 65.

That’s the background. Now, what will this do to retirement patterns?

Some people are going to be re-thinking their retirement plans. For those who are or will be 60 in 2011 and were thinking about starting CPP, they may decide to commence CPP retirement benefits before the slightly larger reductions come into play. The difference is not great but starting in 2012, the penalties are just a little larger for each month before age 65 you retire...and the incentives just a little bigger for each month you delay.

Clearly, these changes are intended to encourage those in the labour force to continue working longer than at present. Other changes, including the post-retirement benefit for those who have retired then return to work, have the same impact of encouraging longer participation in the labour force.

Overall, these changes are not likely to cause a massive swing in retirement patterns. For those with large RRSP or defined benefit plans, these changes are not likely to have a big impact on their retirement plans. The changes will, however, be important to many workers for whom CPP will be the main source of retirement income, particularly those who turn 60 after 2011 and those still working over the age of 65.

The average retirement age for Canadians is about 63 at present. For those planning on using CPP retirement as a major part of their retirement income, age 70 may become an attractive target as their planned retirement date. And that will raise important issues in both compensation policy and prevention efforts for older workers.

For more information on the amendments to CPP, see the Human Resources and Skills Development Canada web page

Friday, March 25, 2011

Is the blitz an effective prevention technique?

The following story was posted on the Australian Broadcast Corporation news website:
WorkSafe warns of asbestos blitz Posted Thu Mar 10, 2011 12:13pm AEDT

WorkSafe [Western Australia] will inspect a number of work sites across regional Western Australia to check safety provisions for asbestos.

Inspectors will target the construction and demolition industries over the next two months, checking licenses, protective equipment and waste procedures are up to standard.

Acting WorkSafe commissioner Lex McCulloch says businesses can face serious fines if they knowingly break the law.

"If they are made under 'duty of care' provisions of the Act then it can be up to $400,000," he said.

"If they are made under the regulations for an individual it can be $25,000 and for a company it can be $50,000, it just depends."

The story highlights a couple of important points. First, is that asbestos is the once and continuing threat to the long-term health of workers. Despite what we know about asbestos and what we can do to protect workers, workers are still getting exposed to asbestos without the protection they need. The second point is that we know many places where asbestos likely exists but that information is not always transmitted to everyone who might need to know.

The third aspect of this story is the compliance/enforcement technique employed: the blitz. By focusing attention on a few key issues (often in a particular region or industry) and publicly declaring their intention to enforce, the prevention organization heightens awareness. This may trigger questions in advance of the action that create consultation and education opportunities, and generates greater workplace vigilance and adherence to safe work procedures.

This technique is not unique to Australia. Other jurisdictions are using similar techniques but rarely do these initiatives gain the profile they do in Australia. Part of that may be timing. It is no coincidence that asbestos exposure stories—particularly in schools—have gained significant profile in the Australian press. The death of a young service station attendant in B.C. generated a lot of press, and a blitz of training and safety procedures in that industry. It also resulted in Canada’s first pay-before-you-pump standard.

I think the blitz is an important and effective prevention technique. It is important that people understand the blitz is just one technique of many, and one that will have a different impact on different workplaces. It certainly can heighten awareness and get people thinking and talking about safety. For workplaces with great safety cultures, the blitz will have little effect. Workers and employers in these workplaces know what to do and are doing it every day. The advance notice of a blitz will help other workplaces where the participants in the workplace mean well but do not have the knowledge or lack the skill or resolve to make safety a priority. The blitz announcement can be the impetus to make changes. For the minority of workplaces where participants know better (or should know better), advance notice of the blitz may cause some workplaces to take note, but it is unlikely to make any difference at all to places that routinely ignore safety precautions. For these workplaces, the orders or “improvement notices” issued when the blitz actually takes place, may prove to be the wake-up call that will start the workplace on the road towards a changed safety culture.

Friday, March 4, 2011

Does a timely First Report of Injury really matter or is it just a bureaucratic requirement?

My last post was about the requirements many jurisdictions have for timely reporting of work-injury claims to the workers’ compensation authority. I stated my reasons in support of timely reporting and compliance with whatever standard set by the jurisdiction: health and safety of other workers, timely treatment and benefits for the workers. A number of people commented to me about the post. Most agreed that there was some value in requiring employers report injuries on a timely basis but thought short legislative reporting requirements imposed by the workers’ compensation authority were simply a bureaucratic requirement. They argued there is no real harm done to the worker, the authority or the system if firms failed to comply with the first report of injury (FROI) requirements. Some also suggested that the penalties imposed and the fines collected in some jurisdictions looked more like a “money grab”.

