Monday, March 31, 2014

Do California and Canada have a lot in common when it comes to workers’ compensation?

Do California and Canada have a lot in common when it comes to workers’ compensation?   In preparing my presentation to the annual meeting of the California Workers’ Compensation Institute (,  I updated some of the information from a very nice briefing comparing coverage in California and Canada published by the Institute for Work and Health ( 2010.  The broad parameters of the workers’ compensation context are similar:
                                         Canada                     California                
Employed labour force (2013):   17,731,000     17,053,071  (June)
Estimated covered by WC:  14.8 million (2013)   14.7 million (2012)
Actual [weighted]Average
 Assessment Rate for Assessable 
employers  ($/$100):            1.96  (2011)         2.46 (June 2012)
The coverage in California is set by legislation and similar to what you might find in many US states:
  • 2/3rds  Average Weekly Wage
  • Three day waiting period (with two week retroactive period)
  • Max insured 2014: $1,611.96 per week (about $84,000 per year)
Each Canadian province has its own limits.  Most do not have any waiting period; most cover 85 to 90% of Net average earnings to a maximum ($77,900 BC, $92,300 Alberta, $84,100 Ontario, no maximum in Manitoba). 
Administration costs are difficult to compare.  In Canada, each province has a workers’ compensation board or commission that is the equivalent of an exclusive state fund.  The Association of Workers’ Compensation Boards of Canada ( reports Administration Costs for Assessable Employers was $1,474,841,000 in 2011.  The IWH study reports 2007 data for California that pegs  the insurer underwriting profit of  $1,976 million and Administration expense $5,323 million.   That makes the administrative cost in California about five times that of Canada. 
What accounts for this significant difference?  A lot of US commentators have suggested that Canada’s universal healthcare may account for some of the difference.  In fact, however, Canadian workers’ compensation boards are “first payers” for healthcare costs.  Payments by provincial workers’ compensation boards are excluded from the definition of “insured health services” under the Canada Health Act.  So the same healthcare costs paid for by US workers’ compensation insurers are also paid for by Canadian workers’ compensation boards. While the Canadian systems benefit from a population who all have health care coverage and certain economies of scale by building on systems, medical fee schedules negotiated by provincial agencies and lower prescription medicine costs. 
Another possible source for the difference between California and Canada is the number of insurers authorized to provide workers’ compensation coverage.  In Canada, there are a dozen workers’ compensation boards—each with its own exclusive jurisdiction (monopoly providers in their own jurisdictions); in California there are more than 200 authorized insurers writing at least $50,000.00 of premiums (the largest by market share is the STATE COMPENSATION INSURANCE FUND). 
There are, of course, many other differences between Canada and California.  The rate of disputes, the way disputes are settled, differences in self-insurance with and without self-administration, the risk associated with the mix of industry,  and the scope and involvement of workers’ compensation in occupational health and safety (prevention, education, enforcement and regulation) are just the beginning of areas to consider in comparison.   That said, both Canada and California continue to see substantial human and financial costs of work-related injury, disease and death.  Comparing approaches to workers’ compensation between jurisdictions may yield new insights into prevention, treatment and return to work—something valuable to everyone. 

Friday, March 14, 2014

Can a Childhood Illnesses be considered an "occupational disease"?

Key  “measles outbreak” into a news search engine (or ask Siri) and you will see stories from Canada, New Zealand, the US, Syria and many other countries about recent clusters of cases in schools and communities.  Other search terms reveal similar results.  The health concerns reported are often focused on kids but occasionally you see stories that include concerns for teachers, staff and  other community members. 

Every time there is a reported “outbreak” I  get a lot of questions about the compensability and prevention obligations of employer regarding infectious diseases. 

As every parent, caregiver, and early childhood educator knows, a child with a cold can easily pass on their illness to siblings, parents, nannies, caregivers and educators they come into contact.  Considering colds alone, young children may contract 8 to 10 each year before they turn 2 years old (NIH) while older children get an average of 6 to 8 colds per year (Worrall, Common Cold, Can Fam Phys, Nov 2011; 57(11): 1289–1290). Given that the average cold lasts about 10 days, young children can spend a third to a quarter of their pre-school lives with a runny nose.  Add to that other common childhood diseases like influenza, measles,  and chicken pox and you might be forgiven for concluding that “children” are nature’s most perfectly designed vectors of disease.

In reality, however, limiting the spread of infectious diseases can be achieved through frequent, effective hand-washing, routine site hygiene and “distance” during illness.  While inconvenient for parents, keeping kids home when they are infectious (in the case of colds, about five days after the cold symptoms begin) can be an effective strategy in preventing the spread of disease to other students, staff and the community.  There is no vaccine (yet) for the common cold or norovirus, but vaccination is another effective strategy for protecting both the person immunized and the unimmunized population they are in contact with from serious illnesses like many seasonal flu strains, measles, mumps, and chicken pox. 

Childcare centres, kindergartens and schools are obvious targets for preventing the spread of disease.  Sadly, budgetary pressures may lead to actions that actually increase the potential for the spread of disease. Washrooms that are cleaned less frequently, hot water being turned down or off,  and inadequate supplies for washing and drying hands may cost more in terms of work absences and the health of students, families and the community than any marginal savings that may be gained. 

Is any of this a workplace health issue?  Yes.  It is easy to overlook daycares, preschools, tutoring centres and regular schools when thinking about workplaces but for the teachers, teaching assistants,  early childhood educators, custodian and office staff, these locations are workplaces.  And the owners, operators and school boards responsible for them have a duty to provide for the health and safety of all workers and other persons (including children) in the workplace regardless of the compensability of any particular case. 

Many educators, other school-based staff, and cleaners contract illness in their workplace. Some file a claim with a workers’ compensation authority but many simply take two aspirin and a dose of personal sick leave.  For illnesses that are common and active in the community, this is reasonable—it is as likely as not the disease was contracted in the community rather than the school.  This does not remove or lessen the duty of the employer to provide a safe and healthy work environment.  In the case of specific illnesses such as measles, mumps, chickenpox, norovirus, Fifth’s disease, etc. the teachers and other staff infected in a localized outbreak may be maybe entitled to workers’ compensation. 

A few years ago, the British Columbia Teachers’ Federation circulated the accompanying poster to all schools.  It consolidated on a single page many of the illnesses law and policy have defined as occupational diseases that may be work-related for teachers.  The list of diseases that may be related is long but it is far from exhaustive. In practice, very few cases are reported to WorkSafeBC or local WCB agency.  This means that the lost wages and medical costs are being wrongly attributed and born to a greater degree by workers and taxpayers.

The direct message of the poster is simple:  Don’t use sick leave for a work-related illness.  The rationale for the message is even stronger and goes beyond considerations of who pays.  Every unreported work-related illness is a missed opportunity to review the circumstances and protect workers and others from harm.

Next time you attend an immunization clinic or have to stay home with sick child, have a thought for the health of educators, staff and caregivers deserving of protection. 

British Columbia Teachers, Federation ( Occupational Disease Poster (used with permission).