As if in answer to these criticisms, a summary of recent research on this topic arrived in my inbox. Under the heading “Benefits of Early Reporting”, the article from the Utah Workers’ Compensation Fund noted:

· The faster the claims process is started, the lower the workers compensation costs.

· When there was a delay in reporting, there were higher medical costs, higher rates of attorney involvement and litigation, and disputes over causation, and longer than normal periods of disability for a particular injury.

· After seven days, claims costs began to escalate, and when reporting was delayed 29 or more days, the claims costs were about 45 percent higher.

· A study by a private insurer on back injuries, carpal tunnel syndrome and other nerve disorders, they discovered the claims filed five or more days after an injury cost an average of 15 percent more than similar claims filed within 48 hours

· Injuries reported within 10 days cost an average of $12,082. Injuries reported between 11 and 20 days cost $15,582, and those reported between 21 and 30 days cost $17,920 -- an increase of 48 percent more than those reported in 10 days or less.

I think this evidence is compelling. Holding employers to a timely FROI is not just a bureaucratic requirement. It has the proven potential to reduce both the human and financial costs of injury.

Regardless of any jurisdictional requirement for early reporting, getting that FROI in is a benefit to both workers and employers.

Friday, February 18, 2011

How long should it take for a First Report of Injury to be submitted?

A story out of Jefferson City, Missouri, got me thinking about how long it should take an employer to file the first report of injury in worker’s compensation systems. Because timely prevention activity, claim decision making, and payment all depend on reporting, it stands to reason workers’ compensation agencies would be concerned about late reporting.

The Missouri story starts out as follows:

A-G Reaches Settlement Over Worker's Comp Violations
Attorney General Chris Koster said today he has reached agreements with two companies who violated Missouri’s workers’ compensation law by knowingly failing to report worker injuries to the Division of Workers’ Compensation within the prescribed time frame.

In Missouri, the prescribed time for an employer to submit the first report of injury (commonly called FROI in many states) is defined by the Workers' Compensation Law (Missouri Revised Statutes Chapter 287 Section 287.380.1)

“Every employer or his insurer …shall within thirty days after knowledge of the injury, file with the division … a full and complete report of every injury or death to any employee for which the employer would be liable to furnish medical aid, other than immediate first aid which does not result in further medical treatment or lost time from work…”

In practice, employers in many U.S. states buy their workers’ compensation insurance from an insurance company and the insurance company staff or a third party administrator (TPA) manages the claim. Whether the employer or the insurer or the TPA informs the state agency of the time-loss injury, it must be done promptly. In Missouri, the promptness standard is set at 30 days.

The news story goes on to say that two TPAs who were the ones who were repeatedly delaying. In many jurisdictions, the TPA claims managers are located in a different state, and that was the case in this story. As part of their contracts with various firms, the TPAs had taken on the responsibility of filing the first report of injury to the State workers’ compensation agency. The Missouri “Division of Workers’ Compensation” requires the data to ensure timely and appropriate treatment of injured workers and to make certain workers and their families are fully aware of their rights. More generally, that FROI can be used as a prevention tool to protect other workers from similar injuries.

Rather than go to Court, the two TPAs settled with the Attorney General who was prosecuting the case. The two offending TPAs agreed to pay the state just over $100Kbetween them and to admit to violating the law. They also agreed to remain in compliance for two years and to take necessary steps to prevent recurrence of future violations.

Not every state applies a penalty for late filing of the first report of injury. To the best of my knowledge, Alabama, Arizona, Colorado, Michigan and North Dakota are among those that don’t, but I don’t have any data on how compliant employers are in these states with the statutory reporting time (typically 7 or 14 days). Wisconsin has a 14-day standard and publishes an indicator which currently shows more between 74 and 77% of first reports of injury being received promptly.

In Canada, the timeframe for reporting an injury varies from province to province but three- and five-day standards are common. The AWCBC posts the reporting requirements and the penalties prescribed for late reporting and other offenses at the following links:

Ohio reports that 74.5% of FROIs are received within that state’s 7-day time limit. This is impressive but some other states do even better. Maine requires the FROI within 7 days after the employer receives notice or knowledge of an employee lost-time injury. The state has an 85% compliance target but was tracking closer to 90% in mid 2010. My understanding is that Maine applies a $100 penalty for each late filing (beyond 7 days) of the first report of injury.

Minnesota assesses progressively higher penalties for late filing of the first report of injury (typically beyond 10 days of the first day of disability) with each violation. The first offense in any 12 month period attracts a warning but penalties go up after that for each subsequent offense ($125, $250, $375, $500 for five or more offenses). In 2009, the state assessed 694 penalties totalling more than $309,000 for late filing of the first report.

Other states have even more aggressive levels. I understand Texas has a 10-day limit with a fine of up to $25,000 per day for violations although I could not confirm if any firms had to pay anywhere near that amount.

Does the threat of financial penalties increase timely reporting behaviour? I could not find any comparative figures on compliance or penalties but am interested in any data you may have on this topic. I think the Missouri story and published compliance rates from Maine and Ohio certainly send important messages about the seriousness with which these states take the timely reporting of injuries.

Monday, February 7, 2011

Are there any great OH&S apps?

We are living in a time when digital information is literally at your fingertips. In the case of the WorkSafeBC’s Occupational Health and Safety Regulation, it has made the leap to an iPod/iPhone app. Seeing how well that works on my iTouch, it got me thinking about other apps that might be good to have at my fingertips.

You will find a lot of apps out there that range from a simple app that generates a white screen, (works really well as substitute flash light), to one that provides the complete US Army Survival Guide. There are also a lot of simple utilities that can provide a ready and useful source of information, when access to the internet or print material is not readily available.

A good companion item might be American Heart Association's Pocket First Aid & CPR. It has a price tag of $3.99, but it's a good reference document with an efficient interface to get the information you need in a hurry.

I was impressed with the idea behind Safety Button from Sillens AB. The app presents a single red HELP button that can be preprogrammed to text and or email your current position, make a distress call, and sound an alarm. You hope never to have to use the messaging part of the app. Chances are, however, there will be times when you want to initialize the app and have it ready. As soon as you turn it on, your GPS location is tracked by the application and updated to their server every 20 seconds, creating a record of time and location. The inexpensive app comes with three prepaid text messages: one for testing, and two just in case, with refills for the messaging part available for a nominal fee. There is no ongoing subscription required.

The YWCA apparently offers a free app that has some of the same functionality. This operates more like the portable personal siren alarms you may have seen marketed primarily to women. This one, however, comes with a feature that sends an emergency email to a pre-set contact, with the user's approximate coordinates. It can also send out an emergency call to a pre-programmed phone number. The YWCA Safety Siren comes with facts and contacts for women’s health and wellness.

I’m certain there many of you have found workplace health and safety apps for your iPhone, iPad, iTouch, Blackberry, Android, Galaxy… that are really useful. I am equally certain there are applications you would like to see created to fill a particular occupational safety and health need, (for example, I would like to see an app that allows you to decipher the meaning of a warning symbol just by pointing your device’s camera at it). If you have an OH&S app or an idea for one you would like to see, post a comment and maybe we can make workplaces safer one app at a time!

Monday, January 17, 2011

How does new safety technology protect workers?

Many of us use laptops and are familiar with the long power cords from the wall to the adapter and the cord from the adapter that eventually connects to the computer.  Some of us think about the tripping hazard but we are not always as careful as we ought to be about taping down the cord.  Most power cords will break apart from the adapter block—a feature that further reduces the consequences should someone trip over the cord.  Those with MacBooks have the added engineering protection of a magnetic breakaway power cord that further reduces the tripping hazard. 

A few days ago, I was sent a picture of a product that takes the idea of a breakaway cord even further.  The “safety socket” appears to be sold under both the Stanley and Westinghouse brands.  It takes the magnetic breakaway to the wall socket with a two-part assembly. 

This sort of technology is not rocket science and it doesn’t replace proper taping of cords or other procedures but it can make a difference—if it is used.   Some of you will also be familiar with a table saw that stops and retracts instantly if it senses the blade is touching flesh .  This technology does not replace the need for saws to have guards.  Proper adherence to safe work procedures does effectively reduce the risk of injury.  So, what does a $20 breakaway socket or a $70 brake cartridge (and the marginal extra cost at purchase) in a table saw add to the safety equation?

To answer this question, you need to remember that most work activities carry risks.  Safety is about reducing or eliminating the active risks and effectively managing the residual risks.  We manage the residual risks by putting in place barriers, safeguards and defenses.  Knowledge is one of the best defenses so training is one way we can reduce risk.  Safe work procedures, personal protective equipment, and effective supervision further reduce the risk of the inherent danger of a cut from a saw blade or a fall injury because of a trip over a power cord. 

James Reason, an expert in human factors that lead to injury, speaks in terms of barriers and holes that protect workers from injury.  In his "Swiss cheese" model, the inherent danger in a work situation can only harm a worker if there is a hole in each of the defenses, barriers, or safeguards, AND these holes align.   

In my own view, I think of these holes as active or latent defects in the barriers, safeguards, and defenses that protect the worker from harm.  The effect of improved supervision, better training, more complete adherence to safe work procedures is the reduction of the number and size of the defects in the barriers and safeguards that protect workers.  And that is effectively what the design solutions the breakaway power cord and the sawstop device provide.  These are examples that make the barriers and safeguards more complete, which further lessen the opportunity for the inherent risk of tripping or being cut by a spinning saw blade. 

This blog is not intended as an endorsement of these products.  I think, however, they are good illustrations of how technology and good design can contribute to safer work environments by reducing the size and number of holes in the barriers, safeguards, and defences that can protect workers from harm. 

What does the Ontario Expert Panel mean for OH&S?

A year ago, four workers died in Ontario on Christmas eve.  The tragedy triggered the government to set up an Expert Panel on Occupational Health and Safety.  Chaired by the well-respected Tony Dean and supported by representatives from Labour and Employers as well as other academics (including H. Allen Hunt who recently completed a reappraisal of WorkSafeBC’s system), the Panel’s report was released December 16, 2010.  You can review the entire report online or download it from the following link:

As widely anticipated, the report recommends bringing all workplace prevention and enforcement activities under one Chief Prevention Executive in the Ministry of Labour.  This effectively means the Workplace Safety and Insurance Board (WSIB) will transfer its prevention programs and services to the new body within the Ministry. 

There are forty-six recommendations in all.  The final one lists the recommendations the Panel believes should be acted upon first:

1.       A new prevention organization should be created within the Ministry of Labour. The new organization would be headed by a Chief Prevention Executive, and would feature a multi stakeholder Prevention Council; each would have specific powers explicitly defined in the Occupational Health and Safety Act. (Recommendation 1)

2.       The Ministry of Labour should work with the new prevention organization to create a health and safety poster that explains the key rights and responsibilities of the workplace parties, including how to obtain additional health and safety information and how to contact a Ministry of Labour inspector. It should be mandatory to post this in the workplace. (Recommendation 10)

3.       The Ministry of Labour should create a mandatory requirement for training of Health and Safety Representatives. (Recommendation 13)

4.       The Ministry of Labour should require mandatory health and safety awareness training for all workers. (Recommendation 14)

5.       The Ministry of Labour should require mandatory health and safety awareness training for all supervisors who are responsible for frontline workers. (Recommendation 15)

6.       The Ministry of Labour and new prevention organization should develop mandatory entry-level training for construction workers as a priority and consult with stakeholders to determine other sectors that should be subject to mandatory training for workers. (Recommendation 16)

7.       The Ministry of Labour and new prevention organization should develop mandatory fall protection training for workers working at heights as a priority and consult with stakeholders to determine additional high-hazard activities that should be subject to mandatory training for workers. (Recommendation 17)

8.       The Minister of Labour should appoint a committee under Section 21 of the Occupational Health and Safety Act to provide advice on matters related to the occupational health and safety of vulnerable workers. (Recommendation 29)

9.       The Ministry of Labour and the Ontario Labour Relations Board should work together to develop a process to expedite the resolution of reprisal complaints under the Occupational Health and Safety Act. (Recommendation 33)

10.   A worker or employer involved in a reprisal complaint should have access to information and support from an independent, third-party organization, such as the Office of the Worker Adviser or Office of the Employer Adviser. 

11.   The Minister of Labour should create a small business Section 21 committee and appoint members that can represent the needs and interests of employers and workers in small businesses. (Recommendation 36)

The Panel reflected a concern over the reliability and validity of data, noting, “This is evident in fatality statistics, where WSIB and MOL figures differ because they relate to different populations of workers, due to differences in legislative coverage. Data on non-fatal lost-time injuries may be even less reliable as an indicator, due to the potential for misrepresentation of the actual incident through claims management.” 

This difference in mandate affects more than data.  It can impact priorities, policies, and strategies.  If the population insured for workers’ compensation is essentially the same population covered by the prevention mandate, common systems make sense.  Where there is a substantial difference in the workers’ compensation and prevention mandates, there are likely to be differences in what and how data are counted.  This is particularly evident in Ontario where the Occupational Safety and Health law and policy applies to virtually every workplace but WSIB covers only 70% of the employed labour force.  This is vastly different from BC where WorkSafeBC covers about 94% of the employed labour force. 

The policy implications of these top items will cause all jurisdictions to review their own structures and policies.  Fostering increased awareness of worker rights, supervisor responsibility, fall protection and small business should be on everyone’s list.  The recommendations, however, are context-specific.  What is right for Ontario may or may not have any application outside Ontario.  That said, I believe the recommendations of the Ontario expert panel will cause every OH&S focused organization to review its priorities.